Data Guide

Published Date	Data Guide Version	Document	Action	Field	Before	After
11/20/2025	4.0.22	EXP-46-008-8	ADD	N/A		Created
11/20/2025	4.0.22	EXP-46-007-7	ADD	N/A		Created
11/20/2025	4.0.22	EXP-46-006-6	ADD	N/A		Created
11/20/2025	4.0.22	EXP-46-005-5	ADD	N/A		Created
11/20/2025	4.0.22	EXP-46-004-4	ADD	N/A		Created
11/20/2025	4.0.22	EXP-46-003-3	ADD	N/A		Created
11/20/2025	4.0.22	EXP-46-002-2	ADD	N/A		Created
11/20/2025	4.0.22	EXP-46-001-1	ADD	N/A		Created
11/07/2025	4.0.21	FTX.003.086	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.002.019)4. When Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Payment Period Start Date is equal to or greater than Enrollment Effective Date	1. Value must be 20 characters or less2. Situational3. When populated, value must match MSIS Identification Number (ELG.002.019)4. When Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Payment Period Start Date is equal to or greater than Enrollment Effective Date
10/23/2025	4.0.20	FTX.095.371	UPDATE	Definition	The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.).	This describes the type of managed care plan or care coordination model of the payer, when applicable. The valid value list is comprised of the standard managed care plan type list from the MCR and ELG files and a complementary list of care coordination models.
10/23/2025	4.0.20	FTX.095.370	UPDATE	Definition	The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.).	This is a description of what the payer ID represents when the payer ID was reported with a payer type of "Other".
10/23/2025	4.0.20	FTX.095.369	UPDATE	Definition	The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.).	This is a qualifier that indicates what type of ID the payer ID is. For example, if the payer ID represents the state Medicaid or CHIP agency, then the payer ID type will indicate that the payer ID should be interpreted as a submitting state code.
10/23/2025	4.0.20	FTX.095.368	UPDATE	Definition	The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.).	This is the identifier that corresponds with the payer's role in relation to the Medicaid/CHIP system. The payer is the subject taking the action of either making a payment or taking a recoupment, as opposed to the payee who is the object of the transaction. The payer is the entity that is either making a payment or recouping a payment from another entity or individual. The payee is the individual or entity that is either receiving a payment or having a previous payment recouped.
10/23/2025	4.0.20	FTX.095.365	UPDATE	Definition	The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.).	The dollar amount being paid to the payee or recouped from the payee for a previous payment. A recoupment should be reported as a negative amount.
10/23/2025	4.0.20	FTX.095.364	UPDATE	Definition	The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.).	The date that the payment or recoupment was executed by the payer.
10/23/2025	4.0.20	FTX.095.363	UPDATE	Definition	The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.).	Indicates the type of adjustment record.
11/20/2025	4.0.22	MIS-85-026-26	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-85-026-26	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-85-014-14, MIS-85-025-25, and MIS-85-026-26 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
11/20/2025	4.0.22	MIS-85-021-21	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-85-021-21	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-85-014-14, MIS-85-025-25, and MIS-85-026-26 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
11/20/2025	4.0.22	MIS-85-016-16	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-85-016-16	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-85-014-14, MIS-85-025-25, and MIS-85-026-26 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
11/20/2025	4.0.22	MIS-85-014-14	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-85-014-14	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-85-014-14, MIS-85-025-25, and MIS-85-026-26 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
11/20/2025	4.0.22	MIS-85-011-11	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-85-011-11	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-85-014-14, MIS-85-025-25, and MIS-85-026-26 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
11/20/2025	4.0.22	MIS-84-030-30	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-84-030-30	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-84-004-4 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	N/A
11/20/2025	4.0.22	MIS-84-025-25	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-84-025-25	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-84-004-4 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	N/A
11/20/2025	4.0.22	MIS-83-028-28	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-83-028-28	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-83-020-20, MIS-83-028-28, and MIS-83-029-29 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
11/20/2025	4.0.22	MIS-83-022-22	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-83-022-22	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-83-020-20, MIS-83-028-28, and MIS-83-029-29 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
11/20/2025	4.0.22	MIS-83-020-20	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-83-020-20	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-83-020-20, MIS-83-028-28, and MIS-83-029-29 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
11/20/2025	4.0.22	MIS-83-005-5	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-83-005-5	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-83-020-20, MIS-83-028-28, and MIS-83-029-29 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
11/20/2025	4.0.22	MIS-82-017-17	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-82-017-17	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-82-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	N/A
11/20/2025	4.0.22	MIS-82-013-13	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-82-013-13	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-82-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	N/A
11/20/2025	4.0.22	MIS-82-012-12	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-82-012-12	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-82-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	N/A
11/20/2025	4.0.22	MIS-81-047-47	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-81-047-47	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-81-026-26, MIS-81-040-40, and MIS-81-041-41 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures),	N/A
11/20/2025	4.0.22	MIS-81-041-41	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-81-041-41	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-81-026-26, MIS-81-040-40, and MIS-81-041-41 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures),	N/A
11/20/2025	4.0.22	MIS-81-030-30	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-81-030-30	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-81-026-26, MIS-81-040-40, and MIS-81-041-41 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures),	N/A
11/20/2025	4.0.22	MIS-81-026-26	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-81-026-26	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-81-026-26, MIS-81-040-40, and MIS-81-041-41 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures),	N/A
11/20/2025	4.0.22	MIS-80-017-17	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-80-017-17	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-80-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure).	N/A
11/20/2025	4.0.22	MIS-80-013-13	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-80-013-13	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-80-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure).	N/A
11/20/2025	4.0.22	MIS-80-012-12	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-80-012-12	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-80-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure).	N/A
11/20/2025	4.0.22	MIS-79-059-59	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-79-059-59	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
11/20/2025	4.0.22	MIS-79-054-54	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-79-054-54	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
11/20/2025	4.0.22	MIS-79-037-37	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-79-037-37	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
11/20/2025	4.0.22	MIS-79-033-33	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-79-033-33	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
11/20/2025	4.0.22	MIS-28-021-21	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-28-021-21	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
11/20/2025	4.0.22	MIS-27-026-26	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-27-026-26	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	MIS-27-021-21	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-27-021-21	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	MIS-27-016-16	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-27-016-16	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	MIS-27-014-14	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-27-014-14	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	MIS-27-011-11	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-27-011-11	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	MIS-26-031-31	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-26-031-31	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
11/20/2025	4.0.22	MIS-26-026-26	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-26-026-26	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
11/20/2025	4.0.22	MIS-25-028-28	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-25-028-28	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	MIS-25-022-22	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-25-022-22	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	MIS-25-005-5	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-25-005-5	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	MIS-25-002-20	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-25-002-20	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	MIS-24-018-18	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-24-018-18	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
11/20/2025	4.0.22	MIS-24-014-14	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-24-014-14	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
11/20/2025	4.0.22	MIS-24-013-13	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-24-013-13	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
11/20/2025	4.0.22	MIS-23-047-47	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-23-047-47	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS or Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	MIS-23-041-41	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-23-041-41	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS or Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	MIS-23-030-30	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-23-030-30	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS or Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	MIS-23-026-26	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-23-026-26	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS or Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	MIS-22-018-18	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-22-018-18	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
11/20/2025	4.0.22	MIS-22-014-14	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-22-014-14	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
11/20/2025	4.0.22	MIS-22-013-13	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-22-013-13	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
11/20/2025	4.0.22	MIS-21-059-59	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-21-059-59	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	MIS-21-054-54	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-21-054-54	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	MIS-21-037-37	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-21-037-37	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	MIS-21-033-33	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-21-033-33	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	MIS-11-043-43	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-11-043-43	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
11/20/2025	4.0.22	MIS-11-040-40	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-11-040-40	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
11/20/2025	4.0.22	MIS-11-019-19	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-11-019-19	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
11/20/2025	4.0.22	MIS-11-004-4	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-11-004-4	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
11/20/2025	4.0.22	MIS-1-091-91	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-1-091-91	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the MSIS-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
11/20/2025	4.0.22	MIS-1-090-90	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-1-090-90	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the MSIS-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
11/20/2025	4.0.22	MIS-1-079-79	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-1-079-79	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the MSIS-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
11/20/2025	4.0.22	MIS-1-074-74	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-1-074-74	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the MSIS-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
11/20/2025	4.0.22	MIS-1-025-25	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-1-025-25	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the MSIS-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
11/20/2025	4.0.22	MIS-1-024-24	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-1-024-24	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the MSIS-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
11/20/2025	4.0.22	MIS-1-021-21	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-021-21	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
11/20/2025	4.0.22	MIS-1-020-20	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-020-20	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
11/20/2025	4.0.22	MIS-1-019-19	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-1-019-19	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the MSIS-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
11/20/2025	4.0.22	MIS-1-016-16	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-1-016-16	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the MSIS-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
11/20/2025	4.0.22	MIS-1-013-13	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-013-13	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
11/20/2025	4.0.22	MIS-1-005-5	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-1-005-5	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the MSIS-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
11/20/2025	4.0.22	MIS-1-004-4	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-1-004-4	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the MSIS-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
11/20/2025	4.0.22	MCR-9-006_1-18	UPDATE	Annotation	Calculate the percentage of PCCM capitation payment Financial Transaction records with a non-missing plan ID that do not have a corresponding managed care participation PCCM plan	N/A
11/20/2025	4.0.22	MCR-9-006_1-18	UPDATE	Specification	STEP 1: Active non-duplicate paid individual capitation payment financial transactions during report monthDefine the FTX universe for the FTX0002 table by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 2: Managed Care Plan Payee ID TypeOf the records that meet the criteria from STEP 1, further restrict them by the following criteria:1. PAYEE-MCR-PLAN-TYPE - "02" or "03"2. PAYEE-ID-TYPE = "02" or "05" or "06"STEP 3: Non-missing Payee IDOf the records that meet the criteria from STEP 2, further restrict them by the following criteria: 1. PAYEE-ID is not missingSTEP 4: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 5: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 4, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 6: No managed care participation PCCM planOf the records that meet the criteria from STEP 3, further restrict them by attempting to merge them with the data from STEP 5 and keeping those that satisfy the following criteria:1a. PAYEE-ID = MANAGED-CARE-PLAN-ID2a. MSIS-IDENTIFICATION-NUM matches 3a. MANAGED-CARE-PLAN-TYPE does NOT equal "02" or "03" for any records where 1a and 2a are satisfiedORIt is not the case that:1b. PAYEE-ID = MANAGED-CARE-PLAN-ID2b. MSIS-IDENTIFICATION-NUM matches STEP 7: Calculate the percentage for the measureDivide the count of records from STEP 6 by the count of records from STEP 3	N/A
11/20/2025	4.0.22	MCR-65-012-12	UPDATE	Annotation	Calculate the percentage of eligibles enrolled in Integrated Care for Dual Eligibles that do not have Medicaid Capitation Payment Financial Transaction records	N/A
11/20/2025	4.0.22	MCR-65-012-12	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in Integrated Care for Dual EligiblesOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("80")STEP 4: Active non-duplicate paid capitation payment financial transactions during report monthDefine the FTX universe for the FTX0002, FTX0003, and FTX0005 tables respectively by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid & S-CHIP Capitation PaymentOf the records that meet the criteria from STEP 4, further restrict them by the following criteria:1. PAYEE-ID-TYPE = "02"STEP 6: Cost-Sharing Offset Transaction TypeOf the records that meet the criteria from STEP 5, for those in FTX0005 only, further restrict them by the following criteria:1. OFFSET-TRANS-TYPE is not "03"STEP 7: Link MSIS IDs from EL to FTXRetain the MSIS IDs from STEP 3 that link to an FTX record from STEP 6 using the Plan ID (PAYEE-ID in the FTX record)STEP 8: Count MSIS IDs without Integrated Care for Dual EligiblesSubtract the number of unique MSIS IDs in STEP 7 from the number of unique MSIS IDs in STEP 3STEP 9: Calculate percentageDivide the count of unique MSIS IDs in STEP 8 by the count of unique MSIS IDs in STEP 3	N/A
11/20/2025	4.0.22	MCR-65-011-11	UPDATE	Annotation	Calculate the percentage of eligibles enrolled in a Health/Medical Home that do not have Medicaid Capitation Payment Financial Transaction records	N/A
11/20/2025	4.0.22	MCR-65-011-11	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in Health/Medical HomeOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("70")STEP 4: Active non-duplicate paid capitation payment financial transactions during report monthDefine the FTX universe for the FTX0002, FTX0003, and FTX0005 tables respectively by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid & S-CHIP Capitation PaymentOf the records that meet the criteria from STEP 4, further restrict them by the following criteria:1. PAYEE-ID-TYPE = "02"STEP 6: Cost-Sharing Offset Transaction TypeOf the records that meet the criteria from STEP 5, for those in FTX0005 only, further restrict them by the following criteria:1. OFFSET-TRANS-TYPE is not "03"STEP 7: Link MSIS IDs from EL to FTXRetain the MSIS IDs from STEP 3 that link to an FTX record from STEP 6 using the Plan ID (PAYEE-ID in the FTX record)STEP 8: Count MSIS IDs without Health/Medical HomeSubtract the number of unique MSIS IDs in STEP 7 from the number of unique MSIS IDs in STEP 3STEP 9: Calculate percentageDivide the count of unique MSIS IDs in STEP 8 by the count of unique MSIS IDs in STEP 3	N/A
11/20/2025	4.0.22	MCR-65-010-10	UPDATE	Annotation	Calculate the percentage of eligibles enrolled in an ACO that do not have Medicaid Capitation Payment Financial Transaction records	N/A
11/20/2025	4.0.22	MCR-65-010-10	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in ACOOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("60")STEP 4: Active non-duplicate paid capitation payment financial transactions during report monthDefine the FTX universe for the FTX0002, FTX0003, and FTX0005 tables respectively by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid & S-CHIP Capitation PaymentOf the records that meet the criteria from STEP 4, further restrict them by the following criteria:1. PAYEE-ID-TYPE = "02"STEP 6: Cost-Sharing Offset Transaction TypeOf the records that meet the criteria from STEP 5, for those in FTX0005 only, further restrict them by the following criteria:1. OFFSET-TRANS-TYPE is not "03"STEP 7: Link MSIS IDs from EL to FTXRetain the MSIS IDs from STEP 3 that link to an FTX record from STEP 6 using the Plan ID (PAYEE-ID in the FTX record)STEP 8: Count MSIS IDs without ACOSubtract the number of unique MSIS IDs in STEP 7 from the number of unique MSIS IDs in STEP 3STEP 9: Calculate percentageDivide the count of unique MSIS IDs in STEP 8 by the count of unique MSIS IDs in STEP 3	N/A
11/20/2025	4.0.22	MCR-65-009-9	UPDATE	Annotation	Calculate the percentage of eligibles enrolled in Disease Management that do not have Medicaid Capitation Payment Financial Transaction records	N/A
11/20/2025	4.0.22	MCR-65-009-9	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in Disease ManagementOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("02", "03", or "16")STEP 4: Active non-duplicate paid capitation payment financial transactions during report monthDefine the FTX universe for the FTX0002, FTX0003, and FTX0005 tables respectively by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid & S-CHIP Capitation PaymentOf the records that meet the criteria from STEP 4, further restrict them by the following criteria:1. PAYEE-ID-TYPE = "02" or "05" or "06"STEP 6: Cost-Sharing Offset Transaction TypeOf the records that meet the criteria from STEP 5, for those in FTX0005 only, further restrict them by the following criteria:1. OFFSET-TRANS-TYPE is not "03"STEP 7: Link MSIS IDs from EL to FTXRetain the MSIS IDs from STEP 3 that link to an FTX record from STEP 6 using the Plan ID (PAYEE-ID in the FTX record)STEP 8: Count MSIS IDs without Disease ManagementSubtract the number of unique MSIS IDs in STEP 7 from the number of unique MSIS IDs in STEP 3STEP 9: Calculate percentageDivide the count of unique MSIS IDs in STEP 8 by the count of unique MSIS IDs in STEP 3	N/A
11/20/2025	4.0.22	MCR-65-008-8	UPDATE	Annotation	Calculate the percentage of eligibles enrolled in LTSS that do not have Medicaid Capitation Payment Financial Transaction records	N/A
11/20/2025	4.0.22	MCR-65-008-8	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in LTSSOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("07" or "19")STEP 4: Active non-duplicate paid capitation payment financial transactions during report monthDefine the FTX universe for the FTX0002, FTX0003, and FTX0005 tables respectively by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid & S-CHIP Capitation PaymentOf the records that meet the criteria from STEP 4, further restrict them by the following criteria:1. PAYEE-ID-TYPE = "02"STEP 6: Cost-Sharing Offset Transaction TypeOf the records that meet the criteria from STEP 5, for those in FTX0005 only, further restrict them by the following criteria:1. OFFSET-TRANS-TYPE is not "03"STEP 7: Link MSIS IDs from EL to FTXRetain the MSIS IDs from STEP 3 that link to an FTX record from STEP 6 using the Plan ID (PAYEE-ID in the FTX record)STEP 8: Count MSIS IDs without LTSSSubtract the number of unique MSIS IDs in STEP 7 from the number of unique MSIS IDs in STEP 3STEP 9: Calculate percentageDivide the count of unique MSIS IDs in STEP 8 by the count of unique MSIS IDs in STEP 3	N/A
11/20/2025	4.0.22	MCR-65-007-7	UPDATE	Annotation	Calculate the percentage of eligibles enrolled in a Mental Health PAHP that do not have Medicaid Capitation Payment Financial Transaction records	N/A
11/20/2025	4.0.22	MCR-65-007-7	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in Mental Health PAHPOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("09", "11", or "13")STEP 4: Active non-duplicate paid capitation payment financial transactions during report monthDefine the FTX universe for the FTX0002, FTX0003, and FTX0005 tables respectively by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid & S-CHIP Capitation PaymentOf the records that meet the criteria from STEP 4, further restrict them by the following criteria:1. PAYEE-ID-TYPE = "02"STEP 6: Cost-Sharing Offset Transaction TypeOf the records that meet the criteria from STEP 5, for those in FTX0005 only, further restrict them by the following criteria:1. OFFSET-TRANS-TYPE is not "03"STEP 7: Link MSIS IDs from EL to FTXRetain the MSIS IDs from STEP 3 that link to an FTX record from STEP 6 using the Plan ID (PAYEE-ID in the FTX record)STEP 8: Count MSIS IDs without Mental Health PAHPSubtract the number of unique MSIS IDs in STEP 7 from the number of unique MSIS IDs in STEP 3STEP 9: Calculate percentageDivide the count of unique MSIS IDs in STEP 8 by the count of unique MSIS IDs in STEP 3	N/A
11/20/2025	4.0.22	MCR-65-006-6	UPDATE	Annotation	Calculate the percentage of eligibles enrolled in a Mental Health PIHP that do not have Medicaid Capitation Payment Financial Transaction records	N/A
11/20/2025	4.0.22	MCR-65-006-6	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in Mental Health PIHPOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("08", "10", or "12")STEP 4: Active non-duplicate paid capitation payment financial transactions during report monthDefine the FTX universe for the FTX0002, FTX0003, and FTX0005 tables respectively by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid & S-CHIP Capitation PaymentOf the records that meet the criteria from STEP 4, further restrict them by the following criteria:1. PAYEE-ID-TYPE = "02"STEP 6: Cost-Sharing Offset Transaction TypeOf the records that meet the criteria from STEP 5, for those in FTX0005 only, further restrict them by the following criteria:1. OFFSET-TRANS-TYPE is not "03"STEP 7: Link MSIS IDs from EL to FTXRetain the MSIS IDs from STEP 3 that link to an FTX record from STEP 6 using the Plan ID (PAYEE-ID in the FTX record)STEP 8: Count MSIS IDs without Mental Health PIHPSubtract the number of unique MSIS IDs in STEP 7 from the number of unique MSIS IDs in STEP 3STEP 9: Calculate percentageDivide the count of unique MSIS IDs in STEP 8 by the count of unique MSIS IDs in STEP 3	N/A
11/20/2025	4.0.22	MCR-65-005-5	UPDATE	Annotation	Calculate the percentage of eligibles enrolled in a Pharmacy PAHP that do not have Medicaid Capitation Payment Financial Transaction records	N/A
11/20/2025	4.0.22	MCR-65-005-5	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in Pharmacy PAHPOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("18")STEP 4: Active non-duplicate paid capitation payment financial transactions during report monthDefine the FTX universe for the FTX0002, FTX0003, and FTX0005 tables respectively by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid & S-CHIP Capitation PaymentOf the records that meet the criteria from STEP 4, further restrict them by the following criteria:1. PAYEE-ID-TYPE = "02"STEP 6: Cost-Sharing Offset Transaction TypeOf the records that meet the criteria from STEP 5, for those in FTX0005 only, further restrict them by the following criteria:1. OFFSET-TRANS-TYPE is not "03"STEP 7: Link MSIS IDs from EL to FTXRetain the MSIS IDs from STEP 3 that link to an FTX record from STEP 6 using the Plan ID (PAYEE-ID in the FTX record)STEP 8: Count MSIS IDs without Pharmacy PAHPSubtract the number of unique MSIS IDs in STEP 7 from the number of unique MSIS IDs in STEP 3STEP 9: Calculate percentageDivide the count of unique MSIS IDs in STEP 8 by the count of unique MSIS IDs in STEP 3	N/A
11/20/2025	4.0.22	MCR-65-004-4	UPDATE	Annotation	Calculate the percentage of eligibles enrolled in a Dental PAHP that do not have Medicaid Capitation Payment Financial Transaction records	N/A
11/20/2025	4.0.22	MCR-65-004-4	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in Dental PAHPOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("14")STEP 4: Active non-duplicate paid capitation payment financial transactions during report monthDefine the FTX universe for the FTX0002, FTX0003, and FTX0005 tables respectively by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid & S-CHIP Capitation PaymentOf the records that meet the criteria from STEP 4, further restrict them by the following criteria:1. PAYEE-ID-TYPE = "02"STEP 6: Cost-Sharing Offset Transaction TypeOf the records that meet the criteria from STEP 5, for those in FTX0005 only, further restrict them by the following criteria:1. OFFSET-TRANS-TYPE is not "03"STEP 7: Link MSIS IDs from EL to FTXRetain the MSIS IDs from STEP 3 that link to an FTX record from STEP 6 using the Plan ID (PAYEE-ID in the FTX record)STEP 8: Count MSIS IDs without Dental PAHPSubtract the number of unique MSIS IDs in STEP 7 from the number of unique MSIS IDs in STEP 3STEP 9: Calculate percentageDivide the count of unique MSIS IDs in STEP 8 by the count of unique MSIS IDs in STEP 3	N/A
11/20/2025	4.0.22	MCR-65-003-3	UPDATE	Annotation	Calculate the percentage of eligibles enrolled in a Transportation PAHP that do not have Medicaid Capitation Payment Financial Transaction records	N/A
11/20/2025	4.0.22	MCR-65-003-3	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in Transportation PAHPOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("15")STEP 4: Active non-duplicate paid capitation payment financial transactions during report monthDefine the FTX universe for the FTX0002, FTX0003, and FTX0005 tables respectively by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid & S-CHIP Capitation PaymentOf the records that meet the criteria from STEP 4, further restrict them by the following criteria:1. PAYEE-ID-TYPE = "02"STEP 6: Cost-Sharing Offset Transaction TypeOf the records that meet the criteria from STEP 5, for those in FTX0005 only, further restrict them by the following criteria:1. OFFSET-TRANS-TYPE is not "03"STEP 7: Link MSIS IDs from EL to FTXRetain the MSIS IDs from STEP 3 that link to an FTX record from STEP 6 using the Plan ID (PAYEE-ID in the FTX record)STEP 8: Count MSIS IDs without Transportation PAHPSubtract the number of unique MSIS IDs in STEP 7 from the number of unique MSIS IDs in STEP 3STEP 9: Calculate percentageDivide the count of unique MSIS IDs in STEP 8 by the count of unique MSIS IDs in STEP 3	N/A
11/20/2025	4.0.22	MCR-65-002-2	UPDATE	Annotation	Calculate the percentage of eligibles enrolled in a PACE plan that do not have Medicaid Capitation Payment Financial Transaction records	N/A
11/20/2025	4.0.22	MCR-65-002-2	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in PACE planOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("17")STEP 4: Active non-duplicate paid capitation payment financial transactions during report monthDefine the FTX universe for the FTX0002, FTX0003, and FTX0005 tables respectively by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid & S-CHIP Capitation PaymentOf the records that meet the criteria from STEP 4, further restrict them by the following criteria:1. PAYEE-ID-TYPE = "02"STEP 6: Cost-Sharing Offset Transaction TypeOf the records that meet the criteria from STEP 5, for those in FTX0005 only, further restrict them by the following criteria:1. OFFSET-TRANS-TYPE is not "03"STEP 7: Link MSIS IDs from EL to FTXRetain the MSIS IDs from STEP 3 that link to an FTX record from STEP 6 using the Plan ID (PAYEE-ID in the FTX record)STEP 8: Count MSIS IDs without PACE planSubtract the number of unique MSIS IDs in STEP 7 from the number of unique MSIS IDs in STEP 3STEP 9: Calculate percentageDivide the count of unique MSIS IDs in STEP 8 by the count of unique MSIS IDs in STEP 3	N/A
11/20/2025	4.0.22	MCR-65-001-1	UPDATE	Annotation	Calculate the percentage of eligibles enrolled in a Comprehensive MCO that do not have Medicaid Capitation Payment Financial Transaction records with the corresponding managed care plan type	N/A
11/20/2025	4.0.22	MCR-65-001-1	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in Comprehensive MCOOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("01" or "04")STEP 4: Active non-duplicate paid capitation payment financial transactions during report monthDefine the FTX universe for the FTX0002, FTX0003, and FTX0005 tables respectively by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid & S-CHIP Capitation PaymentOf the records that meet the criteria from STEP 4, further restrict them by the following criteria:1. PAYEE-ID-TYPE = "02"STEP 6: Cost-Sharing Offset Transaction TypeOf the records that meet the criteria from STEP 5, for those in FTX0005 only, further restrict them by the following criteria:1. OFFSET-TRANS-TYPE is not "03"STEP 7: Link MSIS IDs from EL to FTXRetain the MSIS IDs from STEP 3 that link to an FTX record from STEP 6 using the Plan ID (PAYEE-ID in the FTX record)STEP 8: Count MSIS IDs without Comprehensive MCOSubtract the number of unique MSIS IDs in STEP 7 from the number of unique MSIS IDs in STEP 3STEP 9: Calculate percentageDivide the count of unique MSIS IDs in STEP 8 by the count of unique MSIS IDs in STEP 3	N/A
11/20/2025	4.0.22	MCR-64-004_1-8	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP encounter: non-void, crossover, paid RX claims where Medicare paid amount, total Medicare coinsurance amount, and total Medicare deductible amount are equal to 0 or are missing	N/A
11/20/2025	4.0.22	MCR-64-004_1-8	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers: 1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Non-void, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. CROSSOVER-IND = "1"3. ADJUSTMENT-IND not equal to "1" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: No Medicare AmountsOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria: 1. MEDICARE-PAID-AMT = 0 or is missing on all lines2. TOT-MEDICARE-COINS-AMT = 0 or is missing3. TOT-MEDICARE-DEDUCTIBLE-AMT = 0 or is missingSTEP 5: Calculate percentageDivide the count of claim headers from STEP 4 by the count of claim headers from STEP 3.	N/A
11/20/2025	4.0.22	MCR-64-003_1-7	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP encounter: non-void, crossover, paid OT claims where Medicare paid amount, total Medicare coinsurance amount, and total Medicare deductible amount are equal to 0 or are missing	N/A
11/20/2025	4.0.22	MCR-64-003_1-7	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers: 1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Non-void, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. CROSSOVER-IND = "1"3. ADJUSTMENT-IND not equal to "1" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: No Medicare AmountsOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria: 1. MEDICARE-PAID-AMT = 0 or is missing on all lines2. TOT-MEDICARE-COINS-AMT = 0 or is missing3. TOT-MEDICARE-DEDUCTIBLE-AMT = 0 or is missingSTEP 5: Calculate percentageDivide the count of claim headers from STEP 4 by the count of claim headers from STEP 3.	N/A
11/20/2025	4.0.22	MCR-64-002_1-6	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP encounter: non-void, crossover, paid LT claims where Medicare paid amount, total Medicare coinsurance amount, and total Medicare deductible amount are equal to 0 or are missing	N/A
11/20/2025	4.0.22	MCR-64-002_1-6	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Non-void, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. CROSSOVER-IND = "1"3. ADJUSTMENT-IND not equal to "1" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: No Medicare Amounts Of the claims that meet the criteria from STEP 3, further restrict them by the following criteria: 1. MEDICARE-PAID-AMT = 0 or is missing2. TOT-MEDICARE-COINS-AMT = 0 or is missing3. TOT-MEDICARE-DEDUCTIBLE-AMT = 0 or is missingSTEP 5: Calculate percentageDivide the count of claim headers from STEP 4 by the count of claim headers from STEP 3.	N/A
11/20/2025	4.0.22	MCR-64-001_1-5	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP encounter: non-void, crossover, paid IP claims where Medicare paid amount, total Medicare coinsurance amount, and total Medicare deductible amount are equal to 0 or are missing	N/A
11/20/2025	4.0.22	MCR-64-001_1-5	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Non-void, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. CROSSOVER-IND = "1"3. ADJUSTMENT-IND not equal to "1" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: No Medicare AmountsOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria: 1. MEDICARE-PAID-AMT = 0 or is missing2. TOT-MEDICARE-COINS-AMT = 0 or is missing3. TOT-MEDICARE-DEDUCTIBLE-AMT = 0 or is missingSTEP 5: Calculate percentageDivide the count of claim headers from STEP 4 by the count of claim headers from STEP 3.	N/A
11/20/2025	4.0.22	MCR-59-004-16	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP Encounter: original, paid RX claims that are paid at the line level where the sum of Medicaid paid amount from the lines does not equal the total Medicaid paid amount from the header	N/A
11/20/2025	4.0.22	MCR-59-004-16	UPDATE	Specification	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Exclude childless headersOf the claim headers that meet the criteria from STEP 3, drop all headers that do not merge to at least one lineSTEP 5: Claims paid at the line levelOf claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 6: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 3, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 7: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 6 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 8: Calculate the percentage for the measureDivide the count of claims from STEP 7 by the count of claims from STEP 5.	N/A
11/20/2025	4.0.22	MCR-59-003-15	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP Encounter: original, paid OT claims that are paid at the line level where the sum of Medicaid paid amount from the lines does not equal the total Medicaid paid amount from the header	N/A
11/20/2025	4.0.22	MCR-59-003-15	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Exclude childless headersOf the claim headers that meet the criteria from STEP 3, drop all headers that do not merge to at least one lineSTEP 5: Claims paid at the line levelOf claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 6: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 5, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 7: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 6 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 8: Calculate the percentage for the measureDivide the count of claims from STEP 7 by the count of claims from STEP 5.	N/A
11/20/2025	4.0.22	MCR-59-002-14	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP Encounter: original, paid LT claims that are paid at the line level where the sum of Medicaid paid amount from the lines does not equal the total Medicaid paid amount from the header	N/A
11/20/2025	4.0.22	MCR-59-002-14	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Exclude childless headersOf the claim headers that meet the criteria from STEP 3, drop all headers that do not merge to at least one lineSTEP 5: Claims paid at the line levelOf claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 6: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 5, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 7: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 6 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 8: Calculate the percentage for the measureDivide the count of claims from STEP 7 by the count of claims from STEP 5.	N/A
11/20/2025	4.0.22	MCR-59-001-13	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP Encounter: original, paid IP claims that are paid at the line level where the sum of Medicaid paid amount from the lines does not equal the total Medicaid paid amount from the header	N/A
11/20/2025	4.0.22	MCR-59-001-13	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Exclude childless headersOf the claim headers that meet the criteria from STEP 3, drop all headers that do not merge to at least one lineSTEP 5: Claims paid at the line levelOf claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 6: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 3, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 7: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 6 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 8: Calculate the percentage for the measureDivide the count of claims from STEP 7 by the count of claims from STEP 5.	N/A
11/20/2025	4.0.22	MCR-13-006_1-18	UPDATE	Annotation	Calculate the percentage of PCCM capitation payment Financial Transaction records with a non-missing plan ID that do not have a corresponding managed care participation PCCM plan	N/A
11/20/2025	4.0.22	MCR-13-006_1-18	UPDATE	Specification	STEP 1: Active non-duplicate paid individual capitation payment financial transactions during report monthDefine the FTX universe for the FTX0002 table by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 2: Managed Care Plan Payee ID TypeOf the records that meet the criteria from STEP 1, further restrict them by the following criteria:1. PAYEE-MCR-PLAN-TYPE = "02" or "03"2. PAYEE-ID-TYPE = "02"or "05" or "06"STEP 3: Non-missing Payee IDOf the records that meet the criteria from STEP 2, further restrict them by the following criteria: 1. PAYEE-ID is not missingSTEP 4: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 5: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 4, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 6: No managed care participation PCCM planOf the records that meet the criteria from STEP 3, further restrict them by attempting to merge them with the data from STEP 5 and keeping those that satisfy the following criteria:1a. PAYEE-ID = MANAGED-CARE-PLAN-ID2a. MSIS-IDENTIFICATION-NUM matches 3a. MANAGED-CARE-PLAN-TYPE does NOT equal "02" or "03" for any records where 1a and 2a are satisfiedORIt is not the case that:1b. PAYEE-ID = MANAGED-CARE-PLAN-ID2b. MSIS-IDENTIFICATION-NUM matches STEP 7: Calculate the percentage for the measureDivide the count of records from STEP 6 by the count of records from STEP 3	N/A
11/20/2025	4.0.22	MCR-10-022-17	UPDATE	Annotation	Percentage of unique Medicaid Encounter: original, non-crossover, paid OT claims with TYPE-OF-SERVICE = 12, 25, 26 with Local Service Code Ind.	N/A
11/20/2025	4.0.22	MCR-10-022-17	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = "012" or "025" or "026"STEP 4: Procedure code Of the claim lines that meet the criteria from STEP 3, further restrict them by the following criteria:PROCEDURE-CODE-FLAG = "10" through "87"STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	N/A
11/20/2025	4.0.22	FFS-9-023-17	UPDATE	Annotation	Percentage of unique Medicaid FFS: original, non-crossover, paid OT claims with TYPE-OF-SERVICE = 12, 25, 26 with Local Service Code Ind.	N/A
11/20/2025	4.0.22	FFS-9-023-17	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = "012" or "025" or "026"STEP 4: Procedure code Of the claim lines that meet the criteria from STEP 3, further restrict them by the following criteria:PROCEDURE-CODE-FLAG = "10" through "87"STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	N/A
11/20/2025	4.0.22	EXP-45-004-4	UPDATE	Annotation	Calculate the percentage of unique MSIS IDs on Medicaid and S-CHIP Payment Financial Transaction Records found on any enrollment time span segment	N/A
11/20/2025	4.0.22	EXP-45-004-4	UPDATE	Specification	STEP 1: Active non-duplicate paid miscellaneous payment financial transactions during report monthDefine the FTX universe for the FTX00095 table by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 2: Unique MSIS IDsFrom the records in STEP 1, create a list of unique MSIS-IDENTIFICATION-NUM values.STEP 3: Link FTX records to enrollment time span segmentOf the unique MSIS-IDENTIFICATION-NUM values from STEP 2, restrict to those where:1. MSIS-IDENTIFICATION-NUM is found on an ENROLLMENT-TIME-SPAN-ELG00021 segmentSTEP 4: Calculate percentage Divide the count of unique MSIS-IDENTIFICATION-NUM values from STEP 3 by the count from STEP 2	N/A
11/20/2025	4.0.22	EXP-39-001_1-2	UPDATE	Annotation	Calculate the percentage of S-CHIP Encounter: original, non-crossover, paid OT claims billed at the line level where Medicaid paid amount is equal to $0 or missing	N/A
11/20/2025	4.0.22	EXP-39-001_1-2	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Payment at the line levelOf the claims from STEP 3, select records where:1. PAYMENT-LEVEL-IND = "2"STEP 5: Medicaid paid $0 or missingOf the claims from STEP 4, select records where:1. MEDICAID-PAID-AMT = "0" or is missingSTEP 6: Calculate the percentage for the measureDivide the count of claim lines from STEP 5 by the count of claims lines from STEP 4.	N/A
11/20/2025	4.0.22	EXP-37-001_1-2	UPDATE	Annotation	Calculate the percentage of Medicaid Encounter: original, non-crossover, paid OT claims billed at the line level that have Medicaid paid amount equal to $0 or missing	N/A
11/20/2025	4.0.22	EXP-37-001_1-2	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Payment at the line levelOf the claims from STEP 3, select records where:1. PAYMENT-LEVEL-IND = "2"STEP 5: Medicaid paid $0 or missingOf the claims from STEP 4, select records where:1. MEDICAID-PAID-AMT = "0" or is missingSTEP 6: Calculate the percentage for the measureDivide the count of claim lines from STEP 5 by the count of claims lines from STEP 4.	N/A
11/20/2025	4.0.22	EXP-24-009-9	UPDATE	Annotation	Calculate the percentage of S-CHIP Capitation Payment Financial Transaction records where Payment or Recoupment Amount is equal to $0 or missing	N/A
11/20/2025	4.0.22	EXP-24-009-9	UPDATE	Specification	STEP 1: Active non-duplicate paid capitation payment financial transactions during report monthDefine the FTX universe for the FTX0002, FTX0003, and FTX0005 tables respectively by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Capitation Payment: Original, Paid ClaimsOf the records that meet the criteria from STEP 1, further restrict them by the following criteria:1. MBESCBES-FORM-GROUP = "3"2. ADJUSTMENT-IND = "0"STEP 3: Payment or Recoupment Amount $0 or missingOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1a. PAYMENT-OR-RECOUPMENT-AMOUNT = "0" or is missingOR1b. PAYMENT-AMOUNT= "0" or is missingSTEP 4: Calculate the percentage for the measureDivide the count of records from STEP 3 by the count of records from STEP 2	N/A
11/20/2025	4.0.22	EXP-22-009-9	UPDATE	Annotation	Calculate the percentage of Medicaid Capitation Payment Financial Transaction records where Payment or Recoupment Amount is equal to $0 or missing	N/A
11/20/2025	4.0.22	EXP-22-009-9	UPDATE	Specification	STEP 1: Active non-duplicate paid capitation payment financial transactions during report monthDefine the FTX universe for the FTX0002, FTX0003, and FTX0005 tables respectively by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Capitation Payment: Original, Paid ClaimsOf the records that meet the criteria from STEP 1, further restrict them by the following criteria:1. MBESCBES-FORM-GROUP = "1" or "2" 2. ADJUSTMENT-IND = "0"STEP 3: Payment or Recoupment Amount $0 or missingOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1a. PAYMENT-OR-RECOUPMENT-AMOUNT = "0" or is missingOR1b. PAYMENT-AMOUNT= "0" or is missingSTEP 4: Calculate the percentage for the measureDivide the count of records from STEP 3 by the count of records from STEP 2	N/A
11/20/2025	4.0.22	EXP-13-004_1-7	UPDATE	Annotation	Calculate the percentage of S-CHIP FFS: original, non-crossover, paid OT claims billed at the line level where Medicaid paid amount is equal to $0 or missing	N/A
11/20/2025	4.0.22	EXP-13-004_1-7	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Payment at the line levelOf the claims that meet the criteria from STEP 2, count records where:1. PAYMENT-LEVEL-IND = "2"STEP 4: Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 3, restrict to claims that meet the following criteria:1. MEDICAID-PAID-AMT = "0" or is missingSTEP 5: Calculate percentageDivide the number of claims from STEP 4 by the number of claims from STEP 3.	N/A
11/20/2025	4.0.22	EXP-13-003_1-6	UPDATE	Annotation	Calculate the percentage of S-CHIP FFS: original, non-crossover, paid OT claims billed at the line level where the billed amount is $0	N/A
11/20/2025	4.0.22	EXP-13-003_1-6	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Payment at the line levelOf the claims that meet the criteria from STEP 2, count records where:1. PAYMENT-LEVEL-IND = "2"STEP 4: Billed amount $0Of the claims that meet the criteria from STEP 3, count records with1. BILLED-AMT = "0"STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	N/A
11/20/2025	4.0.22	EXP-11-161_1-164	UPDATE	Annotation	Calculate the percentage of Medicaid FFS: original, non-crossover, paid OT claims billed at the line level that have Medicaid paid amount equal to $0 or missing	N/A
11/20/2025	4.0.22	EXP-11-161_1-164	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Payment at the line levelOf the claims that meet the criteria from STEP 2, count records where:1. PAYMENT-LEVEL-IND = "2"STEP 4: Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 3, select records with 1. MEDICAID-PAID-AMT = "0" or is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	N/A
11/20/2025	4.0.22	EXP-11-160_1-163	UPDATE	Annotation	Calculate the percentage of Medicaid FFS: original, non-crossover, paid OT claims billed at the line level where the total amount billed is $0	N/A
11/20/2025	4.0.22	EXP-11-160_1-163	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Payment at the line levelOf the claims that meet the criteria from STEP 2, count records where:1. PAYMENT-LEVEL-IND = "2"STEP 4: Billed amount $0Of the claims that meet the criteria from STEP 3, count records with1. BILLED-AMT = "0"STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	N/A
11/20/2025	4.0.22	EL-8-002-2	UPDATE	Annotation	For each unique plan id in the Eligible, Managed Care, Claims, or FTX files, pull associated plan type from Eligible and Managed Care Plan files and count the number of unique managed care enrollees, capitation payments, capitation ratios, encounters, and encounter ratios for the month referenced.	N/A
11/20/2025	4.0.22	EL-8-002-2	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Managed care plans on the last day of DQ report monthDefine the managed care plan population from segment MANAGED-CARE-MAIN-MCR00002 by keeping active records that satisfy the following criteria:1. MANAGED-CARE-MAIN-REC-EFF-DATE <= last day of the reporting month2. MANAGED-CARE-MAIN-REC-END-DATE >= last day of the reporting month OR missingSTEP 4: Active non-duplicate claims records during DQ report monthDefine the claims universe for IP, LT, and RX at the header level and for OT at the line level by importing headers (and lines for OT) that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, and ADJUDICATION-DATE and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 5: Medicaid and S-CHIP Encounter: Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = ("3" or "C")STEP 6: Capitation payment financial transactions:Define the FTX universe for the FTX0002, FTX0003, and FTX0005 tables respectively by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-DATE or PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 7: Medicaid & S-CHIP Capitation PaymentOf the financial transactions that meet the criteria from STEP 6, further restrict them by the following criteria:1. PAYEE-ID-TYPE = ("02" or "05" or "06")For those in FTX0005 only:1. OFFSET-TRANS-TYPE = "1" or "2"STEP 8: Define Plan_IdDefine Plan_Id as a unique list of: MANAGED-CARE-PLAN-ID from the EL file that meet the constraints in STEP 2, STATE-PLAN-ID-NUM from the MCR file that meet the constraints in STEP 3, PLAN-ID-NUMBER from the claims files that meet the constraints in STEP 5, and PAYEE-ID from records that meet constraints in STEP 7. Also, define a blank Plan_Id for missing.STEP 9: Define Plan_Type_ElIn cases where Plan_Id can be linked to a MANAGED-CARE-PLAN-ID in MANAGED-CARE-PARTICIPATION-ELG00014, and there is only one plan type for that plan, define Plan_Type_El as MANAGED-CARE-PLAN-TYPE. If there are multiple plan types for the Plan_Id, then set Plan_Type_El to the most frequently used plan type, or the lowest plan type if there is a tie. (If there are multiple plan types, also set MultiplePlanTypes_EL = 1.) In all other cases, Plan_Type_El = missing.STEP 10: Define Plan_Type_Mc and LinkedIn cases where Plan_Id can be linked to a STATE-PLAN-ID-NUM in MANAGED-CARE-MAIN-MCR00002, set In_MCR_File = "Yes". If there is only one plan type for that plan, define Plan_Type_Mc as MANAGED-CARE-PLAN-TYPE . If there are multiple plan types for the Plan_Id, then set Plan_Type_Mc to the most frequently used plan type, or the lowest plan type if there is a tie. (If there are multiple plan types, also set MultiplePlanTypes_Mc = 1.) In all other cases, Plan_Type_Mc = missing and In_MCR_File = "No". STEP 11: Count EnrollmentFor each Plan_Id, define Enrollment as the count of unique MSIS-IDENTIFICATION-NUM that satisfy the constraints in STEP 2aSTEP 12: Capitation RecordsFor each record that meets the criteria from STEP 7, further restrict them by the following criteria:1. ADJUSTMENT_IND = 02a. PAYMENT_OR_RECOUPMENT_AMOUNT (FTX00002 and FTX00005) > 0OR2b. PAYMENT_AMOUNT (FTX00003) > 0STEP 13: Set Capitation TypeUsing the records in STEP 12:1a. Set Capitation_Type = “Medicaid and S-CHIP” if at least one record with MBESCBES_FORM_GROUP = "1" OR "2" AND at least one record with MBESCBES_FORM_GROUP = "3" 1b. Set Capitation_Type = “Medicaid” if at least one record with MBESCBES_FORM_GROUP = "1" OR "2" AND no records with MBESCBES_FORM_GROUP = "3"1c. Set Capitation_Type = "S-CHIP" if no records with MBESCBES_FORM_GROUP = "1" OR "2" AND at least one record with MBESCBES_FORM_GROUP = "3" STEP 14: Count Capitation_Hmo_Hio_PaceDefine Capitation_Hmo_Hio_Pace as the count of unique FTX00002 records from STEP 12 that also satisfy the following criteria:1. PAYEE-MCR-PLAN-TYPE = (“01” or “04” or “17”)STEP 15: Count Capitation_PhpDefine Capitation_Php as the count of unique FTX00002 records from STEP 12 that also satisfy the following criteria:1. PAYEE-MCR-PLAN-TYPE = (“05” or “06”or “07”or “08”or “09” or “10” or “11”or “12” or “13”or “14” or “15”or “16” or “18”or “19”)STEP 16: Count Capitation_PccmDefine Capitation_Pccm as the count of unique FTX00002 records from STEP 12 that also satisfy the following criteria:1. PAYEE-MCR-PLAN-TYPE = (“02" or "03")STEP 17: Count Capitation_PhiDefine Capitation_Phi as the count of unique FTX00003 and FTX00005 records from STEP 12 that also satisfy the following criteria:1. For FTX00005 records only, OFFSET-TRANS-TYPE = "2"STEP 18: Count Capitation_OtherDefine Capitation_Other as the count of unique FTX00002 and FTX00005 records from STEP 12 that also satisfy the following criteria:1. PAYEE-MCR-PLAN-TYPE is not equal to (“01”,“02”,“03”,“04”, “05”,“06”,“07”,“08”,“09”,“10”,“11”,“12”,“13”,“14”,“15”,“16”, “17”,“18”,“19”) 2. For FTX00005 records only, OFFSET-TRANS-TYPE = "1"STEP 19: Count Capitation_TotalDefine Capitation_Total as the sum of Capitation_Hmo_Hio_Pace, Capitation_Php, Capitation_Pccm, Capitation_Phi, and Capitation_OtherSTEP 20: Encounter ClaimsSelect encounter claims in the IP, LT, OT, and RX files by the following criteria:1. PLAN-ID-NUMBER = Plan_Id2. TYPE-OF-CLAIM = (“3” or “C”)3. ADJUSTMENT-IND = “0”STEP 21: Set Encounter TypeUsing the records in STEP 20:1a. Set Encounter_Type = “Medicaid and S-CHIP” if at least one record with TYPE-OF-CLAIM = “3” AND at least one record with TYPE-OF-CLAIM = “C” 1b. Set Encounter_Type = “Medicaid” if at least one record with TYPE-OF-CLAIM = “3” AND no records with TYPE-OF-CLAIM = “C” 1c. Set Encounter_Type = "S-CHIP" if no records with TYPE-OF-CLAIM = “3” AND at least one record with TYPE-OF-CLAIM = “C”STEP 22: Count Encounters_IpDefine Encounters_Ip as the count of unique IP header records from STEP 20STEP 23: Count Encounters_LtDefine Encounters_Lt as the count of unique LT header records from STEP 20STEP 24: Count Encounters_OtDefine Encounters_Ot as the count of unique OT line records from STEP 20STEP 25: Count Encounters_RxDefine Encounters_Rx as the count of unique RX header records from STEP 20STEP 26: Count Encounters_TotalDefine Encounters_Total as the sum of Encounters_Ip, Encounters_Lt, Encounters_Ot, and Encounters_RxSTEP 27: Count RatiosSET Capitation_Ratio = Capitation_Total / EnrollmentSET Encounters_Ip_Ratio = Encounters_Ip / EnrollmentSET Encounters_Lt_Ratio = Encounters_Lt / EnrollmentSET Encounters_Ot_Ratio = Encounters_Ot / EnrollmentSET Encounters_Rx_Ratio = Encounters_Rx / EnrollmentSTEP 28: Repeat for each Plan_IdREPEAT STEPS 9-27 for each Plan_Id identified in STEP 8	N/A
11/20/2025	4.0.22	EL-6-041-41	UPDATE	Annotation	Calculate the percentage of MSIS IDs enrolled in the past 12 months with at least three gaps in enrollment during that time period	N/A
11/20/2025	4.0.22	EL-6-041-41	UPDATE	Specification	STEP 1: Enrolled at any time within the past 12 monthsDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= 12 months prior to last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Enrollment Type is Medicaid or CHIPUsing the MSIS IDs that meet the criteria from STEP 1, further refine the population by keeping records with: 1. ENROLLMENT-TYPE = "1" or "2"STEP 3: Non-duplicate enrollment spansDuplicate records are dropped if the following three data elements are the same: MSIS-IDENTIFICATION-NUM, ENROLLMENT-EFF-DATE, and ENROLLMENT-END-DATESTEP 4: Sort records chronologically for each MSIS IDFor each MSIS ID identified in STEP 2, sort records chronologically by ENROLLMENT-EFF-DATE and ENROLLMENT-END-DATESTEP 5: Maximum enrollment end date thus farFor each combination of ENROLLMENT-EFF-DATE, and ENROLLMENT-END-DATE for a given MSIS ID, set Max_End_Date_Thus_Far = the maximum value for ENROLLMENT-END-DATE for that combinationSTEP 6: Total record count by MSIS IDFor each MSIS ID identified in STEP 2, set Tot_Rec = Count of unique combinations of ENROLLMENT-EFF-DATE and ENROLLMENT-END-DATESTEP 7: Previous enrollment end dateFor each combination of ENROLLMENT-EFF-DATE, and ENROLLMENT-END-DATE for a given MSIS ID, set Prev_Enrollment_End_Date = the ENROLLMENT-END-DATE value immediately prior to the ENROLLMENT-END-DATE value for that combinationSTEP 8: Enrollment span startFor each combination of ENROLLMENT-EFF-DATE, and ENROLLMENT-END-DATE for a given MSIS ID, set Enrollment_Span_Start = "1" as follows:1a. Tot_Rec = 1 for the MSIS IDOR1b. ENROLLMENT-EFF-DATE is greater than Prev_Enrollment_End_Date ELSESet Enrollment_Span_Start = "0"STEP 9: Total count of noncontiguous enrollment spansFor each MSIS ID that meets the criteria from STEP 2, set Tot_Enrollment_Span = Count of rows where Enrollment_Span_Start = "1"STEP 10: Count of MSIS IDs with three or more enrollment gapsFor each MSIS ID that meets the criteria from STEP 2, further refine the population by keeping records where Tot_Enrollment_Span is greater than 3. Note that since gaps exist between enrollment spans, there must be at least 4 noncontiguous enrollment spans to equal 3 enrollment gaps for a given MSIS ID. STEP 11: Calculate percentage for measureDivide the count of MSIS IDs from STEP 10 by the count of MSIS IDs from STEP 2	N/A
11/20/2025	4.0.22	EL-6-040-40	UPDATE	Annotation	Calculate the percentage of MSIS IDs enrolled in the past 12 months with at least one gap in enrollment during that time period	N/A
11/20/2025	4.0.22	EL-6-040-40	UPDATE	Specification	STEP 1: Enrolled at any time within the past 12 monthsDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= 12 months prior to last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Enrollment Type is Medicaid or CHIPUsing the MSIS IDs that meet the criteria from STEP 1, further refine the population by keeping records with: 1. ENROLLMENT-TYPE = "1" or "2"STEP 3: Enrollment status by monthUsing the MSIS IDs that meet the criteria from STEP 2, for each month within the 12 month period identified in STEP 1, set Enrollment_Status = "1" where:1. ENROLLMENT-EFF-DATE <= first day of the month 2. ENROLLMENT-END-DATE >= last day of the month OR missingELSESet Enrollment_Status = "0"STEP 4: Identify enrollment gapsFor each month within the 12 month period identified in STEP 1, set Enrollment_Gap = "1" where:1. Enrollment_Status = "0" for the month2. There is any prior month within the 12 month period with Enrollment_Status = "1"3. There is any subsequent month within the 12 month period with Enrollment_Status = "1"ELSESet Enrollment_Gap = "0"STEP 5: Address multi-month enrollment gaps by keeping the enrollment gap status only for the earliest monthFor the months identified in STEP 4 where Enrollment_Gap = "1", if the preceding month in the 12 month period also has Enrollment_Gap = "1", set Enrollment_Gap for the month = "0" STEP 6: Total count of enrollment gaps across 12 month periodFor each MSIS ID that meets the criteria from STEP 2, set Gap_Total = Count of months where Enrollment_Gap = "1"STEP 7: Count of MSIS IDs with an enrollment gapFor each MSIS ID that meets the criteria from STEP 2, further refine the population by keeping records where Gap_Total is greater than 0STEP 8: Calculate percentage for measureDivide the count of MSIS IDs from STEP 6 by the count of MSIS IDs from STEP 2	N/A
11/20/2025	4.0.22	EL-6-036-36	UPDATE	Annotation	Calculate the percentage of duals missing a Medicare Beneficiary Identifier	N/A
11/20/2025	4.0.22	EL-6-036-36	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Dual eligiblesOf the MSIS IDs which meet the criteria from STEP 2, restrict to dual eligibles:1. DUAL-ELIGIBLE-CODE equals ("01" or "02" or "03" or "04" or "05" or "06" or "08" or "09" or "10")STEP 4: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 5: Medicare Beneficiary Identifier is missingOf the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping MSIS IDs where:1. MEDICARE-BENEFICIARY-IDENTIFIER is missingSTEP 6: Calculate percentageDivide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 4	N/A
11/20/2025	4.0.22	EL-6-032-35	UPDATE	Annotation	Calculate the percentage of eligibles with a restricted benefits code designating Money Follows the Person participation that are not included in the ELG00010 segment for the same month	N/A
11/20/2025	4.0.22	EL-6-032-35	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Money Follows the Person participationOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping MSIS IDs where:1. RESTRICTED-BENEFITS-CODE = “D”STEP 4: MFP enrollment on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment MFP-INFORMATION-ELG00010 by keeping records that satisfy the following criteria:1. MFP-ENROLLMENT-EFF-DATE <= last day of the DQ report month AND is not missing2. MFP-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingSTEP 5: No MFP EnrollmentSubtract the count of unique MSIS IDs from STEP 3 by the count of unique MSIS IDs from STEP 4STEP 6: Calculate percentageDivide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 3	N/A
11/20/2025	4.0.22	EL-3-034-43	UPDATE	Annotation	Calculate the percentage of MSIS IDs with a ELIGIBILITY-GROUP value of "05", where SEX is not "M", that are between the ages of 40 and 44	N/A
11/20/2025	4.0.22	EL-3-034-43	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: ELIGIBILITY-GROUP = "05"Of the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with ELIGIBILITY-GROUP = "05"STEP 4: Primary demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment PRIMARY-DEMOGRAPHICS-ELG00002 by keeping records that satisfy the following criteria:1a. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 5: SEX is not equal to "M"Of the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping records where SEX is not "M" STEP 6: Calculate AgeOf the MSIS IDs that meet the criteria from STEP 5, calculate age:1a. If DATE-OF-DEATH is non-missing and occurs before the last day of the DQ report month, Age is equal to the years between DATE-OF-DEATH and DATE-OF-BIRTH.1b. Otherwise, Age is equal to the years between the last day of the DQ report month and DATE-OF-BIRTH.STEP 7: Individuals between the ages of 40 and 44Refine the MSIS IDs from STEP 6 by keeping records with:1. Age >= 40 and Age <= 44STEP 8: Calculate percentage for measureDIVIDE the count of MSIS IDs from STEP 7 by the count of MSIS IDs from STEP 3	N/A
11/20/2025	4.0.22	EL-3-033-42	UPDATE	Annotation	Calculate the percentage of MSIS IDs with an ELIGIBILITY-GROUP value of "11" that are not receiving full benefits	N/A
11/20/2025	4.0.22	EL-3-033-42	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: ELIGIBILITY-GROUP = "11"Of the MSIS IDs that meet criteria from STEP 2, further refine the population by keeping records with ELIGIBILITY-GROUP = "11"STEP 4: Enrollees without full benefitsOf the MSIS ID's that meet the criteria from STEP 3, further refine the population by keeping records that satisfy the following criteria:1. RESTRICTED-BENEFITS-CODE is not ("1", "4", "5" "7", "A", "B", "D") OR2. RESTRICTED-BENEFITS-CODE is missingSTEP: 5: Calculate percentage for measureDIVIDE the count of MSIS IDs from STEP 4 by the count of MSIS IDs from STEP 3	N/A
11/20/2025	4.0.22	EL-3-029-38	UPDATE	Annotation	Calculate the percentage of MSIS IDs with a RESTRICTED-BENEFITS-CODE value of "4" that have a SEX value of “M”	N/A
11/20/2025	4.0.22	EL-3-029-38	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: RESTRICTED-BENEFITS-CODE = "4"Of the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with RESTRICTED-BENEFITS-CODE = "4"STEP 4: Primary demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment PRIMARY-DEMOGRAPHICS-ELG00002 by keeping records that satisfy the following criteria:1a. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 5: SEX = "M"Of the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping records with SEX = "M"STEP 6: Calculate percentage for measureDIVIDE the count of MSIS IDs from STEP 5 by the count of MSIS IDs from STEP 3	N/A
11/20/2025	4.0.22	EL-3-028-37	UPDATE	Annotation	Calculate the percentage of MSIS IDs with a PREGNANCY-INDICATOR value of 1 that have a SEX value of “M”	N/A
11/20/2025	4.0.22	EL-3-028-37	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment VARIABLE-DEMOGRAPHICS-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: Pregnancy Indicator = "1"Of the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with PREGNANCY-INDICATOR= "1"STEP 4: Primary demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment PRIMARY-DEMOGRAPHICS-ELG00002 by keeping records that satisfy the following criteria:1a. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 5: SEX = "M"Of the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping records with SEX = "M"STEP 6: Calculate percentage for measureDIVIDE the count of MSIS IDs from STEP 5 by the count of MSIS IDs from STEP 3	N/A
11/20/2025	4.0.22	EL-3-027-36	UPDATE	Annotation	Calculate the percentage of MSIS IDs with an ELIGIBILITY-GROUP value of "12" for states that are not 209(b) states	N/A
11/20/2025	4.0.22	EL-3-027-36	UPDATE	Specification	STEP 1: Measure applies to submitting state1a. If submitting state is NOT expected to report ELIGIBILITY-GROUP value "12" because the state is NOT a 209(b) state, proceed to STEP 2.ELSE1b. If submitting state is expected to report ELIGIBILITY-GROUP value "12" because the state is a 209(b) state, the final measure statistic will be displayed as "N/A".STEP 2: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 3: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 2, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 4: MSIS IDs with eligibility group 12Of the MSIS IDs that meet the criteria from STEP 3, keep those where ELIGIBILITY-GROUP = "12"STEP 5: Calculate percentageDivide the count of unique MSIS IDs from STEP 4 by the count from STEP 2	N/A
11/20/2025	4.0.22	EL-3-026-35	UPDATE	Annotation	Calculate the percentage of MSIS IDs with an ELIGIBILITY-GROUP value of "11" for states that are not 1634 or SSI criteria states	N/A
11/20/2025	4.0.22	EL-3-026-35	UPDATE	Specification	STEP 1: Measure applies to submitting state1a. If submitting state is NOT expected to report ELIGIBILITY-GROUP value "11" because the state is NOT a 1634 or SSI criteria state, proceed to STEP 2.ELSE1b. If submitting state is expected to report ELIGIBILITY-GROUP value "11" because the state is a 1634 or SSI criteria state, the final measure statistic will be displayed as "N/A".STEP 2: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 3: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 2, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 4: MSIS IDs with eligibility group 11Of the MSIS IDs that meet the criteria from STEP 3, keep those where ELIGIBILITY-GROUP = "11"STEP 5: Calculate percentageDivide the count of unique MSIS IDs from STEP 4 by the count from STEP 2	N/A
11/20/2025	4.0.22	EL-3-025-30	UPDATE	Annotation	Count the number of mandatory eligibility groups for SSI or ABD individuals with at least one MSIS ID with a primary eligibility group indicator associated with it	N/A
11/20/2025	4.0.22	EL-3-025-30	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Frequency of mandatory eligibility groupsOf the MSIS IDs that meet the criteria from STEP 2, count the number of unique MSIS IDs where ELIGIBILITY-GROUP is equal to each of the following values: 11, 12STEP 4: Count of categoriesOf the 2 mandatory eligibility group categories referenced in STEP 3, count the number of categories with at least one MSIS ID	N/A
11/20/2025	4.0.22	EL-3-021-26	UPDATE	Annotation	Calculate the percentage of S-CHIP eligibles that are not enrolled in an S-CHIP eligibility group	N/A
11/20/2025	4.0.22	EL-3-021-26	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: CHIP code value indicates S-CHIP enrollmentOf the MSIS IDs that meet the criteria from STEP 2, further restrict to MSIS IDs where:1. CHIP-CODE = "3"STEP 4: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 5: Individuals not enrolled in an S-CHIP eligibility groupOf the MSIS IDs that meet the criteria from STEP 4, further restrict to MSIS IDs where:1a. ELIGBILITY-GROUP not equal to (“61” or “62” or “63” or “64” or “65” or “66” or “67” or “68”)OR1b. ELIGIBILITY-GROUP is missing STEP 6: Calculate percentageDivide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 3	N/A
11/20/2025	4.0.22	EL-3-019_1-34	UPDATE	Annotation	Calculate the percentage of MSIS IDs with an ELIGIBILITY-GROUP value of "73", "74", or "75" for states NOT expected to report these values according to public MBES enrollment data on Medicaid.gov	N/A
11/20/2025	4.0.22	EL-3-019_1-34	UPDATE	Specification	STEP 1: Measure applies to submitting state1a. If submitting state is NOT expected to report ELIGIBILITY-GROUP value "73", "74", or "75" because there are NO enrollees in any "Not Newly Eligible" category in the MBES enrollment data, proceed to STEP 2.ELSE1b. If submitting state is expected to report ELIGIBILITY-GROUP value "73", "74", or "75" because there are enrollees in any "Not Newly Eligible" category in the public MBES enrollment data on Medicaid.gov, the final measure statistic will be displayed as "N/A".STEP 2: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 3: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 2, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 4: MSIS IDs with eligibility group 73, 74, or 75Of the MSIS IDs that meet the criteria from STEP 3, count the number of unique MSIS IDs where ELIGIBILITY-GROUP = "73", "74", or "75"STEP 5: Calculate percentageDivide the count from STEP 4 by the count from STEP 2	N/A
11/20/2025	4.0.22	EL-3-016_1-33	UPDATE	Annotation	Calculate the percentage of MSIS IDs with an ELIGIBILITY-GROUP value of "73", "74", or "75" for states expected to report these values according to public MBES enrollment data on Medicaid.gov	N/A
11/20/2025	4.0.22	EL-3-016_1-33	UPDATE	Specification	STEP 1: Measure applies to submitting state1a. If submitting state is expected to report ELIGIBILITY-GROUP value "73", "74", or "75" because there are enrollees in any "Not Newly Eligible" category in the MBES enrollment data, proceed to STEP 2ELSE1b. If submitting state is NOT expected to report ELIGIBILITY-GROUP value "73", "74", or "75" because there are NO enrollees in any “Not Newly Eligible” category in the public MBES enrollment data on Medicaid.gov, the final measure statistic will be displayed as "N/A"STEP 2: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 3: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 2, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 4: MSIS IDs with eligibility group 73, 74, or 75Of the MSIS IDs that meet the criteria from STEP 3, count the number of unique MSIS IDs where ELIGIBILITY-GROUP = "73", "74", or "75"STEP 5: Calculate percentageDivide the count from STEP 4 by the count from STEP 2	N/A
11/20/2025	4.0.22	EL-3-005-6	UPDATE	Annotation	Calculate the percentage of Ticket to Work enrollees that are between the ages of 16 and 64	N/A
11/20/2025	4.0.22	EL-3-005-6	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month 3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Unique TTW enrolleesOf the MSIS IDs that meet the criteria from STEP 2, select TTW enrollees:1. ELIGIBILITY-GROUP = "48" or "49"2. Remove any duplicates, so each MSIS ID only appears once.STEP 4: Primary demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment PRIMARY-DEMOGRAPHICS-ELG00002 by keeping records that satisfy the following criteria:1a. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month 2a. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 5: Calculate ageOf the MSIS IDs that meet the criteria from STEP 4, calculate age:1a. If DATE-OF-DEATH is non-missing and occurs before the last day of the DQ report month, Age is equal to the years between DATE-OF-DEATH and DATE-OF-BIRTH.1b. Otherwise, Age is equal to the years between the last day of the DQ report month and DATE-OF-BIRTH. Note: perform calculations to count full years (e.g., 5/1/2015 – 8/1/1950 = 64)STEP 6: TTW enrollees aged 16-64Merge the MSIS IDs from STEP 3 and 5 and only keep the matches and make sure there is still only one observation per MSIS-ID. Then, select TTW enrollees with ages between 16 and 64: Age >= 16 and Age <=64.STEP 7: Calculate percentage for measureDIVIDE the count of MSIS IDs from STEP 6 by the count of MSIS IDs from STEP 3	N/A
11/20/2025	4.0.22	EL-19-001-1	UPDATE	Annotation	Calculate the percentage of beneficiaries who were enrolled in the previous month but who aren't enrolled in the current month that do not have an informative eligibility termination reason	N/A
11/20/2025	4.0.22	EL-19-001-1	UPDATE	Specification	STEP 1: Enrolled any day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= first day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Enrolled any day of prior DQ report monthDefine the prior eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the prior DQ report month 2. ENROLLMENT-END-DATE >= first day of the prior DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 3: Enrolled in prior month but not current monthKeep all MSIS IDs from STEP 2 that are NOT in STEP 1STEP 4: Eligibility determinants any day of prior DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the prior DQ report month3. ELIGIBILITY-DETERMINANT-END-DATE >= first day of the prior DQ report month OR missing*Note: If multiple segments meet the criteria for one MSIS ID, keep latest one (sort by max end date, max effective date, min record byte offset)STEP 5: Valid, known eligibility termination reasonOf the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping records with: 1. ELIGIBILITY-TERMINATION-REASON = (“01”,“02”,“04”, “06”,”07”,“08”,“09”,“10”,“11”,“12”, “13”,“14”,“15”,“16”,“17”, “18”,“19”, “20”, “23”, “24”, “25”, “26”, “27”, “28”, “29”, “30”, or “31”)STEP 6: Missing, invalid, unknown, or other eligibility termination reasonKeep all MSIS IDs from STEP 3 that are NOT in STEP 5STEP 7: Calculate percentageDivide the unique count of MSIS IDs from STEP 6 by the unique count of MSIS IDs from STEP 3	N/A
11/20/2025	4.0.22	EL-15-003-3	UPDATE	Annotation	Calculate the percent difference between the total T-MSIS duals count and the total MMA duals count	N/A
11/20/2025	4.0.22	EL-15-003-3	UPDATE	Specification	STEP 1: MMA total duals countRetrieve the total dual count from the MMA data. This is an external source. More information is available at: https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/DataStatisticalResources/StateMMAFileNote: The MMA total duals count is not always available for the T-MSIS DQ analysis month at the time of the measure calculation. In such cases, the DQ team will wait until the MMA data are ready to do the calculation, so that the MMA count and T-MSIS count are for the same month.STEP 2: Total dual-eligible beneficiary countSum the measure statistics from the individual dual code measures: total count of dual-eligible beneficiaries = EL-6-012-12 + EL-6-013-13 + EL-6-014-14 + EL-6-015-15 + EL-6-016-16 + EL-6-017-17 + EL-6-018-18 + EL-6-019-19STEP 3: Difference Subtract the count from STEP 1 from the count of dual eligible beneficiaries from STEP 2STEP 4: PercentageDivide the difference from STEP 3 by the count in STEP 1	N/A
11/20/2025	4.0.22	EL-15-002-2	UPDATE	Annotation	Calculate the percent difference between the number of CHIP enrollees and the Performance Indicator (PI) CHIP enrollment count	N/A
11/20/2025	4.0.22	EL-15-002-2	UPDATE	Specification	STEP 1: Performance indicator CHIP countRetrieve the PI CHIP enrollment count from the PI data. This is an external source. More information is available at: https://www.medicaid.gov/medicaid/national-medicaid-chip-program-information/medicaid-chip-enrollment-data/monthly-medicaid-chip-application-eligibility-determination-and-enrollment-reports-dataNote: The PI CHIP enrollment count is not always available for the T-MSIS DQ analysis month at the time of the measure calculation. In such cases, the DQ team will wait until the PI data are ready to do the calculation, so that the PI count and T-MSIS count are for the same month.STEP 2: CHIP enrollee countUse the measure statistic from EL-S-003-3STEP 3: DifferenceSubtract the count of PI CHIP enrollment from STEP 1 from the count of CHIP enrollees from STEP 2STEP 4: PercentageDivide the difference from STEP 3 by the PI CHIP count from STEP 1	N/A
11/20/2025	4.0.22	EL-15-001-1	UPDATE	Annotation	Calculate the percent difference between the number of T-MSIS full-benefit enrollees and the Performance Indicator (PI) enrollment count	N/A
11/20/2025	4.0.22	EL-15-001-1	UPDATE	Specification	STEP 1: Performance indicator enrollment count Retrieve the total PI enrollment count (Medicaid + CHIP) from the PI data. This is an external source. More information is available at: https://www.medicaid.gov/medicaid/national-medicaid-chip-program-information/medicaid-chip-enrollment-data/monthly-medicaid-chip-application-eligibility-determination-and-enrollment-reports-dataNote: The PI enrollment count is not always available for the T-MSIS DQ analysis month at the time of the measure calculation. In such cases, the DQ team will wait until the PI data are ready to do the calculation, so that the PI count and T-MSIS count are for the same month.STEP 2: Full-benefit enrollee countUse the measure statistic from EL-6-023-23STEP 3: Difference Subtract the count of total PI enrollment from STEP 1 from the count of full-benefit enrollees from STEP 2STEP 4: PercentageDivide the difference from STEP 3 by the count in STEP 1	N/A
11/20/2025	4.0.22	EL-1-038-45	UPDATE	Annotation	Calculate the percentage of eligibles with English as a primary language	N/A
11/20/2025	4.0.22	EL-1-038-45	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: Preferred language code is not missingOf the MSIS IDs that meet the criteria from STEP 2, restrict to segments where:1. PREFERRED-LANGUAGE-CODE is not missingSTEP 4: Preferred language code is EnglishOf the MSIS IDs that meet the criteria from STEP 3, restrict to segments where:1. PREFERRED-LANGUAGE-CODE = "ENG"STEP 5: Calculate percentageDivide the count of unique MSIS IDs from STEP 4 by the count of unique MSIS IDs from STEP 3	N/A
11/20/2025	4.0.22	EL-1-031-38	UPDATE	Annotation	Calculate the percentage of MSIS IDs with a RACE value of "018"	N/A
11/20/2025	4.0.22	EL-1-031-38	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION-ELG00016 by keeping active records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Race is OtherOf the MSIS IDs that meet the criteria from STEP 2, further restrict them by the following criteria:1. RACE equals "018" on any record segmentSTEP 4: PercentageDivide the count from STEP 3 by the count in STEP 1*Note: This can include MSIS IDs from STEP 1 that did not join to a race information segment.	N/A
11/20/2025	4.0.22	EL-1-027-34	UPDATE	Annotation	Calculate the percentage of MSIS IDs with a RACE value of "002"	N/A
11/20/2025	4.0.22	EL-1-027-34	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION-ELG00016 by keeping active records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Race is Black or African AmericanOf the MSIS IDs that meet the criteria from STEP 2, further restrict them by the following criteria:1. RACE equals "002" on any record segmentSTEP 4: PercentageDivide the count from STEP 3 by the count in STEP 1*Note: This can include MSIS IDs from STEP 1 that did not join to a race information segment.	N/A
11/20/2025	4.0.22	EL-1-026-33	UPDATE	Annotation	Calculate the percentage of MSIS IDs with a RACE value of "001"	N/A
11/20/2025	4.0.22	EL-1-026-33	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION-ELG00016 by keeping active records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Race is WhiteOf the MSIS IDs that meet the criteria from STEP 2, further restrict them by the following criteria:1. RACE equals "001" on any record segmentSTEP 4: PercentageDivide the count from STEP 3 by the count in STEP 1*Note: This can include MSIS IDs from STEP 1 that did not join to a race information segment.	N/A
11/20/2025	4.0.22	EL-1-024-30	UPDATE	Annotation	Calculate the percentage of eligibles where any non-primary address county code, zip code, or state is not in-state and is not missing	N/A
11/20/2025	4.0.22	EL-1-024-30	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligible contact on the last day of the DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBLE-CONTACT-INFORMATION-ELG00004 by keeping records that satisfy the following criteria:1a. ELIGIBLE-ADDR-EFF-DATE<= last day of the DQ report month2a. ELIGIBLE-ADDR-END-DATE >= last day of the DQ report month OR missingOR1b. ELIGIBLE-ADDR-EFF-DATE is missing2b. ELIGIBLE-ADDR-END-DATE is missingSTEP 3: Non-primary home addressOf the records that meet the criteria from STEP 2, restrict to segments where:1a. ELIGIBLE-ADDR-TYPE does not equal "01"OR1b. ELIGIBLE-ADDR-TYPE is missingSTEP 4: Eligible county code, zip code, or state is not in-stateOf the segments that meet the criteria from STEP 3, further refine the population by keeping segments where:1a. ELIGIBLE-STATE is not missing2a. ELIGIBLE-STATE does not equal SUBMITTING-STATEOR1b. ELIGIBLE-COUNTY-CODE is not missing2b. ELIGIBLE-COUNTY-CODE is not in-stateOR1c. ELIGIBLE-ZIP-CODE is not missing2c. ELIGIBLE-ZIP-CODE is not in-stateSTEP 5: Calculate percentageDivide the count of unique MSIS IDs from STEP 4 by the count of unique MSIS IDs from STEP 3	N/A
11/20/2025	4.0.22	EL-1-011_1-29	UPDATE	Annotation	Calculate the percentage of MSIS IDs that have more than one race	N/A
11/20/2025	4.0.22	EL-1-011_1-29	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION-ELG00016 by keeping active records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Valid, specified raceOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with: 1. RACE = (“001,” “002,” “003,” “004,” “005,” “006,” “007,” “008,” “009,” “010,” “011,” “012,” “013,” “014,” “015,” “016,” or “018”) STEP 4: More than one valid race valueOf the MSIS IDs that meet the criteria from STEP 3, further refine to distinct MSIS IDs that have more than one specified value for raceSTEP 5: Calculate percentageDivide the unique count of MSIS IDs from STEP 4 by the unique count of MSIS IDs from STEP 2	N/A
11/20/2025	4.0.22	Data Quality Measures	UPDATE	Version text	4.0.3	4.1.0
10/10/2025	4.0.19	FTX.009.343	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Conditional	1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Conditional6. Value must be populated when Payer ID Type equals "01"
10/23/2025	4.0.20	FTX.003.086	UPDATE	Necessity	Mandatory	Situational
10/23/2025	4.0.20	FTX.003.086	UPDATE	Definition	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique 'key' value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. The value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique 'key' value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/. MSIS-IDENTIFICATION-NUM is situational in the FTX00003 segment because some of the covered lives on a commercial individual market health insurance policy may not be eligible for Medicaid or CHIP, although at least one member of the policy must be eligible for Medicaid or CHIP. There should be one FTX00003 segment for each person covered under the commercial individual market policy for which the premium assistance payment is being paid, regardless of whether that particular person is eligible for and enrolled in Medicaid or CHIP.
10/10/2025	4.0.19	FTX.002.046	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. If Subcapitation Indicator equals "1", then value must be populated6. Conditional7. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated8. If Subcapitation Indicator equals "2", then value must not be populated9. When not populated, an associated MBESCBES Form Group and MBESCBES Form must not be populated	1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. If Subcapitation Indicator equals "1", then value must be populated6. Conditional7. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated8. If Subcapitation Indicator equals "2", then value must not be populated9. When not populated, an associated MBESCBES Form Group and MBESCBES Form must not be populated10. Value must be populated when Payer ID Type equals "01"
11/20/2025	4.0.22	TPL-3-006-6	UPDATE	Annotation	Calculate the percentage of Medicaid Encounter: original, non-crossover, paid OT claim lines with any valid value for other TPL collection code	N/A
11/20/2025	4.0.22	TPL-3-006-6	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Other TPL collection codeOf the claims that meet the criteria from STEP 2, select claims with a valid value for other TPL collection code:1. OTHER-TPL-COLLECTION = (“001” or “002” or “003” or “004” or “005” or “006” or “007”)STEP 4: Calculate the percentage for the measureDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
11/20/2025	4.0.22	TPL-3-002-5	UPDATE	Annotation	Calculate the percentage of Medicaid Encounter: original, non-crossover, paid OT claims with other insurance	N/A
11/20/2025	4.0.22	TPL-3-002-5	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Other insuranceOf the claims that meet the criteria from STEP 2, select line records with 1. OTHER-INSURANCE-IND = "1"STEP 4: Calculate the percentage for the measureDivide the count of line records from STEP 3 by the count of claim lines from STEP 2	N/A
11/20/2025	4.0.22	TPL-2-006-6	UPDATE	Annotation	Percentage of Medicaid FFS: original, non-crossover, paid OT claim lines with any valid value for other TPL collection code	N/A
11/20/2025	4.0.22	TPL-2-006-6	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Other TPL collection codeOf the claims that meet the criteria from STEP 2, select claims with a valid value for other TPL collection code:1. OTHER-TPL-COLLECTION = (“001” or “002” or “003” or “004” or “005” or “006” or “007”)STEP 4: Calculate the percentage for the measureDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
11/20/2025	4.0.22	TPL-2-002-5	UPDATE	Annotation	Percentage of Medicaid FFS: original, non-crossover, paid OT claims with other insurance	N/A
11/20/2025	4.0.22	TPL-2-002-5	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Other insuranceOf the claim lines that meet the criteria from STEP 2, select records where 1. OTHER-INSURANCE-IND = "1"STEP 4: Calculate the percentage for the measureDivide the count of claim lines from STEP 3 by the count of claims from STEP 2	N/A
10/07/2025	4.0.19	RULE-8682	UPDATE	Grace period expiration date	None	2026-01-30
10/07/2025	4.0.19	RULE-8681	UPDATE	Grace period expiration date	None	2026-01-30
10/07/2025	4.0.19	RULE-8680	UPDATE	Grace period expiration date	None	2026-01-30
10/07/2025	4.0.19	RULE-8679	UPDATE	Grace period expiration date	None	2026-01-30
10/07/2025	4.0.19	RULE-8678	UPDATE	Grace period expiration date	None	2026-01-30
10/07/2025	4.0.19	RULE-8673	UPDATE	Grace period expiration date	None	2026-01-30
10/07/2025	4.0.19	RULE-8664	UPDATE	Grace period expiration date	None	2026-01-30
10/07/2025	4.0.19	RULE-8655	UPDATE	Grace period expiration date	None	2026-01-30
10/07/2025	4.0.19	RULE-8646	UPDATE	Grace period expiration date	None	2026-02-28
10/07/2025	4.0.19	RULE-8645	UPDATE	Grace period expiration date	None	2026-01-30
10/07/2025	4.0.19	RULE-8644	UPDATE	Grace period expiration date	None	2026-01-30
10/07/2025	4.0.19	RULE-8643	UPDATE	Grace period expiration date	None	2026-01-30
10/07/2025	4.0.19	RULE-8642	UPDATE	Grace period expiration date	None	2026-01-30
10/07/2025	4.0.19	RULE-8641	UPDATE	Grace period expiration date	None	2026-02-28
10/07/2025	4.0.19	RULE-8640	UPDATE	Grace period expiration date	None	2026-02-28
10/07/2025	4.0.19	RULE-8639	UPDATE	Grace period expiration date	None	2026-02-28
10/07/2025	4.0.19	RULE-8638	UPDATE	Grace period expiration date	None	2026-02-28
10/07/2025	4.0.19	RULE-7936	UPDATE	Grace period expiration date	None	2025-04-11
10/07/2025	4.0.19	RULE-7935	UPDATE	Grace period expiration date	None	2025-04-11
10/07/2025	4.0.19	RULE-7934	UPDATE	Grace period expiration date	None	2025-04-11
10/07/2025	4.0.19	RULE-7933	UPDATE	Grace period expiration date	None	2025-04-11
10/07/2025	4.0.19	RULE-7932	UPDATE	Grace period expiration date	None	2025-04-11
10/07/2025	4.0.19	RULE-7931	UPDATE	Grace period expiration date	None	2025-04-11
10/07/2025	4.0.19	RULE-7930	UPDATE	Grace period expiration date	None	2025-04-11
10/07/2025	4.0.19	RULE-7929	UPDATE	Grace period expiration date	None	2025-04-11
10/07/2025	4.0.19	RULE-7928	UPDATE	Grace period expiration date	None	2025-04-11
10/07/2025	4.0.19	RULE-7927	UPDATE	Grace period expiration date	None	2025-04-11
10/07/2025	4.0.19	RULE-7926	UPDATE	Grace period expiration date	None	2025-04-11
10/07/2025	4.0.19	RULE-7925	UPDATE	Grace period expiration date	None	2025-04-11
10/07/2025	4.0.19	RULE-7924	UPDATE	Grace period expiration date	None	2025-04-11
10/07/2025	4.0.19	RULE-7923	UPDATE	Grace period expiration date	None	2025-04-11
10/07/2025	4.0.19	RULE-7922	UPDATE	Grace period expiration date	None	2025-04-11
10/07/2025	4.0.19	RULE-7921	UPDATE	Grace period expiration date	None	2025-04-11
10/07/2025	4.0.19	RULE-7900	UPDATE	Active	True	False
10/07/2025	4.0.19	RULE-7900	UPDATE	Priority	High	N/A
10/07/2025	4.0.19	RULE-7900	UPDATE	Category	File integrity	N/A
10/07/2025	4.0.19	RULE-7900	UPDATE	For ta comprehensive	TA- Inferential	No
10/07/2025	4.0.19	RULE-7900	UPDATE	For ta inferential	Yes	No
10/07/2025	4.0.19	RULE-7900	UPDATE	Ta min	0
10/07/2025	4.0.19	RULE-7900	UPDATE	Ta max	0.02
10/07/2025	4.0.19	RULE-7900	UPDATE	Grace period expiration date	None	2025-04-11
10/07/2025	4.0.19	RULE-7899	UPDATE	Active	True	False
10/07/2025	4.0.19	RULE-7899	UPDATE	Priority	High	N/A
10/07/2025	4.0.19	RULE-7899	UPDATE	Category	File integrity	N/A
10/07/2025	4.0.19	RULE-7899	UPDATE	For ta comprehensive	TA- Inferential	No
10/07/2025	4.0.19	RULE-7899	UPDATE	For ta inferential	Yes	No
10/07/2025	4.0.19	RULE-7899	UPDATE	Ta min	0
10/07/2025	4.0.19	RULE-7899	UPDATE	Ta max	0.02
10/07/2025	4.0.19	RULE-7899	UPDATE	Grace period expiration date	None	2025-04-11
10/07/2025	4.0.19	RULE-7898	UPDATE	Active	True	False
10/07/2025	4.0.19	RULE-7898	UPDATE	Priority	High	N/A
10/07/2025	4.0.19	RULE-7898	UPDATE	Category	File integrity	N/A
10/07/2025	4.0.19	RULE-7898	UPDATE	For ta comprehensive	TA- Inferential	No
10/07/2025	4.0.19	RULE-7898	UPDATE	For ta inferential	Yes	No
10/07/2025	4.0.19	RULE-7898	UPDATE	Ta min	0
10/07/2025	4.0.19	RULE-7898	UPDATE	Ta max	0.02
10/07/2025	4.0.19	RULE-7898	UPDATE	Grace period expiration date	None	2025-04-11
10/07/2025	4.0.19	RULE-7897	UPDATE	Active	True	False
10/07/2025	4.0.19	RULE-7897	UPDATE	Priority	High	N/A
10/07/2025	4.0.19	RULE-7897	UPDATE	Category	File integrity	N/A
10/07/2025	4.0.19	RULE-7897	UPDATE	For ta comprehensive	TA- Inferential	No
10/07/2025	4.0.19	RULE-7897	UPDATE	For ta inferential	Yes	No
10/07/2025	4.0.19	RULE-7897	UPDATE	Ta min	0
10/07/2025	4.0.19	RULE-7897	UPDATE	Ta max	0.02
10/07/2025	4.0.19	RULE-7897	UPDATE	Grace period expiration date	None	2025-04-11
10/07/2025	4.0.19	RULE-7892	UPDATE	Grace period expiration date	None	2024-07-02
10/07/2025	4.0.19	RULE-7785	UPDATE	Grace period expiration date	None	2025-04-11
10/07/2025	4.0.19	RULE-7784	UPDATE	Grace period expiration date	None	2025-04-11
10/07/2025	4.0.19	RULE-7783	UPDATE	Grace period expiration date	None	2025-04-11
10/07/2025	4.0.19	RULE-7782	UPDATE	Grace period expiration date	None	2025-04-11
10/07/2025	4.0.19	RULE-7265	UPDATE	Grace period expiration date	None	2024-07-02
10/07/2025	4.0.19	RULE-7263	UPDATE	Grace period expiration date	None	2024-07-02
10/07/2025	4.0.19	RULE-7262	UPDATE	Grace period expiration date	None	2024-07-02
11/20/2025	4.0.22	MIS-86-020-20	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-86-020-20	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-86-002-2 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	N/A
11/20/2025	4.0.22	MIS-86-018-18	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-86-018-18	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-86-002-2 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	N/A
11/20/2025	4.0.22	MIS-86-015-15	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-86-015-15	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-86-002-2 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	N/A
11/20/2025	4.0.22	MIS-86-014-14	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-86-014-14	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-86-002-2 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	N/A
11/20/2025	4.0.22	MIS-86-003-3	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-86-003-3	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-86-002-2 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	N/A
11/20/2025	4.0.22	MIS-86-002-2	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-86-002-2	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-86-002-2 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	N/A
10/07/2025	4.0.19	MIS-84-030-30	UPDATE	Grace period expiration date	None	2023-02-28
11/20/2025	4.0.22	MIS-84-028-28	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-84-028-28	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-84-004-4 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	N/A
11/20/2025	4.0.22	MIS-84-026-26	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-84-026-26	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-84-004-4 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	N/A
10/07/2025	4.0.19	MIS-84-025-25	UPDATE	Grace period expiration date	None	2023-02-28
11/20/2025	4.0.22	MIS-84-019-19	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-84-019-19	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-84-004-4 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	N/A
11/20/2025	4.0.22	MIS-84-004-4	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-84-004-4	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-84-004-4 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	N/A
10/07/2025	4.0.19	MIS-82-017-17	UPDATE	Grace period expiration date	None	2023-02-28
11/20/2025	4.0.22	MIS-82-014-14	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-82-014-14	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-82-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	N/A
10/07/2025	4.0.19	MIS-82-013-13	UPDATE	Grace period expiration date	None	2023-02-28
10/07/2025	4.0.19	MIS-82-012-12	UPDATE	Grace period expiration date	None	2023-02-28
11/20/2025	4.0.22	MIS-82-011-11	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-82-011-11	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-82-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	N/A
10/07/2025	4.0.19	MIS-80-017-17	UPDATE	Grace period expiration date	None	2023-02-28
11/20/2025	4.0.22	MIS-80-014-14	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-80-014-14	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-80-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure).	N/A
10/07/2025	4.0.19	MIS-80-013-13	UPDATE	Grace period expiration date	None	2023-02-28
10/07/2025	4.0.19	MIS-80-012-12	UPDATE	Grace period expiration date	None	2023-10-31
11/20/2025	4.0.22	MIS-80-011-11	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-80-011-11	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-80-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure).	N/A
10/07/2025	4.0.19	MIS-28-021-21	UPDATE	Grace period expiration date	None	2023-02-28
11/20/2025	4.0.22	MIS-28-019-19	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-28-019-19	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
11/20/2025	4.0.22	MIS-28-016-16	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-28-016-16	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
11/20/2025	4.0.22	MIS-28-015-15	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-28-015-15	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
11/20/2025	4.0.22	MIS-28-004-4	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-28-004-4	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
10/07/2025	4.0.19	MIS-26-031-31	UPDATE	Grace period expiration date	None	2023-02-28
11/20/2025	4.0.22	MIS-26-029-29	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-26-029-29	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
11/20/2025	4.0.22	MIS-26-027-27	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-26-027-27	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
10/07/2025	4.0.19	MIS-26-026-26	UPDATE	Grace period expiration date	None	2023-02-28
11/20/2025	4.0.22	MIS-26-002-20	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-26-002-20	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
10/07/2025	4.0.19	MIS-24-018-18	UPDATE	Grace period expiration date	None	2023-02-28
11/20/2025	4.0.22	MIS-24-015-15	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-24-015-15	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
10/07/2025	4.0.19	MIS-24-014-14	UPDATE	Grace period expiration date	None	2023-02-28
10/07/2025	4.0.19	MIS-24-013-13	UPDATE	Grace period expiration date	None	2023-02-28
10/07/2025	4.0.19	MIS-22-018-18	UPDATE	Grace period expiration date	None	2023-02-28
11/20/2025	4.0.22	MIS-22-015-15	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-22-015-15	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
10/07/2025	4.0.19	MIS-22-014-14	UPDATE	Grace period expiration date	None	2023-02-28
10/07/2025	4.0.19	MIS-22-013-13	UPDATE	Grace period expiration date	None	2023-10-31
11/20/2025	4.0.22	MCR-S-021-7	UPDATE	Annotation	Calculate the percentage of Medicaid Encounter: original, paid OT claims that are crossover claims	N/A
11/20/2025	4.0.22	MCR-S-021-7	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"STEP 3: Medicaid Encounter: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 2, select crossover claims:1. CROSSOVER-INDICATOR = "1"STEP 4 : Calculate percentage for measureDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
11/20/2025	4.0.22	MCR-S-013-8	UPDATE	Annotation	Percentage of Medicaid Encounter: original and adjustment, paid OT claim lines that are original	N/A
11/20/2025	4.0.22	MCR-S-013-8	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Original linesOf the records that meet the criteria from STEP 2, select records where1. LINE-ADJUSTMENT-IND = "0"STEP 4: Calculate the percentage for the measureDivide the count of line records from STEP 3 by the number of line records in STEP 2	N/A
11/20/2025	4.0.22	MCR-7-004-18	UPDATE	Annotation	Average number of diagnosis codes for S-CHIP Encounter original, non-crossover, paid LT claims	N/A
11/20/2025	4.0.22	MCR-7-004-18	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. DX segments merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBERSTEP 4: Non-missing diagnosis codesOf the DX segments that meet the criteria from STEP 3, set Count_Elements equal to the total number of DX segments in STEP 3 where 1. DIAGNOSIS-CODE is not missing2a. DIAGNOSIS-TYPE is not missingAND2b. DIAGNOSIS-TYPE is not equal to ("A")STEP 5: Total number of diagnosesSum Count_Elements for all claims in STEP 4STEP 6: Calculate the average for measureDivide the sum from STEP 5 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	MCR-7-003-17	UPDATE	Annotation	Percentage of S-CHIP Encounter: original, non-crossover, paid LT claims with diagnosis code	N/A
11/20/2025	4.0.22	MCR-7-003-17	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 2, select records where 1. There is at least one CLAIM-DX-LT (CLT00004) segment where DIAGNOSIS-CODE is not missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 2	N/A
10/07/2025	4.0.19	MCR-64-004_1-8	UPDATE	Grace period expiration date	None	2023-04-30
10/07/2025	4.0.19	MCR-64-003_1-7	UPDATE	Grace period expiration date	None	2023-04-30
11/20/2025	4.0.22	MCR-62-007-7	UPDATE	Annotation	Calculate the percent of Medicaid and S-CHIP: Encounter, original and adjustment, paid OT claims where type of bill does not begin with a value normally found on the OT file	N/A
11/20/2025	4.0.22	MCR-62-007-7	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"STEP 3: Non-missing type of billOf the claims that meet the criteria from STEP 2, restrict to non-missing TYPE-OF-BILLSTEP 4: Count of claims with an invalid type of billOf the claims that meet the criteria from STEP 3, count claims where TYPE-OF-BILL does not begin with “03”or “07”or “08”or “012”or “013”or “014”or “022”or “023”or "024”STEP 5: Calculate percentDivide the count from STEP 4 by the count from STEP 3	N/A
11/20/2025	4.0.22	MCR-62-004-4	UPDATE	Annotation	Calculate the percentage Medicaid and S-CHIP Encounter: original and adjustment, paid OT claim lines with accommodation revenue codes	N/A
11/20/2025	4.0.22	MCR-62-004-4	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"STEP 3: Non-missing revenue codeOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing REVENUE-CODESTEP 4: Accommodation revenue codesOf the claims that meet the criteria from STEP 3, select records where:1. REVENUE-CODE = "0100" through "0219"STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 3	N/A
11/20/2025	4.0.22	MCR-59P-004-16	UPDATE	Annotation	For each unique Plan ID, calculate the percentage of Medicaid and S-CHIP Encounter: original, paid RX claims that are paid at the line level where the sum of Medicaid paid amount from the lines does not equal the total Medicaid paid amount from the header	N/A
11/20/2025	4.0.22	MCR-59P-004-16	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Managed care plans on the last day of DQ report monthDefine the managed care plan population from segment MANAGED-CARE-MAIN-MCR00002 by keeping active records that satisfy the following criteria:1. MANAGED-CARE-MAIN-REC-EFF-DATE <= last day of the reporting month2. MANAGED-CARE-MAIN-REC-END-DATE >= last day of the reporting month OR missingSTEP 4: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 5: Medicaid and S-CHIP Capitation Payment and Encounter: Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = (“2” or "3" or “B” or "C")STEP 6: Define Plan_IdDefine Plan_Id as a unique list of: MANAGED-CARE-PLAN-ID from the EL file that meet the constraints in STEP 2, STATE-PLAN-ID-NUM from the MCR file that meet the constraints in STEP 3, and PLAN-ID-NUMBER from the claims files that meet the constraints in STEP 5. Also, define a blank Plan_Id for missing.STEP 7: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 5, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 8: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 7, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 9: Exclude childless headersOf the claim headers that meet the criteria from STEP 8, drop all headers that do not merge to at least one lineSTEP 10: Claims paid at the line levelOf claims that meet the criteria from STEP 9, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 11: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 10, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 12: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 11 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 13: Calculate the percentage for the measureDivide the count of claims from STEP 12 by the count of claims from STEP 11STEP 14: Repeat for each Plan_IdREPEAT STEPS 7-13 for each Plan_Id identified in STEP 6	N/A
11/20/2025	4.0.22	MCR-59P-003-15	UPDATE	Annotation	For each unique Plan ID, calculate the percentage of Medicaid and S-CHIP Encounter: original, paid OT claims that are paid at the line level where the sum of Medicaid paid amount from the lines does not equal the total Medicaid paid amount from the header	N/A
11/20/2025	4.0.22	MCR-59P-003-15	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Managed care plans on the last day of DQ report monthDefine the managed care plan population from segment MANAGED-CARE-MAIN-MCR00002 by keeping active records that satisfy the following criteria:1. MANAGED-CARE-MAIN-REC-EFF-DATE <= last day of the reporting month2. MANAGED-CARE-MAIN-REC-END-DATE >= last day of the reporting month OR missingSTEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 5: Medicaid and S-CHIP Capitation Payment and Encounter: Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = (“2” or "3" or “B” or "C")STEP 6: Define Plan_IdDefine Plan_Id as a unique list of: MANAGED-CARE-PLAN-ID from the EL file that meet the constraints in STEP 2, STATE-PLAN-ID-NUM from the MCR file that meet the constraints in STEP 3, and PLAN-ID-NUMBER from the claims files that meet the constraints in STEP 5. Also, define a blank Plan_Id for missing.STEP 7: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 5, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 8: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 7, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 9: Exclude childless headersOf the claim headers that meet the criteria from STEP 8, drop all headers that do not merge to at least one lineSTEP 10: Claims paid at the line levelOf claims that meet the criteria from STEP 9, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 11: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 10, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 12: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 11 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 13: Calculate the percentage for the measureDivide the count of claims from STEP 12 by the count of claims from STEP 11STEP 14: Repeat for each Plan_IdREPEAT STEPS 7-13 for each Plan_Id identified in STEP 6	N/A
11/20/2025	4.0.22	MCR-59P-002-14	UPDATE	Annotation	For each unique Plan ID, calculate the percentage of Medicaid and S-CHIP Encounter: original, paid LT claims that are paid at the line level where the sum of Medicaid paid amount from the lines does not equal the total Medicaid paid amount from the header	N/A
11/20/2025	4.0.22	MCR-59P-002-14	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Managed care plans on the last day of DQ report monthDefine the managed care plan population from segment MANAGED-CARE-MAIN-MCR00002 by keeping active records that satisfy the following criteria:1. MANAGED-CARE-MAIN-REC-EFF-DATE <= last day of the reporting month2. MANAGED-CARE-MAIN-REC-END-DATE >= last day of the reporting month OR missingSTEP 4: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 5: Medicaid and S-CHIP Capitation Payment and Encounter: Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = (“2” or "3" or “B” or "C")STEP 6: Define Plan_IdDefine Plan_Id as a unique list of: MANAGED-CARE-PLAN-ID from the EL file that meet the constraints in STEP 2, STATE-PLAN-ID-NUM from the MCR file that meet the constraints in STEP 3, and PLAN-ID-NUMBER from the claims files that meet the constraints in STEP 5. Also, define a blank Plan_Id for missing.STEP 7: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 5, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 8: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 7, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 9: Exclude childless headersOf the claim headers that meet the criteria from STEP 8, drop all headers that do not merge to at least one lineSTEP 10: Claims paid at the line levelOf claims that meet the criteria from STEP 9, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 11: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 10, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 12: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 11 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 13: Calculate the percentage for the measureDivide the count of claims from STEP 12 by the count of claims from STEP 11STEP 14: Repeat for each Plan_IdREPEAT STEPS 7-13 for each Plan_Id identified in STEP 6	N/A
11/20/2025	4.0.22	MCR-59P-001-13	UPDATE	Annotation	For each unique Plan ID, calculate the percentage of Medicaid and S-CHIP Encounter: original, paid IP claims that are paid at the line level where the sum of Medicaid paid amount from the lines does not equal the total Medicaid paid amount from the header	N/A
11/20/2025	4.0.22	MCR-59P-001-13	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Managed care plans on the last day of DQ report monthDefine the managed care plan population from segment MANAGED-CARE-MAIN-MCR00002 by keeping active records that satisfy the following criteria:1. MANAGED-CARE-MAIN-REC-EFF-DATE <= last day of the reporting month2. MANAGED-CARE-MAIN-REC-END-DATE >= last day of the reporting month OR missingSTEP 4: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 5: Medicaid and S-CHIP Capitation Payment and Encounter: Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = (“2” or "3" or “B” or "C")STEP 6: Define Plan_IdDefine Plan_Id as a unique list of: MANAGED-CARE-PLAN-ID from the EL file that meet the constraints in STEP 2, STATE-PLAN-ID-NUM from the MCR file that meet the constraints in STEP 3, and PLAN-ID-NUMBER from the claims files that meet the constraints in STEP 5. Also, define a blank Plan_Id for missing.STEP 7: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 5, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 8: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 7, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 9: Exclude childless headersOf the claim headers that meet the criteria from STEP 8, drop all headers that do not merge to at least one lineSTEP 10: Claims paid at the line levelOf claims that meet the criteria from STEP 9, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 11: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 10, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 12: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 11 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 13: Calculate the percentage for the measureDivide the count of claims from STEP 12 by the count of claims from STEP 11STEP 14: Repeat for each Plan_IdREPEAT STEPS 7-13 for each Plan_Id identified in STEP 6	N/A
11/20/2025	4.0.22	MCR-59-011-11	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP Encounter: original, paid OT claim lines with a payment level indicator of 2 where the Medicaid paid amount is greater than the allowed amount	N/A
11/20/2025	4.0.22	MCR-59-011-11	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Claim Line DetailOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 5: Non-missing Medicaid paid and allowed amountsOf the records from STEP 4, further refine the population with the following criteria: 1. MEDICAID-PAID-AMT is not missing2. ALLOWED-AMT is not missing3. ALLOWED-AMT is not equal to 0STEP 6: Medicaid paid is greater than allowedOf the records from STEP 5, further refine the population with the following criteria:1. MEDICAID-PAID-AMT > ALLOWED-AMTSTEP 7: PercentageDivide the count of claim lines from STEP 6 by the count of claim lines from STEP 5.	N/A
11/20/2025	4.0.22	MCR-59-010-10	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP Encounter: original, paid LT claim lines with a payment level indicator of 2 where the Medicaid paid amount is greater than the allowed amount	N/A
11/20/2025	4.0.22	MCR-59-010-10	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Claim Line DetailOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 5: Non-missing Medicaid paid and allowed amountsOf the records from STEP 4, further refine the population with the following criteria: 1. MEDICAID-PAID-AMT is not missing2. ALLOWED-AMT is not missing3. ALLOWED-AMT is not equal to 0STEP 6: Medicaid paid is greater than allowedOf the records from STEP 5, further refine the population with the following criteria:1. MEDICAID-PAID-AMT > ALLOWED-AMTSTEP 7: PercentageDivide the count of claim lines from STEP 6 by the count of claim lines from STEP 5.	N/A
11/20/2025	4.0.22	MCR-59-009-9	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP Encounter: original, paid IP claim lines with a payment level indicator of 2 where the Medicaid paid amount is greater than the allowed amount	N/A
11/20/2025	4.0.22	MCR-59-009-9	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Claim Line DetailOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 5: Non-missing Medicaid paid and allowed amountsOf the records from STEP 4, further refine the population with the following criteria: 1. MEDICAID-PAID-AMT is not missing2. ALLOWED-AMT is not missing3. ALLOWED-AMT is not equal to 0STEP 6: Medicaid paid is greater than allowedOf the records from STEP 5, further refine the population with the following criteria:1. MEDICAID-PAID-AMT > ALLOWED-AMTSTEP 7: PercentageDivide the count of claim lines from STEP 6 by the count of claim lines from STEP 5.	N/A
10/07/2025	4.0.19	MCR-59-004-16	UPDATE	Grace period expiration date	None	2022-10-31
10/07/2025	4.0.19	MCR-59-003-15	UPDATE	Grace period expiration date	None	2022-10-31
10/07/2025	4.0.19	MCR-59-002-14	UPDATE	Grace period expiration date	None	2022-10-31
10/07/2025	4.0.19	MCR-59-001-13	UPDATE	Grace period expiration date	None	2022-10-31
11/20/2025	4.0.22	MCR-55-004-4	UPDATE	Annotation	Calculate overall capitation ratio for plan ids in the EL-8-002-2 table with plan type equal to 70	N/A
11/20/2025	4.0.22	MCR-55-004-4	UPDATE	Specification	STEP 1: Health Home Plan TypeOf the Plan_Ids identified in EL-8-002-2, limit to Plan_Ids where:1. Plan_Type_El = "70"STEP 2: Capitation RatioOf the Plan_Ids that meet the criteria in STEP 1, calculate the HHome_Capitation_Ratio as sum of Capitation_Total / sum of Enrollment	N/A
11/20/2025	4.0.22	MCR-55-003-3	UPDATE	Annotation	Calculate overall capitation ratio for plan ids in the EL-8-002-2 table with plan type equal to 17	N/A
11/20/2025	4.0.22	MCR-55-003-3	UPDATE	Specification	STEP 1: PACE Plan TypeOf the Plan_Ids identified in EL-8-002-2, limit to Plan_Ids where:1. Plan_Type_El = "17"STEP 2: Capitation RatioOf the Plan_Ids that meet the criteria in STEP 1, calculate the PACE_Capitation_Ratio as sum of Capitation_Total / sum of Enrollment	N/A
11/20/2025	4.0.22	MCR-55-002-2	UPDATE	Annotation	Calculate overall capitation ratio for plan ids in the EL-8-002-2 table with plan type equal to 03	N/A
11/20/2025	4.0.22	MCR-55-002-2	UPDATE	Specification	STEP 1: Enhanced PCCM Plan TypeOf the Plan_Ids identified in EL-8-002-2, limit to Plan_Ids where:1. Plan_Type_El = "03"STEP 2: Capitation RatioOf the Plan_Ids that meet the criteria in STEP 1, calculate the EPCCM_Capitation_Ratio as sum of Capitation_Total / sum of Enrollment	N/A
11/20/2025	4.0.22	MCR-55-001-1	UPDATE	Annotation	Calculate overall capitation ratio for plan ids in the EL-8-002-2 table with plan type equal to 02	N/A
11/20/2025	4.0.22	MCR-55-001-1	UPDATE	Specification	STEP 1: Traditional PCCM Plan TypeOf the Plan_Ids identified in EL-8-002-2, limit to Plan_Ids where:1. Plan_Type_El = "02"STEP 2: Capitation RatioOf the Plan_Ids that meet the criteria in STEP 1, calculate the PCCM_Capitation_Ratio as sum of Capitation_Total / sum of Enrollment	N/A
11/20/2025	4.0.22	MCR-54-012-12	UPDATE	Annotation	Count plan ids in the EL-8-002-2 table with plan type equal to 02 and with at least 100 enrollments, 100 capitations, or 100 encounters that do not link to a plan id on the managed care file	N/A
11/20/2025	4.0.22	MCR-54-012-12	UPDATE	Specification	STEP 1: Traditional PCCMOf the Plan_Ids identified in EL-8-002-2, limit to Plan_Ids where:1. Plan_Type_El = "02" STEP 2: Enrollment, capitation, or encountersOf the Plan_Ids that meet the criteria in STEP 1, further refine them by keeping those that satisfy the following criteria:1a. Enrollment >= 100OR1b. Total_Capitation > 100OR1c. Total_Encounters >= 100STEP 3: Do not link to managed care fileOf the Plan_Ids that meet the criteria in STEP 1, count the non-missing Plan_Ids where:1. In_MCR_File = "No"	N/A
11/20/2025	4.0.22	MCR-54-011-11	UPDATE	Annotation	Count plan ids in the EL-8-002-2 table with plan type equal to 02	N/A
11/20/2025	4.0.22	MCR-54-011-11	UPDATE	Specification	STEP 1: Traditional PCCMOf the Plan_Ids identified in EL-8-002-2, count the non-missing Plan_Ids that satisfy the following criterion:1. Plan_Type_El = "02"	N/A
11/20/2025	4.0.22	MCR-54-010-10	UPDATE	Annotation	Count plan ids in the EL-8-002-2 table where the plan type on the eligibility file does not match the plan type on the managed care file, excluding cases where either plan type is missing	N/A
11/20/2025	4.0.22	MCR-54-010-10	UPDATE	Specification	STEP 1: Non-missing plan typesOf the Plan_Ids identified in EL-8-002-2, limit to Plan_Ids where:1. Plan_Type_El is not missing2. Plan_Type_Mc is not missingSTEP 2: Plan types do not matchOf the Plan_Ids that meet the criteria in STEP 1, count the non-missing Plan_Ids that also satisfy the following criteria:1. Plan_Type_El does not equal Plan_Type_Mc	N/A
11/20/2025	4.0.22	MCR-54-009-9	UPDATE	Annotation	Count plan ids in the EL-8-002-2 table with at least 100 enrollments, 100 capitations, or 100 encounters that do not link to a plan id on the managed care file	N/A
11/20/2025	4.0.22	MCR-54-009-9	UPDATE	Specification	STEP 1: Enrollment or capitation or encountersOf the Plan_Ids identified in EL-8-002-2, restrict them by keeping those that satisfy the following criteria:1a. Enrollment >= 100OR1b. Total_Capitation >= 100OR1c. Total_Encounters >= 100STEP 2: Do not link to managed care fileOf the Plan_Ids that meet the criteria in STEP 1, count the non-missing Plan_Ids where:1. In_MCR_File = "No"	N/A
11/20/2025	4.0.22	MCR-54-008-8	UPDATE	Annotation	Count plan ids in the EL-8-002-2 table with at least 100 enrollments and some encounters that have an encounter RX ratio outside of (0.02, 5), with plan types equal to 01, 04, 18, or 80	N/A
11/20/2025	4.0.22	MCR-54-008-8	UPDATE	Specification	STEP 1: Include Comprehensive MCO, HIO, Pharmacy PAHP, and Integrated Care for Duals Plan TypesOf the Plan_Ids identified in EL-8-002-2, limit to Plan_Ids where:1. Plan_Type_El is equal to ("01","04", "18", or "80")STEP 2: Enrollment and encountersOf the Plan_Ids that meet the criteria in STEP 1, further refine them by keeping those that satisfy the following criteria:1. Enrollment >= 1002. Total_Encounters > 0STEP 3: Encounters RX ratio out of expected rangeOf the Plan_Ids that meet the criteria in STEP 2, count the non-missing Plan_Ids where:1. Encounters_Rx_Ratio < 0.02 OR Encounters_Rx_Ratio > 5	N/A
11/20/2025	4.0.22	MCR-54-007-7	UPDATE	Annotation	Count plan ids in the EL-8-002-2 table with at least 100 enrollments and some encounters that have an encounter OT ratio outside of (0.1, 20), with plan types equal to 01, 04, 05, 06, 07, 08, 09, 10, 11, 12, 13, 14, 15, 16, or 80	N/A
11/20/2025	4.0.22	MCR-54-007-7	UPDATE	Specification	STEP 1: Inclusions Based on Plan TypeOf the Plan_Ids identified in EL-8-002-2, limit to Plan_Ids where:1. Plan_Type_El is equal to ("01","04", "05", "06", "07", "08", "09", "10", "11", "12", "13", "14", "15", "16", or "80")STEP 2: Enrollment and encountersOf the Plan_Ids that meet the criteria in STEP 1, further refine them by keeping those that satisfy the following criteria:1. Enrollment >= 1002. Total_Encounters > 0STEP 3: Encounters OT ratio out of expected rangeOf the Plan_Ids that meet the criteria in STEP 2, count the non-missing Plan_Ids where:1. Encounters_Ot_Ratio < 0.1 OR Encounters_Ot_Ratio > 20	N/A
11/20/2025	4.0.22	MCR-54-006-6	UPDATE	Annotation	Count plan ids in the EL-8-002-2 table with at least 100 enrollments and some encounters that have an encounter IP ratio outside of (0.012, 2), with plan types equal to 01, 04, or 80	N/A
11/20/2025	4.0.22	MCR-54-006-6	UPDATE	Specification	STEP 1: Include Comprehensive MCO, HIO, and Integrated Care for Duals Plan TypesOf the Plan_Ids identified in EL-8-002-2, limit to Plan_Ids where:1. Plan_Type_El is equal to ("01","04", or "80")STEP 2: Enrollment and encountersOf the Plan_Ids that meet the criteria in STEP 1, further refine them by keeping those that satisfy the following criteria:1. Enrollment >= 1002. Total_Encounters > 0STEP 3: Encounters IP ratio out of expected rangeOf the Plan_Ids that meet the criteria in STEP 2, count the non-missing Plan_Ids where:1. Encounters_Ip_Ratio < 0.01 OR Encounters_Ip_Ratio > 2	N/A
11/20/2025	4.0.22	MCR-54-005-5	UPDATE	Annotation	Count plan ids in the EL-8-002-2 table with at least 100 capitations or 100 encounters that don't have enrollment	N/A
11/20/2025	4.0.22	MCR-54-005-5	UPDATE	Specification	STEP 1: Capitation or encounters without enrollmentOf the Plan_Ids identified in EL-8-002-2, count the non-missing Plan_Ids that satisfy the following criteria:1a. Total_Capitation >= 100OR1b. Total_Encounters >= 100AND2. Enrollment = 0	N/A
11/20/2025	4.0.22	MCR-54-004-4	UPDATE	Annotation	Count plan ids in the EL-8-002-2 table with at least 100 enrollments and some capitation that have a capitation ratio outside of (0.7, 1.3), excluding those with plan types: 02, 03, 17, 60, 70, 99 or missing	N/A
11/20/2025	4.0.22	MCR-54-004-4	UPDATE	Specification	STEP 1: Exclude PCCM, PACE, Health Home, ACO, Missing Plan TypesOf the Plan_Ids identified in EL-8-002-2, limit to Plan_Ids where:1. Plan_Type_El is not equal to ("02","03", "17", "60", "70", or "99") or is missingSTEP 2: Enrollment and capitationOf the Plan_Ids that meet the criteria in STEP 1, further refine them by keeping those that satisfy the following criteria:1. Enrollment >= 1002. Total_Capitation > 0STEP 3: Capitation ratio out of expected rangeOf the Plan_Ids that meet the criteria in STEP 2, count the non-missing Plan_Ids where:1. Capitation_Ratio < 0.7 OR Capitation_Ratio > 1.3	N/A
11/20/2025	4.0.22	MCR-54-003-3	UPDATE	Annotation	Count plan ids in the EL-8-002-2 table with at least 100 enrollments and some encounters or at least 100 encounters and some enrollment that don't have capitations, excluding those with plan types: 02, 03, 17, 60, 70, 99, or missing	N/A
11/20/2025	4.0.22	MCR-54-003-3	UPDATE	Specification	STEP 1: Exclude PCCM, PACE, Health Home, ACO, Missing Plan TypesOf the Plan_Ids identified in EL-8-002-2, limit to Plan_Ids where:1. Plan_Type_El is not equal to ("02","03", "17", "60", "70", or "99") or is missingSTEP 2: Enrollment or encounters without capitationOf the Plan_Ids that meet the criteria in STEP 1, count the non-missing Plan_Ids that also satisfy the following criteria:1a. Enrollment >= 1002a. Total_Encounters > 0OR1b. Enrollment > 02b. Total_Encounters >= 100AND3. Total_Capitation = 0	N/A
11/20/2025	4.0.22	MCR-54-002-2	UPDATE	Annotation	Count plan ids in the EL-8-002-2 table with at least 100 enrollments and some capitations or at least 100 capitations and some enrollment that don't have encounters, excluding those with plan types: 02, 03, 17, 60, 70, 99, or missing	N/A
11/20/2025	4.0.22	MCR-54-002-2	UPDATE	Specification	STEP 1: Exclude PCCM, PACE, Health Home, ACO, Missing Plan TypesOf the Plan_Ids identified in EL-8-002-2, limit to Plan_Ids where:1. Plan_Type_El is not equal to ("02","03", "17", "60", "70", or "99") or is missingSTEP 2: Enrollment or capitation without encountersOf the Plan_Ids that meet the criteria in STEP 1, count the non-missing Plan_Ids that also satisfy the following criteria:1a. Enrollment >= 1002a. Total_Capitation > 0OR1b. Enrollment > 02b. Total_Capitation >= 100AND3. Total_Encounters = 0	N/A
11/20/2025	4.0.22	MCR-54-001-1	UPDATE	Annotation	Count plan ids in the EL-8-002-2 table with at least 100 enrollments, but no capitation or encounters, excluding those with plan types: 02, 03, 17, 60, 70, 99, or missing	N/A
11/20/2025	4.0.22	MCR-54-001-1	UPDATE	Specification	STEP 1: Exclude PCCM, PACE, ACO, Health Home, Missing Plan TypesOf the Plan_Ids identified in EL-8-002-2, limit to Plan_Ids where:1. Plan_Type_El is not equal to ("02","03", "17", "60", "70", or "99") or is missingSTEP 2: Enrollment without capitation and encountersOf the Plan_Ids that meet the criteria in STEP 1, count the non-missing Plan_Ids that also satisfy the following criteria:1. Enrollment >= 1002. Total_Capitation = 03. Total_Encounters = 0	N/A
11/20/2025	4.0.22	MCR-53-003-3	UPDATE	Annotation	Sum total encounters for all plan ids in the EL-8-002-2 table, excluding those with plan types: 02, 03, 17, and 70	N/A
11/20/2025	4.0.22	MCR-53-003-3	UPDATE	Specification	STEP 1: Exclude Traditional PCCM, Enhanced PCCM, PACE, Health Home Plan TypesOf the Plan_Ids identified in EL-8-002-2, limit to Plan_Ids where:1. Plan_Type_El is not equal to ("02","03", "17", or "70")STEP 2: Total encountersOf the non-missing Plan_Ids that meet the criteria in STEP 1, sum Encounters_Total	N/A
11/20/2025	4.0.22	MCR-53-002-2	UPDATE	Annotation	Sum total capitation payments for all plan ids in the EL-8-002-2 table	N/A
11/20/2025	4.0.22	MCR-53-002-2	UPDATE	Specification	STEP 1: Total capitation paymentsFor each non-missing Plan_Id identified in EL-8-002-2, sum Capitation_Total	N/A
11/20/2025	4.0.22	MCR-53-001-1	UPDATE	Annotation	Sum total enrollment for all plan ids in the EL-8-002-2 table	N/A
11/20/2025	4.0.22	MCR-53-001-1	UPDATE	Specification	STEP 1: Total enrollmentFor each non-missing Plan_Id identified in EL-8-002-2, sum Enrollment	N/A
11/20/2025	4.0.22	MCR-5-021-8	UPDATE	Annotation	The percentage of Medicaid Encounter: original, non-crossover, paid LT claims for Skilled Nursing Facility Services under 21 without NF days	N/A
11/20/2025	4.0.22	MCR-5-021-8	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DenominatorOf the records that satisfy STEP 2, count those with the following criteria:1. TYPE-OF-SERVICE = "059"STEP 4: NumeratorOf the records that satisfy STEP 3, count those with the following criteria:1. NURSING-FACILITY-DAYS = "0" or missingSTEP 5: Calculate the percentage for the measureDivide the count of records from STEP 4 by the count of records in STEP 3	N/A
11/20/2025	4.0.22	MCR-5-020-7	UPDATE	Annotation	The percentage of Medicaid Encounter: original, non-crossover, paid LT claims for Inpatient and residential substance abuse without IP days	N/A
11/20/2025	4.0.22	MCR-5-020-7	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Inpatient and residential substance abuseOf the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "050"STEP 4: No IP daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1a. MEDICAID-COV-INPATIENT-DAYS = "0"OR1b. MEDICAID-COV-INPATIENT-DAYS is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	N/A
11/20/2025	4.0.22	MCR-5-019-6	UPDATE	Annotation	The percentage of Medicaid Encounter: original, non-crossover, paid LT claims for Inpatient psychiatric services under 21 without IP days	N/A
11/20/2025	4.0.22	MCR-5-019-6	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Inpatient psychiatric services under 21Of the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "048"STEP 4: No IP daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1a. MEDICAID-COV-INPATIENT-DAYS = "0"OR1b. MEDICAID-COV-INPATIENT-DAYS is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	N/A
11/20/2025	4.0.22	MCR-5-018-5	UPDATE	Annotation	Percentage of Medicaid Encounter: original, non-crossover, paid LT claims with Nursing Facility services other than mental diseases without NF days	N/A
11/20/2025	4.0.22	MCR-5-018-5	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Nursing Facility services other than mental diseasesOf the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "047"STEP 4: No NF daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1a. NURSING-FACILITY-DAYS = "0"OR1b. NURSING-FACILITY-DAYS is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	N/A
11/20/2025	4.0.22	MCR-5-017-4	UPDATE	Annotation	Percentage of Medicaid Encounter: original, non-crossover, paid LT claims with intermediate care facility services without ICF days	N/A
11/20/2025	4.0.22	MCR-5-017-4	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Intermediate Care Facility ServicesOf the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "046"STEP 4: No ICF daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1a. ICF-IID-DAYS = "0"OR1b. ICF-IID-DAYS is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	N/A
11/20/2025	4.0.22	MCR-5-016-3	UPDATE	Annotation	Percentage of Medicaid Encounter: original, non-crossover, paid LT claims with nursing facility services for 65+ for mental diseases without NF days	N/A
11/20/2025	4.0.22	MCR-5-016-3	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Skilled nursing facility services 65+ for mental diseasesOf the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "045"STEP 4: No NF daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1a. NURSING-FACILITY-DAYS = "0"OR1b. NURSING-FACILITY-DAYS is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	N/A
11/20/2025	4.0.22	MCR-5-015-2	UPDATE	Annotation	The percentage of Medicaid Encounter: original, non-crossover, paid LT claims for Inpatient Hospital Services for Individuals age 65+ for mental diseases without IP days	N/A
11/20/2025	4.0.22	MCR-5-015-2	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Inpatient Hospital Services for individuals age 65+ for mental diseasesOf the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "044"STEP 4: No IP daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1a. MEDICAID-COV-INPATIENT-DAYS = "0"OR1b. MEDICAID-COV-INPATIENT-DAYS is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	N/A
11/20/2025	4.0.22	MCR-5-014-1	UPDATE	Annotation	The percentage of Medicaid Encounter: original, non-crossover, paid LT claims for Nursing Facility Services age 21+ without NF days	N/A
11/20/2025	4.0.22	MCR-5-014-1	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DenominatorOf the records that satisfy STEP 2, count those where 1. TYPE-OF-SERVICE = "009"STEP 4: NumeratorOf the records that satisfy STEP 3, count those with the following criteria:1. NURSING-FACILITY-DAYS = "0" or missingSTEP 5: Calculate the percentage for the measureDivide the count of records from STEP 4 by the count of records in STEP 3	N/A
11/20/2025	4.0.22	MCR-5-004-19	UPDATE	Annotation	Average number of diagnosis codes for Medicaid Encounter original, non-crossover, paid LT claims	N/A
11/20/2025	4.0.22	MCR-5-004-19	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. DX segments merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBERSTEP 4: Non-missing diagnosis codesOf the DX segments that meet the criteria from STEP 3, set Count_Elements equal to the total number of DX segments in STEP 3 where 1. DIAGNOSIS-CODE is not missing2a. DIAGNOSIS-TYPE is not missingAND2b. DIAGNOSIS-TYPE is not equal to ("A")STEP 5: Total number of diagnosesSum Count_Elements for all claims in STEP 4STEP 6: Calculate the average for measureDivide the sum from STEP 5 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	MCR-5-003-18	UPDATE	Annotation	Percentage of Medicaid Encounter: original, non-crossover, paid LT claims with diagnosis code	N/A
11/20/2025	4.0.22	MCR-5-003-18	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 2, select records where 1. There is at least one CLAIM-DX-LT (CLT00004) segment where DIAGNOSIS-CODE is not missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	MIS-30-002-2	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-30-002-2	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Capitation Payment: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "2" or "B"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
11/20/2025	4.0.22	MCR-32-018-18	UPDATE	Annotation	Calculate the percentage of unique line records associated with S-CHIP Encounter: original and adjustment, paid OT claims with an invalid or missing adjustment indicator value	N/A
11/20/2025	4.0.22	MCR-32-018-18	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP FFS Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3	N/A
11/20/2025	4.0.22	MCR-32-014-14	UPDATE	Annotation	Calculate the percentage of unique line records associated with S-CHIP Encounter: original and adjustment, paid LT claims with an invalid or missing adjustment indicator value	N/A
11/20/2025	4.0.22	MCR-32-014-14	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3	N/A
11/20/2025	4.0.22	MCR-32-012-12	UPDATE	Annotation	Calculate the percentage of unique line records associated with S-CHIP Encounter: original and adjustment, paid IP claims with an invalid or missing adjustment indicator value	N/A
11/20/2025	4.0.22	MCR-32-012-12	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3	N/A
11/20/2025	4.0.22	MCR-32-010-20	UPDATE	Annotation	Calculate the percentage of unique line records associated with S-CHIP Encounter: original and adjustment, paid RX claims with an invalid or missing adjustment indicator value	N/A
11/20/2025	4.0.22	MCR-32-010-20	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3	N/A
11/20/2025	4.0.22	MCR-32-010-10	UPDATE	Annotation	Calculate the percentage of unique line records associated with Medicaid Encounter: original and adjustment, paid RX claims with an invalid or missing adjustment indicator value	N/A
11/20/2025	4.0.22	MCR-32-010-10	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3	N/A
11/20/2025	4.0.22	MCR-32-008-8	UPDATE	Annotation	Calculate the percentage of unique line records associated with Medicaid Encounter: original and adjustment, paid OT claims with an invalid or missing adjustment indicator value	N/A
11/20/2025	4.0.22	MCR-32-008-8	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3	N/A
11/20/2025	4.0.22	MCR-32-004-4	UPDATE	Annotation	Calculate the percentage of unique line records associated with Medicaid Encounter: original and adjustment, paid LT claims with an invalid or missing adjustment indicator value	N/A
11/20/2025	4.0.22	MCR-32-004-4	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3	N/A
11/20/2025	4.0.22	MCR-32-002-2	UPDATE	Annotation	Calculate the percentage of unique line records associated with Medicaid Encounter: original and adjustment, paid IP claims with an invalid or missing adjustment indicator value	N/A
11/20/2025	4.0.22	MCR-32-002-2	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3	N/A
11/20/2025	4.0.22	MCR-3-005-10	UPDATE	Annotation	Percentage of S-CHIP Encounter: original, non-crossover, paid IP claims with only 1 diagnosis	N/A
11/20/2025	4.0.22	MCR-3-005-10	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 3, select records where:1. There is only one CLAIM-DX-IP (CIP00004) segment where DIAGNOSIS-CODE is not missing STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 2.	N/A
11/20/2025	4.0.22	MCR-3-004-16	UPDATE	Annotation	Average number of diagnosis codes for S-CHIP Encounter: original, non-crossover, paid IP claims	N/A
11/20/2025	4.0.22	MCR-3-004-16	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. DX segments merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Non-missing diagnosis codesOf the DX segments that meet the criteria from STEP 3, set Count_Elements equal to the total number of DX segments in STEP 3 where 1. DIAGNOSIS-CODE is not missing2a. DIAGNOSIS-TYPE is not missingAND2b. DIAGNOSIS-TYPE is not equal to ("A")STEP 5: Total number of diagnosesSum Count_Elements for all claims in STEP 4STEP 6: Calculate the average for measureDivide the sum from STEP 5 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	MCR-3-003-9	UPDATE	Annotation	Percentage of S-CHIP Encounter: original, non-crossover, paid IP claims with diagnosis code	N/A
11/20/2025	4.0.22	MCR-3-003-9	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 2, select records where 1. There is at least one CLAIM-DX-IP (CIP00004) segment where DIAGNOSIS-CODE is not missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	MCR-21-004-1	UPDATE	Annotation	Percentage of Medicaid Encounter: original, non-crossover, paid OT claims with provider specialty codes	N/A
11/20/2025	4.0.22	MCR-21-004-1	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Physician claimsOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. TYPE-OF-SERVICE = "012"STEP 4: SpecialtyOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. SERVICING-PROV-SPECIALTY is not missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	N/A
11/20/2025	4.0.22	MCR-21-003-2	UPDATE	Annotation	Percentage of unique Medicaid Encounter: original, non-crossover, paid OT claims for TYPE-OF-SERVICE = 12, 29, 15, 2, 61, 28, 41 that have the same service provider ID and billing provider ID	N/A
11/20/2025	4.0.22	MCR-21-003-2	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = "012"or "029" or "015" "002" or "061" or "028" or "041"STEP 4: Same service provider ID and billing provider IDOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. SERVICING-PROV-NUM = BILLING-PROV-NUMSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	N/A
11/20/2025	4.0.22	MCR-19-008-2	UPDATE	Annotation	Percentage of S-CHIP Encounter: original, non-crossover, paid RX claims with missing quantity	N/A
11/20/2025	4.0.22	MCR-19-008-2	UPDATE	Specification	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Missing Prescription Quantity ActualOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. PRESCRIPTION-QUANTITY-ACTUAL is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	MCR-19-007-3	UPDATE	Annotation	Percentage of S-CHIP Encounter: original, non-crossover, paid RX claims with NDC	N/A
11/20/2025	4.0.22	MCR-19-007-3	UPDATE	Specification	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: National drug codeOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. NATIONAL-DRUG-CODE character is 11 numeric digitsSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	MCR-19-005-1	UPDATE	Annotation	Percentage of S-CHIP Encounter: original, non-crossover, paid RX claims with missing days supply	N/A
11/20/2025	4.0.22	MCR-19-005-1	UPDATE	Specification	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Prescription supply daysOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. DAYS-SUPPLY is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	MCR-17-008-2	UPDATE	Annotation	Percentage of Medicaid Encounter: original, non-crossover, paid RX claims with missing quantity	N/A
11/20/2025	4.0.22	MCR-17-008-2	UPDATE	Specification	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Missing Prescription Quantity ActualOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. PRESCRIPTION-QUANTITY-ACTUAL is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	MCR-17-007-4	UPDATE	Annotation	Calculate the percentage of Medicaid encounter: original, non-crossover, paid RX records where a single drug, service, or product was rendered/dispensed	N/A
11/20/2025	4.0.22	MCR-17-007-4	UPDATE	Specification	STEP 1: Active non-duplicate paid RX records during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3”2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Drugs, services, or products rendered is 1Of the records that meet the criteria from STEP 2, count line records with1. PRESCRIPTION-QUANTITY-ACTUAL = 1STEP 4 : Calculate percentage for measureDivide the count of line records from STEP 3 by the count of line records from STEP 2.	N/A
11/20/2025	4.0.22	MCR-17-006-3	UPDATE	Annotation	Percentage of Medicaid Encounter: original, non-crossover, paid RX claims with NDC	N/A
11/20/2025	4.0.22	MCR-17-006-3	UPDATE	Specification	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: National drug codeOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. NATIONAL-DRUG-CODE character is 11 numeric digitsSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	MCR-17-005-1	UPDATE	Annotation	Percentage of Medicaid Encounter: original, non-crossover, paid RX claims with missing days supply	N/A
11/20/2025	4.0.22	MCR-17-005-1	UPDATE	Specification	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Prescription supply daysOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. DAYS-SUPPLY is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	MCR-17-004-5	UPDATE	Annotation	Percentage of Medicaid Encounter: original, non-crossover, paid RX claims with days of supply greater than 30	N/A
11/20/2025	4.0.22	MCR-17-004-5	UPDATE	Specification	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Days of supplyOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. DAYS-SUPPLY > 30STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	MCR-14-004-21	UPDATE	Annotation	Percentage of unique S-CHIP Encounter: original, non-crossover, paid OT claims with TYPE-OF-SERVICE = 12, 2, 61, 28, 41 with DX Codes	N/A
11/20/2025	4.0.22	MCR-14-004-21	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.DX Segments:1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = “012” or “002” or “061” or "028" or "041"STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 3, select records where 1. There is at least one CLAIM-DX-OT (COT00004) segment where DIAGNOSIS-CODE is not missingSTEP 5: Link claim lines to claim DX recordsMerge the lines from STEP 3 with the DX records from STEP 4 by header.STEP 6: Drop lines without diagnosis codesOf the claim lines from STEP 5, keep only lines linked to a DX record from STEP 4STEP 7: Calculate the percentage for the measureDivide the count of claim lines from STEP 6 by the count of claim lines from STEP 3	N/A
11/20/2025	4.0.22	MCR-14-001-24	UPDATE	Annotation	Total number of S-CHIP Encounter: original, non-crossover, paid OT claim lines	N/A
11/20/2025	4.0.22	MCR-14-001-24	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Count claim linesCount the number of unique line records that satisfy STEP 2	N/A
11/20/2025	4.0.22	MCR-1-017-21	UPDATE	Annotation	Average number of ancillary revenue codes for Medicaid Encounter: original, non-crossover, paid IP claims	N/A
11/20/2025	4.0.22	MCR-1-017-21	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Ancillary revenue codesOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria: REVENUE-CODE IN “0220” through “0998”STEP 4: Unique header recordsCount the number of unique header records that meet the criteria from STEP 3STEP 5: Unique line recordsCount the number of unique line records that meet the criteria from STEP 3STEP 6: Calculate the average for measureDivide the count from STEP 5 by the count from STEP 4	N/A
11/20/2025	4.0.22	MCR-1-016-20	UPDATE	Annotation	Average number of accommodation revenue codes for Medicaid Encounter: original, non-crossover, paid IP claims	N/A
11/20/2025	4.0.22	MCR-1-016-20	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Accommodation revenue codesOf the claims that meet the criteria from STEP 2, select records where: 1. REVENUE-CODE = "0100" through "0219"STEP 4: Unique header recordsCount the number of unique header records that meet the criteria from STEP 3STEP 5: Unique line recordsCount the number of unique line records that meet the criteria from STEP 3STEP 6: Calculate the average for measureDivide the count from STEP 5 by the count from STEP 4	N/A
11/20/2025	4.0.22	MCR-1-015-13	UPDATE	Annotation	Percentage of Medicaid Encounter: original, non-crossover, paid IP claims with any ancillary revenue codes	N/A
11/20/2025	4.0.22	MCR-1-015-13	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Revenue codesOf the claims that meet the criteria from STEP 2, select records where 1. REVENUE-CODE = “0220” through “0998”STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	MCR-1-014-12	UPDATE	Annotation	Percentage of Medicaid Encounter: original, non-crossover, paid IP claims with any accommodation revenue codes	N/A
11/20/2025	4.0.22	MCR-1-014-12	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3”2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Accommodation revenue codesOf the claims that meet the criteria from STEP 2, select records where: 1. REVENUE-CODE = "0100" through "0219"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	MCR-1-005-10	UPDATE	Annotation	Percentage of Medicaid Encounter: original, non-crossover, paid IP claims with only 1 diagnosis	N/A
11/20/2025	4.0.22	MCR-1-005-10	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 3, select records where:1. There is only one CLAIM-DX-IP (CIP00004) segment where DIAGNOSIS-CODE is not missing STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 2.	N/A
11/20/2025	4.0.22	MCR-1-004-16	UPDATE	Annotation	Average number of diagnosis codes for Medicaid Encounter: original, non-crossover, paid IP claims	N/A
11/20/2025	4.0.22	MCR-1-004-16	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. DX segments merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Non-missing diagnosis codesOf the DX segments that meet the criteria from STEP 3, set Count_Elements equal to the total number of DX segments in STEP 3 where 1. DIAGNOSIS-CODE is not missing2a. DIAGNOSIS-TYPE is not missingAND2b. DIAGNOSIS-TYPE is not equal to ("A")STEP 5: Total number of diagnosesSum Count_Elements for all claims in STEP 4 STEP 6: Calculate the average for measureDivide the sum from STEP 5 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	MCR-1-003-9	UPDATE	Annotation	Percentage of Medicaid Encounter: original, non-crossover, paid IP claims with diagnosis code	N/A
11/20/2025	4.0.22	MCR-1-003-9	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 2, select records where 1. There is at least one CLAIM-DX-IP (CIP00004) segment where DIAGNOSIS-CODE is not missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	MCR-10-024-2	UPDATE	Annotation	Calculate the percentage of Medicaid encounter: original, non-crossover, paid OT records where a single drug, service, or product was rendered/dispensed	N/A
11/20/2025	4.0.22	MCR-10-024-2	UPDATE	Specification	STEP 1: Active non-duplicated OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Drugs, services, or products rendered is 1Of the records that meet the criteria from STEP 2, count line records with1. SERVICE-QUANTITY-ACTUAL = 1STEP 4 : Calculate percentage for measureDivide the count of line records from STEP 3 by the count of line records from STEP 2.	N/A
11/20/2025	4.0.22	MCR-10-023-1	UPDATE	Annotation	Percentage of unique Medicaid Encounter: original, non-crossover, paid OT claims in outpatient department with accommodation revenue codes	N/A
11/20/2025	4.0.22	MCR-10-023-1	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = "002" or "061"STEP 4: Accommodation revenue codesOf the claim lines that meet the criteria from STEP 3, further restrict them by the following criteria:1. REVENUE-CODE = "0100" through "0219"STEP 5: Calculate the percentage for the measureDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 3	N/A
11/20/2025	4.0.22	MCR-1-002-3	UPDATE	Annotation	Percentage of Medicaid Encounter: original, non-crossover, paid IP claims with service end date within the past year	N/A
11/20/2025	4.0.22	MCR-1-002-3	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Service end date in past yearOf the claims that meet the criteria from STEP 2, select records where 1. ENDING-DATE-OF-SERVICE >-= Measure_Month_End minus 365STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	MCR-10-008-19	UPDATE	Annotation	Percentage of Medicaid Encounter: original, non-crossover, paid OT claims with office place of service	N/A
11/20/2025	4.0.22	MCR-10-008-19	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Office place of serviceOf the claims that meet the criteria from STEP 2, select records where 1. PLACE-OF-SERVICE = "11"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	MCR-10-007-9	UPDATE	Annotation	Percentage of Medicaid Encounter: original, non-crossover, paid OT claims with ER place of service	N/A
11/20/2025	4.0.22	MCR-10-007-9	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: ER place of serviceOf the claims that meet the criteria from STEP 2, select records where 1. PLACE-OF-SERVICE = "23"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	MCR-10-005-21	UPDATE	Annotation	Percentage of unique Medicaid Encounter: original, non-crossover, paid OT claims with TYPE-OF-SERVICE = 12, 2, 61, 28, 41 with DX Codes	N/A
11/20/2025	4.0.22	MCR-10-005-21	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing headers, lines, and DX segments that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.DX Segments:1. DX segments merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBERSTEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = “012” or “002” or “061” or "028" or "041"STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 4, select records where1. There is at least one CLAIM-DX-OT (COT00004) segment where DIAGNOSIS-CODE is not missingSTEP 5: Link claim lines to claim DX recordsMerge the lines from STEP 3 with the DX records from STEP 4 by header.STEP 6: Drop lines without diagnosis codesOf the claim lines from STEP 5, keep only lines linked to a DX record from STEP 4STEP 7: Calculate the percentage for the measureDivide the count of claim lines from STEP 6 by the count of claim lines from STEP 3	N/A
11/20/2025	4.0.22	MCR-10-003-8	UPDATE	Annotation	Percentage of Medicaid Encounter: original, non-crossover, paid OT claims with service end date within the past year	N/A
11/20/2025	4.0.22	MCR-10-003-8	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claim lines that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Service end date in past yearOf the claim lines that meet the criteria from STEP 2, select records where 1. ENDING-DATE-OF-SERVICE >-= Measure_Month_End minus 365STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	MCR-10-002-23	UPDATE	Annotation	Calculate the percentage of Medicaid encounter: original, non-crossover, paid OT records with procedure codes	N/A
11/20/2025	4.0.22	MCR-10-002-23	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Procedure codeOf the records that meet the criteria from STEP 2, count line records with1. PROCEDURE-CODE is not missingSTEP 4 : Calculate percentage for measureDivide the count of line records from STEP 3 by the count of line records from STEP 2.	N/A
11/20/2025	4.0.22	MCR-10-001-24	UPDATE	Annotation	Total number of Medicaid Encounter: original, non-crossover, paid OT claim lines	N/A
11/20/2025	4.0.22	MCR-10-001-24	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: CountCount the number of unique line records that satisfy STEP 2	N/A
11/20/2025	4.0.22	FFS-S-018-7	UPDATE	Annotation	Calculate the percentage of Medicaid FFS: original, paid OT claims that are crossover claims	N/A
11/20/2025	4.0.22	FFS-S-018-7	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Paid ClaimsOf the claim that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"STEP 3: Medicaid FFS: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 2, select crossover claims:1. CROSSOVER-INDICATOR = "1"STEP 4 : Calculate percentage for measureDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
11/20/2025	4.0.22	FFS-S-010-8	UPDATE	Annotation	Percentage of Medicaid FFS: original and adjustment, paid OT claim lines that are original	N/A
11/20/2025	4.0.22	FFS-S-010-8	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Original claim linesOf the claims that meet the criteria from STEP 2, select records where 1. LINE-ADJUSTMENT-IND = "0"STEP 4: Calculate the percentage for the measureDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
11/20/2025	4.0.22	FFS-9-025-2	UPDATE	Annotation	Calculate the percentage of Medicaid FFS: original, non-crossover, paid OT records where a single drug, service, or product was rendered/dispensed	N/A
11/20/2025	4.0.22	FFS-9-025-2	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Drugs, services, or products rendered is 1Of the records that meet the criteria from STEP 2, count line records with1. SERVICE-QUANTITY-ACTUAL = 1STEP 4 : Calculate percentage for measureDivide the count of line records from STEP 3 by the count of line records from STEP 2.	N/A
11/20/2025	4.0.22	FFS-9-024-1	UPDATE	Annotation	Calculate the percentage of Medicaid FFS: original, non-crossover, IP paid outpatient department claims that have accommodation revenue codes	N/A
11/20/2025	4.0.22	FFS-9-024-1	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Outpatient Department ClaimsOf the claims that meet the criteria from STEP 2, select records whereTYPE-OF-SERVICE = “002” or "061"STEP 4: Accommodation revenue codesOf the claims that meet the criteria from STEP 3, select records where: 1. REVENUE-CODE = "0100" through "0219"STEP 5: Calculate the percentage for the measureDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 3	N/A
11/20/2025	4.0.22	FFS-9-022-5	UPDATE	Annotation	Percent of unique Medicaid FFS: Original, Non-crossover, Paid OT claims for TYPE-OF-SERVICE = 12, 25, 26 that have CRVS64 (05) Procedure Code Flag	N/A
11/20/2025	4.0.22	FFS-9-022-5	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = "012" or "025" or "026"STEP 4: Procedure code flag Of the claim lines that meet the criteria from STEP 3, further restrict them by the following criteria:1a. PROCEDURE-CODE-FLAG = "05”STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	N/A
11/20/2025	4.0.22	FFS-9-021-6	UPDATE	Annotation	Percent of unique Medicaid FFS: Original, Non-crossover, Paid OT claims for TYPE-OF-SERVICE = 12, 25, 26 that have CRVS69 (04) Procedure Code Flag	N/A
11/20/2025	4.0.22	FFS-9-021-6	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = "012" or "025" or "026"STEP 4: Procedure code flag Of the claim lines that meet the criteria from STEP 3, further restrict them by the following criteria:1a. PROCEDURE-CODE-FLAG = "04”STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	N/A
11/20/2025	4.0.22	FFS-9-020-7	UPDATE	Annotation	Percent of unique Medicaid FFS: Original, Non-crossover, Paid OT claims for TYPE-OF-SERVICE = 12, 25, 26 that have CRVS74 (03) Procedure Code Flag	N/A
11/20/2025	4.0.22	FFS-9-020-7	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = "012" or "025" or "026"STEP 4: Procedure code flag Of the claim lines that meet the criteria from STEP 3, further restrict them by the following criteria:1a. PROCEDURE-CODE-FLAG = "03”STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	N/A
11/20/2025	4.0.22	FFS-9-019-16	UPDATE	Annotation	Percent of unique Medicaid FFS: Original, Non-crossover, Paid OT claims for TYPE-OF-SERVICE = 12, 25, 26 that have ICD9CM (02) or ICD10CM (07) Procedure Code Flag	N/A
11/20/2025	4.0.22	FFS-9-019-16	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = "012" or "025" or "026"STEP 4: Procedure code flag Of the claim lines that meet the criteria from STEP 3, further restrict them by the following criteria:1a. PROCEDURE-CODE-FLAG = "07" and “02”STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	N/A
11/20/2025	4.0.22	FFS-9-008-98	UPDATE	Annotation	Percentage of Medicaid FFS: original, non-crossover, paid OT claims with office place of service	N/A
11/20/2025	4.0.22	FFS-9-008-98	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Office place of serviceOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. PLACE-OF-SERVICE = "11"STEP 4: Calculate the percentage for the measureDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
11/20/2025	4.0.22	FFS-9-007-9	UPDATE	Annotation	Percentage of Medicaid FFS: original, non-crossover, paid OT claims with ER place of service	N/A
11/20/2025	4.0.22	FFS-9-007-9	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Place of serviceOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. PLACE-OF-SERVICE = "23"STEP 4: Calculate the percentage for the measureDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
11/20/2025	4.0.22	FFS-9-004-100	UPDATE	Annotation	Percentage of unique Medicaid FFS: original, non-crossover, paid OT claims with TYPE-OF-SERVICE = 12, 2, 61, 28, 41 with DX Codes	N/A
11/20/2025	4.0.22	FFS-9-004-100	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing headers, lines, and DX segments that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.For DX segments: 1. DX segments merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = “012” or “002” or “061” or "028" or "041"STEP 4: Non-missing diagnosis codeOf the claims that meet the criteria from STEP 3, select records where: 1. DIAGNOSIS-CODE is not missingSTEP 5: Link claim lines to claim DX recordsMerge the lines from STEP 3 with the DX records from STEP 4 by header.STEP 6: Drop lines without diagnosis codesOf the claim lines from STEP 5, keep only lines linked to a DX record from STEP 4STEP 7: Calculate the percentage for the measureDivide the count of claim lines from STEP 6 by the count of claim lines from STEP 3	N/A
11/20/2025	4.0.22	FFS-9-003-8	UPDATE	Annotation	Percentage of Medicaid FFS: original, non-crossover, paid OT claims with service end date within the past year	N/A
11/20/2025	4.0.22	FFS-9-003-8	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Service end date in past yearOf the claims that meet the criteria from STEP 2, select records where 1. ENDING-DATE-OF-SERVICE >-= Measure_Month_End minus 365STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	FFS-9-002-102	UPDATE	Annotation	Calculate the percentage of Medicaid FFS: original, non-crossover, paid OT records with procedure codes	N/A
11/20/2025	4.0.22	FFS-9-002-102	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Procedure codeOf the records that meet the criteria from STEP 2, count line records with1. PROCEDURE-CODE is not missingSTEP 4 : Calculate percentage for measureDivide the count of line records from STEP 3 by the count of line records from STEP 2.	N/A
11/20/2025	4.0.22	FFS-9-001-103	UPDATE	Annotation	Total number of Medicaid FFS: original, non-crossover, paid OT claim lines	N/A
11/20/2025	4.0.22	FFS-9-001-103	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claim lines that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Count claim linesCount the number of unique claim lines that satisfy the constraints of STEP 2	N/A
11/20/2025	4.0.22	FFS-7-004-18	UPDATE	Annotation	Average number of diagnosis codes for S-CHIP FFS: original, non-crossover, paid LT claims	N/A
11/20/2025	4.0.22	FFS-7-004-18	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. DX segments merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Non-missing diagnosis codesOf the DX segments that meet the criteria from STEP 3, set Count_Elements equal to the total number of DX segments in STEP 3 where 1. DIAGNOSIS-CODE is not missing2a. DIAGNOSIS-TYPE is not missingAND2b. DIAGNOSIS-TYPE is not equal to ("A")STEP 5: Total number of diagnosesSum Count_Elements for all claims in STEP 4STEP 6: Calculate the average for measureDivide the sum from STEP 5 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	FFS-7-003-17	UPDATE	Annotation	Percentage of S-CHIP FFS: original, non-crossover, paid LT claims with diagnosis code	N/A
11/20/2025	4.0.22	FFS-7-003-17	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 2, select records where 1. There is at least one CLAIM-DX-LT (CLT00004) segment where DIAGNOSIS-CODE is not missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	FFS-52-007-7	UPDATE	Annotation	Calculate the percent of Medicaid and S-CHIP: FFS, original and adjustment, paid OT claims where type of bill does not begin with a value normally found on the OT file	N/A
11/20/2025	4.0.22	FFS-52-007-7	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" STEP 3: Non-missing type of billOf the claims that meet the criteria from STEP 2, restrict to non-missing TYPE-OF-BILLSTEP 4: Count of claims with an invalid type of billOf the claims that meet the criteria from STEP 3, count claims where TYPE-OF-BILL does not begin with “03”or “07”or “08”or “012”or “013”or “014”or “022”or “023”or “024”STEP 5: Calculate percentDivide the count from STEP 4 by the count from STEP 3	N/A
11/20/2025	4.0.22	FFS-52-004-4	UPDATE	Annotation	Calculate the percentage Medicaid and S-CHIP FFS: original and adjustment, paid OT claim lines with accommodation revenue codes	N/A
11/20/2025	4.0.22	FFS-52-004-4	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"STEP 3: Non-missing revenue codeOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing REVENUE-CODESTEP 4: Accommodation revenue codesOf the claims that meet the criteria from STEP 3, select records where:1. REVENUE-CODE = "0100" through "0219"STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 3	N/A
11/20/2025	4.0.22	FFS-5-029-8	UPDATE	Annotation	Percentage of Medicaid FFS: original, non-crossover, paid LT claims with skilled nursing facility services under 21 without NF days	N/A
11/20/2025	4.0.22	FFS-5-029-8	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Skilled nursing facility services under 21Of the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "059"STEP 4: No NF daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1a. NURSING-FACILITY-DAYS = "0"OR1b. NURSING-FACILITY-DAYS is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	N/A
11/20/2025	4.0.22	FFS-5-027-7	UPDATE	Annotation	The percentage of Medicaid FFS: original, non-crossover, paid LT claims for Inpatient and residential substance abuse without IP days	N/A
11/20/2025	4.0.22	FFS-5-027-7	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Inpatient and residential substance abuseOf the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "050"STEP 4: No IP daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1a. MEDICAID-COV-INPATIENT-DAYS = "0"OR1b. MEDICAID-COV-INPATIENT-DAYS is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	N/A
11/20/2025	4.0.22	FFS-5-025-6	UPDATE	Annotation	The percentage of Medicaid FFS: original, non-crossover, paid LT claims for Inpatient psychiatric services under 21 without IP days	N/A
11/20/2025	4.0.22	FFS-5-025-6	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Inpatient psychiatric services under 21Of the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "048"STEP 4: No IP daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1a. MEDICAID-COV-INPATIENT-DAYS = "0"OR1b. MEDICAID-COV-INPATIENT-DAYS is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	N/A
11/20/2025	4.0.22	FFS-5-023-5	UPDATE	Annotation	Percentage of Medicaid FFS: original, non-crossover, paid LT claims with nursing facility services other than mental diseases without NF days	N/A
11/20/2025	4.0.22	FFS-5-023-5	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Nursing facility services other than mental diseasesOf the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "047"STEP 4: No NF daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1a. NURSING-FACILITY-DAYS = "0"OR1b. NURSING-FACILITY-DAYS is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	N/A
11/20/2025	4.0.22	FFS-5-021-4	UPDATE	Annotation	Percentage of Medicaid FFS: original, non-crossover, paid LT claims with intermediate care facility services without ICF days	N/A
11/20/2025	4.0.22	FFS-5-021-4	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Intermediate Care Facility ServicesOf the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "046"STEP 4: No ICF daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1a. ICF-IID-DAYS = "0"OR1b. ICF-IID-DAYS is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	N/A
11/20/2025	4.0.22	FFS-5-019-3	UPDATE	Annotation	Percentage of Medicaid FFS: original, non-crossover, paid LT claims which were for nursing facility services and have no covered days	N/A
11/20/2025	4.0.22	FFS-5-019-3	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Nursing facility recordsOf the claims that meet the criteria from STEP 2, select those with 1. TYPE-OF-SERVICE = "45"STEP 4: Nursing facility records with zero covered daysOf the claims that meet the criteria from STEP 3, select those with 1. NURSING-FACILITY-DAYS = "0" or missingSTEP 5 : Calculate percentage for measureDivide the count of claims from STEP 4 by the count of claims from STEP 3.	N/A
11/20/2025	4.0.22	FFS-5-017-2	UPDATE	Annotation	The percentage of Medicaid FFS: original, non-crossover, paid LT claims for Inpatient Hospital Services for Individuals age 65+ for mental diseases without IP days	N/A
11/20/2025	4.0.22	FFS-5-017-2	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Inpatient Hospital Services for individuals age 65+ for mental diseasesOf the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "044"STEP 4: No IP daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. MEDICAID-COV-INPATIENT-DAYS = "0" or missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	N/A
11/20/2025	4.0.22	FFS-5-015-1	UPDATE	Annotation	Percentage of Medicaid FFS: original, non-crossover, paid LT claims with nursing facility services age 21+ without NF days	N/A
11/20/2025	4.0.22	FFS-5-015-1	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Nursing facility services age 21+Of the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "009"STEP 4: No NF daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. NURSING-FACILITY-DAYS = "0" or missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	N/A
11/20/2025	4.0.22	FFS-5-004-28	UPDATE	Annotation	Average number of diagnosis codes for Medicaid FFS: original, non-crossover, paid LT claims	N/A
11/20/2025	4.0.22	FFS-5-004-28	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. DX segments merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Non-missing diagnosis codesOf the DX segments that meet the criteria from STEP 3, set Count_Elements equal to the total number of DX segments in STEP 3 where 1. DIAGNOSIS-CODE is not missing2a. DIAGNOSIS-TYPE is not missingAND2b. DIAGNOSIS-TYPE is not equal to ("A")STEP 5: Total number of diagnosesSum Count_Elements for all claims in STEP 4STEP 6: Calculate the average for measureDivide the sum from STEP 5 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	FFS-5-003-27	UPDATE	Annotation	Percentage of Medicaid FFS: original, non-crossover, paid LT claims with diagnosis code	N/A
11/20/2025	4.0.22	FFS-5-003-27	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 2, select records where 1. There is at least one CLAIM-DX-LT (CLT00004) segment where DIAGNOSIS-CODE is not missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	FFS-49-012-12	UPDATE	Annotation	Calculate the percent of Medicaid and S-CHIP FFS: original, paid RX claim lines with a payment level indicator of 2 where the Medicaid paid amount is greater than the allowed amount	N/A
11/20/2025	4.0.22	FFS-49-012-12	UPDATE	Specification	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" STEP 3: Claim Line DetailOf the claims that meet the criteria from STEP2, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 4: Non-missing Medicaid paid and allowed amountsOf the records from STEP 3, further refine the population with the following criteria: 1. MEDICAID-PAID-AMT is not missing2. ALLOWED-AMT is not missing3. ALLOWED-AMT is not equal to 0STEP 5: Medicaid paid is greater than allowedOf the records from STEP 4, further refine the population with the following criteria:1. MEDICAID-PAID-AMT > ALLOWED-AMTSTEP 6: PercentageDivide the count of claim lines from STEP 5 by the count of claim lines from STEP 4	N/A
11/20/2025	4.0.22	FFS-49-011-11	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP FFS: original, paid OT claim lines with a payment level indicator of 2 where the Medicaid paid amount is greater than the allowed amount	N/A
11/20/2025	4.0.22	FFS-49-011-11	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" STEP 3: Claim Line DetailOf the claims that meet the criteria from STEP2, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 4: Non-missing Medicaid paid and allowed amountsOf the records from STEP 3, further refine the population with the following criteria: 1. MEDICAID-PAID-AMT is not missing2. ALLOWED-AMT is not missing3. ALLOWED-AMT is not equal to 0STEP 5: Medicaid paid is greater than allowedOf the records from STEP 4, further refine the population with the following criteria:1. MEDICAID-PAID-AMT > ALLOWED-AMTSTEP 6: PercentageDivide the count of claim lines from STEP 5 by the count of claim lines from STEP 4	N/A
11/20/2025	4.0.22	FFS-49-010-10	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP FFS: original, paid LT claim lines with a payment level indicator of 2 where the Medicaid paid amount is greater than the allowed amount	N/A
11/20/2025	4.0.22	FFS-49-010-10	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" STEP 3: Claim Line DetailOf the claims that meet the criteria from STEP2, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 4: Non-missing Medicaid paid and allowed amountsOf the records from STEP 3, further refine the population with the following criteria: 1. MEDICAID-PAID-AMT is not missing2. ALLOWED-AMT is not missing3. ALLOWED-AMT is not equal to 0STEP 5: Medicaid paid is greater than allowedOf the records from STEP 4, further refine the population with the following criteria:1. MEDICAID-PAID-AMT > ALLOWED-AMTSTEP 6: PercentageDivide the count of claim lines from STEP 5 by the count of claim lines from STEP 4	N/A
11/20/2025	4.0.22	FFS-49-009-9	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP FFS: original, paid IP claim lines with a payment level indicator of 2 where the Medicaid paid amount is greater than the allowed amount	N/A
11/20/2025	4.0.22	FFS-49-009-9	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" STEP 3: Claim Line DetailOf the claims that meet the criteria from STEP2, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 4: Non-missing Medicaid paid and allowed amountsOf the records from STEP 3, further refine the population with the following criteria: 1. MEDICAID-PAID-AMT is not missing2. ALLOWED-AMT is not missing3. ALLOWED-AMT is not equal to 0STEP 5: Medicaid paid is greater than allowedOf the records from STEP 4, further refine the population with the following criteria:1. MEDICAID-PAID-AMT > ALLOWED-AMTSTEP 6: PercentageDivide the count of claim lines from STEP 5 by the count of claim lines from STEP 4	N/A
11/20/2025	4.0.22	FFS-3-005-10	UPDATE	Annotation	Percentage of S-CHIP FFS: original, non-crossover, paid IP claims with only 1 diagnosis	N/A
11/20/2025	4.0.22	FFS-3-005-10	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 3, select records where:1. There is only one CLAIM-DX-IP (CIP00004) segment where DIAGNOSIS-CODE is not missing STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 2.	N/A
11/20/2025	4.0.22	FFS-3-004-16	UPDATE	Annotation	Average number of diagnosis codes for S-CHIP FFS: original, non-crossover, paid IP claims	N/A
11/20/2025	4.0.22	FFS-3-004-16	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. DX segments merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Non-missing diagnosis codesOf the DX segments that meet the criteria from STEP 3, set Count_Elements equal to the total number of DX segments in STEP 3 where 1. DIAGNOSIS-CODE is not missing2a. DIAGNOSIS-TYPE is not missingAND2b. DIAGNOSIS-TYPE is not equal to ("A")STEP 5: Total number of diagnosesSum Count_Elements for all claims in STEP 4 STEP 6: Calculate the average for measureDivide the sum from STEP 5 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	FFS-3-003-9	UPDATE	Annotation	Percentage of S-CHIP FFS: original, non-crossover, paid IP claims with diagnosis code	N/A
11/20/2025	4.0.22	FFS-3-003-9	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 2, select records where 1. There is at least one CLAIM-DX-IP (CIP00004) segment where DIAGNOSIS-CODE is not missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	FFS-26-016-16	UPDATE	Annotation	Calculate the percentage of unique line records associated with S-CHIP FFS: original and adjustment, paid RX claims with an invalid or missing adjustment indicator value	N/A
11/20/2025	4.0.22	FFS-26-016-16	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3	N/A
11/20/2025	4.0.22	FFS-26-014-14	UPDATE	Annotation	Calculate the percentage of unique line records associated with S-CHIP FFS: original and adjustment, paid OT claims with an invalid or missing adjustment indicator value	N/A
11/20/2025	4.0.22	FFS-26-014-14	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A" STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3	N/A
11/20/2025	4.0.22	FFS-26-012-12	UPDATE	Annotation	Calculate the percentage of unique line records associated with S-CHIP FFS: original and adjustment, paid LT claims with an invalid or missing adjustment indicator value	N/A
11/20/2025	4.0.22	FFS-26-012-12	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3	N/A
11/20/2025	4.0.22	FFS-26-010-10	UPDATE	Annotation	Calculate the percentage of unique line records associated with S-CHIP FFS: original and adjustment, paid IP claims with an invalid or missing adjustment indicator value	N/A
11/20/2025	4.0.22	FFS-26-010-10	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3	N/A
11/20/2025	4.0.22	FFS-26-008-8	UPDATE	Annotation	Calculate the percentage of unique line records associated with Medicaid FFS: original and adjustment, paid RX claims with an invalid or missing adjustment indicator value	N/A
11/20/2025	4.0.22	FFS-26-008-8	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3	N/A
11/20/2025	4.0.22	FFS-26-006-6	UPDATE	Annotation	Calculate the percentage of unique line records associated with Medicaid FFS: original and adjustment, paid OT claims with an invalid or missing adjustment indicator value	N/A
11/20/2025	4.0.22	FFS-26-006-6	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3	N/A
11/20/2025	4.0.22	FFS-26-004-4	UPDATE	Annotation	Calculate the percentage of unique line records associated with Medicaid FFS: original and adjustment, paid LT claims with an invalid or missing adjustment indicator value	N/A
11/20/2025	4.0.22	FFS-26-004-4	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3	N/A
11/20/2025	4.0.22	FFS-26-002-2	UPDATE	Annotation	Calculate the percentage of unique line records associated with Medicaid FFS: original and adjustment, paid IP claims with an invalid or missing adjustment indicator value	N/A
11/20/2025	4.0.22	FFS-26-002-2	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3	N/A
11/20/2025	4.0.22	FFS-2-002-1	UPDATE	Annotation	Calculate the percentage of Medicaid FFS: original, crossover, paid IP claims where the TYPE-OF-SERVICE ="001"	N/A
11/20/2025	4.0.22	FFS-2-002-1	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "1"STEP 3: Inpatient hospital servicesOf the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "001"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count from STEP 2	N/A
11/20/2025	4.0.22	FFS-19-002-1	UPDATE	Annotation	Percent of unique Medicaid FFS: Original, Crossover, Paid OT claims for TYPE-OF-SERVICE = 12, 29, 15, 2, 61, 28, 41 that have the same service provider ID and billing provider ID	N/A
11/20/2025	4.0.22	FFS-19-002-1	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "1"STEP 3: Type of Service Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. TYPE-OF-SERVICE = (“012” or “029” or “015” or “002” or “061” or “028” or “041”STEP 4: Service Provider and Billing ProviderOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. SERVICING-PROV-NUM = BILLING-PROV-NUMSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	N/A
11/20/2025	4.0.22	FFS-18-003-1	UPDATE	Annotation	Percentage of Medicaid FFS: original, non-crossover, paid OT claims with provider specialty codes	N/A
11/20/2025	4.0.22	FFS-18-003-1	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Physician claimsOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. TYPE-OF-SERVICE = "012"STEP 4: SpecialtyOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. SERVICING-PROV-SPECIALTY is not missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	N/A
11/20/2025	4.0.22	FFS-18-002-2	UPDATE	Annotation	Percentage of unique Medicaid FFS: original, non-crossover, paid OT claims for TYPE-OF-SERVICE = 12, 29, 15, 2, 61, 28, 41 that have the same service provider ID and billing provider ID	N/A
11/20/2025	4.0.22	FFS-18-002-2	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = "012"or "029" or "015" "002" or "061" or "028" or "041"STEP 4: Same service provider ID and billing provider IDOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. SERVICING-PROV-NUM = BILLING-PROV-NUM2. SERVICING-PROV-NUM is non-missing3. BILLING-PROV-NUM is non-missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	N/A
11/20/2025	4.0.22	FFS-16-008-2	UPDATE	Annotation	Calculate the percentage of S-CHIP FFS: original, non-crossover, paid RX records with a missing quantity	N/A
11/20/2025	4.0.22	FFS-16-008-2	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers: 1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Missing Prescription Quantity ActualOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. PRESCRIPTION-QUANTITY-ACTUAL is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	FFS-16-006-3	UPDATE	Annotation	Calculate the percentage of S-CHIP FFS: original, non-crossover, paid RX records with an NDC	N/A
11/20/2025	4.0.22	FFS-16-006-3	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers: 1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: National drug codeOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. NATIONAL-DRUG-CODE character is 11 numeric digitsSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	FFS-16-005-1	UPDATE	Annotation	Percentage of S-CHIP Encounter: original, non-crossover, paid RX claims with missing days supply	N/A
11/20/2025	4.0.22	FFS-16-005-1	UPDATE	Specification	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Prescription supply daysOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. DAYS-SUPPLY is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	FFS-14-008-2	UPDATE	Annotation	Calculate the percentage of Medicaid FFS: original, non-crossover, paid RX records with a missing quantity	N/A
11/20/2025	4.0.22	FFS-14-008-2	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers: 1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Missing Prescription Quantity ActualOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. PRESCRIPTION-QUANTITY-ACTUAL is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	FFS-14-007-4	UPDATE	Annotation	Calculate the percentage of Medicaid FFS: original, non-crossover, paid RX records where a single drug, service, or product was rendered/dispensed	N/A
11/20/2025	4.0.22	FFS-14-007-4	UPDATE	Specification	STEP 1: Active non-duplicate paid RX records during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Drugs, services, or products rendered is 1Of the records that meet the criteria from STEP 2, count line records with1. PRESCRIPTION-QUANTITY-ACTUAL = 1STEP 4 : Calculate percentage for measureDivide the count of line records from STEP 3 by the count of line records from STEP 2	N/A
11/20/2025	4.0.22	FFS-14-006-3	UPDATE	Annotation	Calculate the percentage of Medicaid FFS: original, non-crossover, paid RX records with an NDC	N/A
11/20/2025	4.0.22	FFS-14-006-3	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers: 1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: National drug codeOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. NATIONAL-DRUG-CODE character is 11 numeric digitsSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	FFS-14-005-1	UPDATE	Annotation	Calculate the percentage of Medicaid FFS: original, non-crossover, paid RX records with a missing Days Supply	N/A
11/20/2025	4.0.22	FFS-14-005-1	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers: 1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Prescription supply daysOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. DAYS-SUPPLY is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	FFS-14-004-5	UPDATE	Annotation	Percentage of Medicaid FFS: original, non-crossover, paid RX claims with days of supply greater than 30	N/A
11/20/2025	4.0.22	FFS-14-004-5	UPDATE	Specification	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Days of supplyOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. DAYS-SUPPLY > 30STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	FFS-11-005-21	UPDATE	Annotation	Percentage of unique S-CHIP FFS: original, non-crossover, paid OT claims with TYPE-OF-SERVICE = 12, 2, 61, 28, 41 with DX Codes	N/A
11/20/2025	4.0.22	FFS-11-005-21	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing headers, lines, and DX segments that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.For DX segments:1. DX segments merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = “012” or “002” or “061” or "028" or "041"STEP 4: Non-missing diagnosis codeOf the DX segments that meet the criteria from STEP 1, select records where 1. DIAGNOSIS-CODE value is not missing.STEP 5: Link claim lines to claim DX recordsMerge the lines from STEP 3 with the DX records from STEP 4 by header.STEP 6: Drop lines without diagnosis codesOf the claim lines from STEP 5, keep only lines linked to a DX record from STEP 4STEP 7: Calculate the percentage for the measureDivide the count of claim lines from STEP 6 by the count of claim lines from STEP 3	N/A
11/20/2025	4.0.22	FFS-11-001-24	UPDATE	Annotation	Total number of S-CHIP FFS: original, non-crossover, paid OT claim lines	N/A
11/20/2025	4.0.22	FFS-11-001-24	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Count claim linesCount the number of unique line records that satisfy the constraints of STEP 2	N/A
11/20/2025	4.0.22	FFS-1-019-5	UPDATE	Annotation	Calculate the percentage of Medicaid FFS: original, non-crossover, paid IP claims where the TYPE-OF-SERVICE = "001"	N/A
11/20/2025	4.0.22	FFS-1-019-5	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Inpatient hospital servicesOf the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "001"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count from STEP 2	N/A
11/20/2025	4.0.22	FFS-1-018-33	UPDATE	Annotation	Average number of ancillary revenue codes for Medicaid FFS: original, non-crossover, paid IP claims	N/A
11/20/2025	4.0.22	FFS-1-018-33	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Ancillary revenue codesOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria: REVENUE-CODE IN “0220” through “0998”STEP 4: Unique header recordsCount the number of unique header records that meet the criteria from STEP 3STEP 5: Unique line recordsCount the number of unique line records that meet the criteria from STEP 3STEP 6: Calculate the average for measureDivide the count from STEP 5 by the count from STEP 4	N/A
11/20/2025	4.0.22	FFS-1-017-32	UPDATE	Annotation	Average number of accommodation revenue codes for Medicaid FFS: original, non-crossover, paid IP claims	N/A
11/20/2025	4.0.22	FFS-1-017-32	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Accommodation revenue codesOf the claims that meet the criteria from STEP 2, select records where: 1. REVENUE-CODE = "0100" through "0219"STEP 4: Unique header recordsCount the number of unique header records that meet the criteria from STEP 3STEP 5: Unique line recordsCount the number of unique line records that meet the criteria from STEP 3STEP 6: Calculate the average for measureDivide the count from STEP 5 by the count from STEP 4	N/A
11/20/2025	4.0.22	FFS-1-016-25	UPDATE	Annotation	Percentage of Medicaid Encounter: original, non-crossover, paid IP claims with any ancillary revenue codes	N/A
11/20/2025	4.0.22	FFS-1-016-25	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Ancillary revenue codesOf the claims that meet the criteria from STEP 2, select records where 1. REVENUE-CODE = "0229" through "0998"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	FFS-1-015-24	UPDATE	Annotation	Percentage of Medicaid FFS: original, non-crossover, paid IP claims with any accommodation revenue codes	N/A
11/20/2025	4.0.22	FFS-1-015-24	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Accommodation revenue codesOf the claims that meet the criteria from STEP 2, select records where: 1. REVENUE-CODE = "0100" through "0219"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	FFS-1-005-22	UPDATE	Annotation	Percentage of Medicaid FFS: original, non-crossover, paid IP claims with only 1 diagnosis	N/A
11/20/2025	4.0.22	FFS-1-005-22	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 3, select records where:1. There is only one CLAIM-DX-IP (CIP00004) segment where DIAGNOSIS-CODE is not missing STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 2.	N/A
11/20/2025	4.0.22	FFS-1-004-28	UPDATE	Annotation	Average number of diagnosis codes for Medicaid FFS: original, non-crossover, paid IP claims	N/A
11/20/2025	4.0.22	FFS-1-004-28	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Non-missing diagnosis codesOf the DX segments that meet the criteria from STEP 3, set Count_Elements equal to the total number of DX segments in STEP 3 where 1. DIAGNOSIS-CODE is not missing2a. DIAGNOSIS-TYPE is not missingAND2b. DIAGNOSIS-TYPE is not equal to ("A")STEP 5: Total number of diagnosesSum Count_Elements for all claims in STEP 4 STEP 6: Calculate the average for measureDivide the sum from STEP 5 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	FFS-1-003-21	UPDATE	Annotation	Percentage of Medicaid FFS: original, non-crossover, paid IP claims with diagnosis code	N/A
11/20/2025	4.0.22	FFS-1-003-21	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 2, select records where 1. There is at least one CLAIM-DX-IP (CIP00004) segment where DIAGNOSIS-CODE is not missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	FFS-1-002-3	UPDATE	Annotation	Percentage of Medicaid FFS: original, non-crossover, paid IP claims with service end date within the past year	N/A
11/20/2025	4.0.22	FFS-1-002-3	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Service end date in past yearOf the claims that meet the criteria from STEP 2, select records where 1. ENDING-DATE-OF-SERVICE >-= Measure_Month_End minus 365STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	FFS-10-006-2	UPDATE	Annotation	Calculate the percentage of Medicaid FFS: original, crossover, paid OT claim lines with Medicaid Paid Amount greater than 0, where Procedure Code or Revenue Code is not missing	N/A
11/20/2025	4.0.22	FFS-10-006-2	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "1"STEP 3: Medicaid Paid Amount > 0Of the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria:1. MEDICAID-PAID-AMT > 0STEP 4: Procedure Code or Revenue CodeOf the claim lines that meet the criteria from STEP 3, further restrict them by the following criteria:1a. PROCEDURE-CODE is not missingOR1b. REVENUE-CODE is not missingSTEP 5: Calculate the percentageDivide the count of claim lines from STEP 4 by the count of claim lines for STEP 3	N/A
11/20/2025	4.0.22	FFS-10-005-1	UPDATE	Annotation	Percentage of Medicaid FFS: original, crossover, paid OT claims with procedure code flag	N/A
11/20/2025	4.0.22	FFS-10-005-1	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "1"STEP 3: Medicaid paid amountOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. MEDICAID-PAID-AMT > 0STEP 4: Procedure code flagOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. PROCEDURE-CODE-FLAG is not missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	N/A
11/20/2025	4.0.22	FFS-10-003-84	UPDATE	Annotation	Percentage of Medicaid FFS: original, crossover, paid OT claims with office as place of service	N/A
11/20/2025	4.0.22	FFS-10-003-84	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "1"STEP 3: Medicaid paid amountOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. MEDICAID-PAID-AMT > 0STEP 4: Place of serviceOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. PLACE-OF-SERVICE = 11STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	N/A
11/20/2025	4.0.22	FFS-10-002-3	UPDATE	Annotation	Percentage of Medicaid FFS: original, crossover, paid OT claims with TYPE-OF-SERVICE = 12, 2, 61 with ER Place of Service	N/A
11/20/2025	4.0.22	FFS-10-002-3	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "1"STEP 3: Type of service and Medicaid paid amountOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1.MEDICAID-PAID-AMT > 0 2.TYPE-OF-SERVICE = “012” or “002” or “061”STEP 4: ER place of serviceOf the claims that meet the criteria from STEP 3, select records where 1. PLACE-OF-SERVICE = "23"STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	N/A
10/07/2025	4.0.19	EXP-45-004-4	UPDATE	Grace period expiration date	None	2026-01-30
10/07/2025	4.0.19	EXP-39-001_1-2	UPDATE	Grace period expiration date	None	2024-03-11
11/20/2025	4.0.22	EXP-37P-001-1-2	UPDATE	Annotation	For each unique Plan ID, calculate the percentage of Medicaid Encounter: original, non-crossover, paid OT claims billed at the line level that have Medicaid paid amount equal to $0 or missing	N/A
11/20/2025	4.0.22	EXP-37P-001-1-2	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Managed care plans on the last day of DQ report monthDefine the managed care plan population from segment MANAGED-CARE-MAIN-MCR00002 by keeping active records that satisfy the following criteria:1. MANAGED-CARE-MAIN-REC-EFF-DATE <= last day of the reporting month2. MANAGED-CARE-MAIN-REC-END-DATE >= last day of the reporting month OR missingSTEP 4: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 5: Medicaid and S-CHIP Capitation Payment and Encounter: Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = (“2” or "3" or “B” or "C")STEP 6: Define Plan_IdDefine Plan_Id as a unique list of: MANAGED-CARE-PLAN-ID from the EL file that meet the constraints in STEP 2, STATE-PLAN-ID-NUM from the MCR file that meet the constraints in STEP 3, and PLAN-ID-NUMBER from the claims files that meet the constraints in STEP 5. Also, define a blank Plan_Id for missing.STEP 7: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 5, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 8: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 7, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 9: Payment at the line levelOf the claims from STEP 8, select records where:1. PAYMENT-LEVEL-IND = "2"STEP 10: Total Medicaid paid $0 or missingOf the claims from STEP 9, select records where:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 11: Calculate the percentage for the measureDivide the count of claims from STEP 10 by the count of claims from STEP 9STEP 12: Repeat for each Plan_IdREPEAT STEPS 7-11 for each Plan_Id identified in STEP 6	N/A
10/07/2025	4.0.19	EXP-37-001_1-2	UPDATE	Grace period expiration date	None	2024-03-11
10/07/2025	4.0.19	EXP-24-009-9	UPDATE	Grace period expiration date	None	2026-01-30
10/07/2025	4.0.19	EXP-22-009-9	UPDATE	Grace period expiration date	None	2026-01-30
10/07/2025	4.0.19	EXP-13-004_1-7	UPDATE	Grace period expiration date	None	2024-12-21
10/07/2025	4.0.19	EXP-13-003_1-6	UPDATE	Grace period expiration date	None	2024-12-21
11/20/2025	4.0.22	EXP-13-001-5	UPDATE	Annotation	Calculate the sum of the Medicaid amount paid for S-CHIP FFS: original, non-crossover, paid OT claims	N/A
11/20/2025	4.0.22	EXP-13-001-5	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Sum the Medicaid paid amountSum the MEDICAID-PAID-AMT of the records which meet the criteria from STEP 2	N/A
10/07/2025	4.0.19	EXP-11-161_1-164	UPDATE	Grace period expiration date	None	2024-03-11
10/07/2025	4.0.19	EXP-11-160_1-163	UPDATE	Grace period expiration date	None	2024-03-11
11/20/2025	4.0.22	EXP-11-082-5	UPDATE	Annotation	Calculate the average amount paid (excluding outliers with Medicaid Amount Paid > $200,000) for Medicaid FFS: original, non-crossover, paid OT claims for HCBS program	N/A
11/20/2025	4.0.22	EXP-11-082-5	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS Payment: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: HCBS service codeOf the records that meet the criteria from STEP 2, select records with HCBS-SERVICE-CODE is not missingSTEP 4: Restrict claims with paid amounts less than $200,000Of the records that meet the criteria from STEP 3, further restrict them to those with MEDICAID-PAID-AMT > 0 and MEDICAID-PAID-AMT < $200,000STEP 5: Average1. Of the line records that meet the criteria in STEP 4, take the average of MEDICAID-PAID-AMT	N/A
11/20/2025	4.0.22	EXP-11-081-3	UPDATE	Annotation	Calculate the percentage of records with amount paid greater than $100,000 for Medicaid FFS: original, non-crossover, paid OT claims	N/A
11/20/2025	4.0.22	EXP-11-081-3	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS Payment: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Medicaid amount paid > $100,000Of the claims that meet the criteria from STEP 2, count records with MEDICAID-PAID-AMT > 100,000STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	EXP-11-003-83	UPDATE	Annotation	Calculate the percentage of Medicaid FFS: original, non-crossover, paid HCBS taxonomy claims that have HCBS taxonomy values beginning with 02, 04, or 08	N/A
11/20/2025	4.0.22	EXP-11-003-83	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the line records that meet the criteria from STEP 2, further restrict them by the following criteria:1. HCBS-TAXONOMY starts with "02", "04", or "08"2. MEDICAID-PAID-AMT is not missingSTEP 4: Amount paid1. Of the line records that meet the criteria from STEP 3, sum MEDICAID-PAID-AMT(this will be the numerator)STEP 5: All servicesOf the line records that meet the criteria from STEP 2, further restrict them by the following criteria:1. HCBS-TAXONOMY is not missing2. MEDICAID-PAID-AMT is not missingSTEP 6: Amount paidOf the line records that meet the criteria from STEP 5, sum MEDICAID-PAID-AMT(this will be the denominator)STEP 7: Calculate percentageDivide the numerator by the denominator	N/A
11/20/2025	4.0.22	EXP-11-001-85	UPDATE	Annotation	Calculate the sum of the Medicaid amount paid for Medicaid FFS: original, non-crossover, paid OT claims	N/A
11/20/2025	4.0.22	EXP-11-001-85	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claim lines that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Sum the Medicaid paid amountSum the MEDICAID-PAID-AMT of the records which meet the criteria from STEP 2	N/A
10/07/2025	4.0.19	EL-8-002-2	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Managed care plans on the last day of DQ report monthDefine the managed care plan population from segment MANAGED-CARE-MAIN-MCR00002 by keeping active records that satisfy the following criteria:1. MANAGED-CARE-MAIN-REC-EFF-DATE <= last day of the reporting month2. MANAGED-CARE-MAIN-REC-END-DATE >= last day of the reporting month OR missingSTEP 4: Active non-duplicate claims records during DQ report monthDefine the claims universe for IP, LT, and RX at the header level and for OT at the line level by importing headers (and lines for OT) that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, and ADJUDICATION-DATE and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 5: Medicaid and S-CHIP Encounter: Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = ("3" or "C")STEP 6: Capitation payment financial transactions:Define the FTX universe for the FTX0002, FTX0003, and FTX0005 tables respectively by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-DATE or PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 7: Medicaid & S-CHIP Capitation PaymentOf the financial transactions that meet the criteria from STEP 6, further restrict them by the following criteria:1. PAYEE-ID-TYPE = "02"For those in FTX0005 only:1. OFFSET-TRANS-TYPE = "1" or "2"STEP 8: Define Plan_IdDefine Plan_Id as a unique list of: MANAGED-CARE-PLAN-ID from the EL file that meet the constraints in STEP 2, STATE-PLAN-ID-NUM from the MCR file that meet the constraints in STEP 3, PLAN-ID-NUMBER from the claims files that meet the constraints in STEP 5, and PAYEE-ID from records that meet constraints in STEP 7. Also, define a blank Plan_Id for missing.STEP 9: Define Plan_Type_ElIn cases where Plan_Id can be linked to a MANAGED-CARE-PLAN-ID in MANAGED-CARE-PARTICIPATION-ELG00014, and there is only one plan type for that plan, define Plan_Type_El as MANAGED-CARE-PLAN-TYPE. If there are multiple plan types for the Plan_Id, then set Plan_Type_El to the most frequently used plan type, or the lowest plan type if there is a tie. (If there are multiple plan types, also set MultiplePlanTypes_EL = 1.) In all other cases, Plan_Type_El = missing.STEP 10: Define Plan_Type_Mc and LinkedIn cases where Plan_Id can be linked to a STATE-PLAN-ID-NUM in MANAGED-CARE-MAIN-MCR00002, set In_MCR_File = "Yes". If there is only one plan type for that plan, define Plan_Type_Mc as MANAGED-CARE-PLAN-TYPE . If there are multiple plan types for the Plan_Id, then set Plan_Type_Mc to the most frequently used plan type, or the lowest plan type if there is a tie. (If there are multiple plan types, also set MultiplePlanTypes_Mc = 1.) In all other cases, Plan_Type_Mc = missing and In_MCR_File = "No". STEP 11: Count EnrollmentFor each Plan_Id, define Enrollment as the count of unique MSIS-IDENTIFICATION-NUM that satisfy the constraints in STEP 2aSTEP 12: Capitation RecordsFor each record that meets the criteria from STEP 7, further restrict them by the following criteria:1. ADJUSTMENT_IND = 02a. PAYMENT_OR_RECOUPMENT_AMOUNT (FTX00002 and FTX00005) > 0OR2b. PAYMENT_AMOUNT (FTX00003) > 0STEP 13: Set Capitation TypeUsing the records in STEP 12:1a. Set Capitation_Type = “Medicaid and S-CHIP” if at least one record with MBESCBES_FORM_GROUP = "1" OR "2" AND at least one record with MBESCBES_FORM_GROUP = "3" 1b. Set Capitation_Type = “Medicaid” if at least one record with MBESCBES_FORM_GROUP = "1" OR "2" AND no records with MBESCBES_FORM_GROUP = "3"1c. Set Capitation_Type = "S-CHIP" if no records with MBESCBES_FORM_GROUP = "1" OR "2" AND at least one record with MBESCBES_FORM_GROUP = "3" STEP 14: Count Capitation_Hmo_Hio_PaceDefine Capitation_Hmo_Hio_Pace as the count of unique FTX00002 records from STEP 12 that also satisfy the following criteria:1. PAYEE-MCR-PLAN-TYPE = (“01” or “04” or “17”)STEP 15: Count Capitation_PhpDefine Capitation_Php as the count of unique FTX00002 records from STEP 12 that also satisfy the following criteria:1. PAYEE-MCR-PLAN-TYPE = (“05” or “06”or “07”or “08”or “09” or “10” or “11”or “12” or “13”or “14” or “15”or “16” or “18”or “19”)STEP 16: Count Capitation_PccmDefine Capitation_Pccm as the count of unique FTX00002 records from STEP 12 that also satisfy the following criteria:1. PAYEE-MCR-PLAN-TYPE = (“02" or "03")STEP 17: Count Capitation_PhiDefine Capitation_Phi as the count of unique FTX00003 and FTX00005 records from STEP 12 that also satisfy the following criteria:1. For FTX00005 records only, OFFSET-TRANS-TYPE = "2"STEP 18: Count Capitation_OtherDefine Capitation_Other as the count of unique FTX00002 and FTX00005 records from STEP 12 that also satisfy the following criteria:1. PAYEE-MCR-PLAN-TYPE is not equal to (“01”,“02”,“03”,“04”, “05”,“06”,“07”,“08”,“09”,“10”,“11”,“12”,“13”,“14”,“15”,“16”, “17”,“18”,“19”) 2. For FTX00005 records only, OFFSET-TRANS-TYPE = "1"STEP 19: Count Capitation_TotalDefine Capitation_Total as the sum of Capitation_Hmo_Hio_Pace, Capitation_Php, Capitation_Pccm, Capitation_Phi, and Capitation_OtherSTEP 20: Encounter ClaimsSelect encounter claims in the IP, LT, OT, and RX files by the following criteria:1. PLAN-ID-NUMBER = Plan_Id2. TYPE-OF-CLAIM = (“3” or “C”)3. ADJUSTMENT-IND = “0”STEP 21: Set Encounter TypeUsing the records in STEP 20:1a. Set Encounter_Type = “Medicaid and S-CHIP” if at least one record with TYPE-OF-CLAIM = “3” AND at least one record with TYPE-OF-CLAIM = “C” 1b. Set Encounter_Type = “Medicaid” if at least one record with TYPE-OF-CLAIM = “3” AND no records with TYPE-OF-CLAIM = “C” 1c. Set Encounter_Type = "S-CHIP" if no records with TYPE-OF-CLAIM = “3” AND at least one record with TYPE-OF-CLAIM = “C”STEP 22: Count Encounters_IpDefine Encounters_Ip as the count of unique IP header records from STEP 20STEP 23: Count Encounters_LtDefine Encounters_Lt as the count of unique LT header records from STEP 20STEP 24: Count Encounters_OtDefine Encounters_Ot as the count of unique OT line records from STEP 20STEP 25: Count Encounters_RxDefine Encounters_Rx as the count of unique RX header records from STEP 20STEP 26: Count Encounters_TotalDefine Encounters_Total as the sum of Encounters_Ip, Encounters_Lt, Encounters_Ot, and Encounters_RxSTEP 27: Count RatiosSET Capitation_Ratio = Capitation_Total / EnrollmentSET Encounters_Ip_Ratio = Encounters_Ip / EnrollmentSET Encounters_Lt_Ratio = Encounters_Lt / EnrollmentSET Encounters_Ot_Ratio = Encounters_Ot / EnrollmentSET Encounters_Rx_Ratio = Encounters_Rx / EnrollmentSTEP 28: Repeat for each Plan_IdREPEAT STEPS 9-27 for each Plan_Id identified in STEP 8	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Managed care plans on the last day of DQ report monthDefine the managed care plan population from segment MANAGED-CARE-MAIN-MCR00002 by keeping active records that satisfy the following criteria:1. MANAGED-CARE-MAIN-REC-EFF-DATE <= last day of the reporting month2. MANAGED-CARE-MAIN-REC-END-DATE >= last day of the reporting month OR missingSTEP 4: Active non-duplicate claims records during DQ report monthDefine the claims universe for IP, LT, and RX at the header level and for OT at the line level by importing headers (and lines for OT) that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, and ADJUDICATION-DATE and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 5: Medicaid and S-CHIP Encounter: Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = ("3" or "C")STEP 6: Capitation payment financial transactions:Define the FTX universe for the FTX0002, FTX0003, and FTX0005 tables respectively by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-DATE or PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 7: Medicaid & S-CHIP Capitation PaymentOf the financial transactions that meet the criteria from STEP 6, further restrict them by the following criteria:1. PAYEE-ID-TYPE = ("02" or "05" or "06")For those in FTX0005 only:1. OFFSET-TRANS-TYPE = "1" or "2"STEP 8: Define Plan_IdDefine Plan_Id as a unique list of: MANAGED-CARE-PLAN-ID from the EL file that meet the constraints in STEP 2, STATE-PLAN-ID-NUM from the MCR file that meet the constraints in STEP 3, PLAN-ID-NUMBER from the claims files that meet the constraints in STEP 5, and PAYEE-ID from records that meet constraints in STEP 7. Also, define a blank Plan_Id for missing.STEP 9: Define Plan_Type_ElIn cases where Plan_Id can be linked to a MANAGED-CARE-PLAN-ID in MANAGED-CARE-PARTICIPATION-ELG00014, and there is only one plan type for that plan, define Plan_Type_El as MANAGED-CARE-PLAN-TYPE. If there are multiple plan types for the Plan_Id, then set Plan_Type_El to the most frequently used plan type, or the lowest plan type if there is a tie. (If there are multiple plan types, also set MultiplePlanTypes_EL = 1.) In all other cases, Plan_Type_El = missing.STEP 10: Define Plan_Type_Mc and LinkedIn cases where Plan_Id can be linked to a STATE-PLAN-ID-NUM in MANAGED-CARE-MAIN-MCR00002, set In_MCR_File = "Yes". If there is only one plan type for that plan, define Plan_Type_Mc as MANAGED-CARE-PLAN-TYPE . If there are multiple plan types for the Plan_Id, then set Plan_Type_Mc to the most frequently used plan type, or the lowest plan type if there is a tie. (If there are multiple plan types, also set MultiplePlanTypes_Mc = 1.) In all other cases, Plan_Type_Mc = missing and In_MCR_File = "No". STEP 11: Count EnrollmentFor each Plan_Id, define Enrollment as the count of unique MSIS-IDENTIFICATION-NUM that satisfy the constraints in STEP 2aSTEP 12: Capitation RecordsFor each record that meets the criteria from STEP 7, further restrict them by the following criteria:1. ADJUSTMENT_IND = 02a. PAYMENT_OR_RECOUPMENT_AMOUNT (FTX00002 and FTX00005) > 0OR2b. PAYMENT_AMOUNT (FTX00003) > 0STEP 13: Set Capitation TypeUsing the records in STEP 12:1a. Set Capitation_Type = “Medicaid and S-CHIP” if at least one record with MBESCBES_FORM_GROUP = "1" OR "2" AND at least one record with MBESCBES_FORM_GROUP = "3" 1b. Set Capitation_Type = “Medicaid” if at least one record with MBESCBES_FORM_GROUP = "1" OR "2" AND no records with MBESCBES_FORM_GROUP = "3"1c. Set Capitation_Type = "S-CHIP" if no records with MBESCBES_FORM_GROUP = "1" OR "2" AND at least one record with MBESCBES_FORM_GROUP = "3" STEP 14: Count Capitation_Hmo_Hio_PaceDefine Capitation_Hmo_Hio_Pace as the count of unique FTX00002 records from STEP 12 that also satisfy the following criteria:1. PAYEE-MCR-PLAN-TYPE = (“01” or “04” or “17”)STEP 15: Count Capitation_PhpDefine Capitation_Php as the count of unique FTX00002 records from STEP 12 that also satisfy the following criteria:1. PAYEE-MCR-PLAN-TYPE = (“05” or “06”or “07”or “08”or “09” or “10” or “11”or “12” or “13”or “14” or “15”or “16” or “18”or “19”)STEP 16: Count Capitation_PccmDefine Capitation_Pccm as the count of unique FTX00002 records from STEP 12 that also satisfy the following criteria:1. PAYEE-MCR-PLAN-TYPE = (“02" or "03")STEP 17: Count Capitation_PhiDefine Capitation_Phi as the count of unique FTX00003 and FTX00005 records from STEP 12 that also satisfy the following criteria:1. For FTX00005 records only, OFFSET-TRANS-TYPE = "2"STEP 18: Count Capitation_OtherDefine Capitation_Other as the count of unique FTX00002 and FTX00005 records from STEP 12 that also satisfy the following criteria:1. PAYEE-MCR-PLAN-TYPE is not equal to (“01”,“02”,“03”,“04”, “05”,“06”,“07”,“08”,“09”,“10”,“11”,“12”,“13”,“14”,“15”,“16”, “17”,“18”,“19”) 2. For FTX00005 records only, OFFSET-TRANS-TYPE = "1"STEP 19: Count Capitation_TotalDefine Capitation_Total as the sum of Capitation_Hmo_Hio_Pace, Capitation_Php, Capitation_Pccm, Capitation_Phi, and Capitation_OtherSTEP 20: Encounter ClaimsSelect encounter claims in the IP, LT, OT, and RX files by the following criteria:1. PLAN-ID-NUMBER = Plan_Id2. TYPE-OF-CLAIM = (“3” or “C”)3. ADJUSTMENT-IND = “0”STEP 21: Set Encounter TypeUsing the records in STEP 20:1a. Set Encounter_Type = “Medicaid and S-CHIP” if at least one record with TYPE-OF-CLAIM = “3” AND at least one record with TYPE-OF-CLAIM = “C” 1b. Set Encounter_Type = “Medicaid” if at least one record with TYPE-OF-CLAIM = “3” AND no records with TYPE-OF-CLAIM = “C” 1c. Set Encounter_Type = "S-CHIP" if no records with TYPE-OF-CLAIM = “3” AND at least one record with TYPE-OF-CLAIM = “C”STEP 22: Count Encounters_IpDefine Encounters_Ip as the count of unique IP header records from STEP 20STEP 23: Count Encounters_LtDefine Encounters_Lt as the count of unique LT header records from STEP 20STEP 24: Count Encounters_OtDefine Encounters_Ot as the count of unique OT line records from STEP 20STEP 25: Count Encounters_RxDefine Encounters_Rx as the count of unique RX header records from STEP 20STEP 26: Count Encounters_TotalDefine Encounters_Total as the sum of Encounters_Ip, Encounters_Lt, Encounters_Ot, and Encounters_RxSTEP 27: Count RatiosSET Capitation_Ratio = Capitation_Total / EnrollmentSET Encounters_Ip_Ratio = Encounters_Ip / EnrollmentSET Encounters_Lt_Ratio = Encounters_Lt / EnrollmentSET Encounters_Ot_Ratio = Encounters_Ot / EnrollmentSET Encounters_Rx_Ratio = Encounters_Rx / EnrollmentSTEP 28: Repeat for each Plan_IdREPEAT STEPS 9-27 for each Plan_Id identified in STEP 8
11/20/2025	4.0.22	ALL-8-001-1	UPDATE	Annotation	The percentage of Medicaid FFS: original, paid OT claims that are crossovers	N/A
11/20/2025	4.0.22	ALL-8-001-1	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS and Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3"2. ADJUSTMENT-IND = "0"STEP 3: Crossover claimsOf the claims that meet the criteria from STEP 2, select records where 1. CROSSOVER-INDICATOR = "1"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/20/2025	4.0.22	ALL-5-008-8	UPDATE	Annotation	Calculate the percentage of unique RX claim line records that appear more than once	N/A
11/20/2025	4.0.22	ALL-5-008-8	UPDATE	Specification	STEP 1: Active paid RX claims during DQ report monthDefine the RX claims universe at the line level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND, and keep all claims, including orphan lines1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines)1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Total CountOf the claims that meet the criteria from STEP 1, count the number of unique line records. A unique line record is defined by distinct combinations of the following data elements: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND. STEP 3: Count duplicatesFrom the records in STEP 1, count unique line records that appear more than onceSTEP 4: PercentageDivide the count of unique line records from STEP 3 by the count in STEP 2	N/A
11/20/2025	4.0.22	ALL-5-007-7	UPDATE	Annotation	Calculate the percentage of unique OT claim line records that appear more than once	N/A
11/20/2025	4.0.22	ALL-5-007-7	UPDATE	Specification	STEP 1: Active paid OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND, and keep all claims, including orphan lines1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines)1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Total CountOf the claims that meet the criteria from STEP 1, count the number of unique line records. A unique line record is defined by distinct combinations of the following data elements: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND. STEP 3: Count duplicatesFrom the records in STEP 1, count unique line records that appear more than onceSTEP 4: PercentageDivide the count of unique line records from STEP 3 by the count in STEP 2	N/A
11/20/2025	4.0.22	ALL-5-006-6	UPDATE	Annotation	Calculate the percentage of unique LT claim line records that appear more than once	N/A
11/20/2025	4.0.22	ALL-5-006-6	UPDATE	Specification	STEP 1: Active paid LT claims during DQ report monthDefine the LT claims universe at the line level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND, and keep all claims, including orphan lines1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines)1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Total CountOf the claims that meet the criteria from STEP 1, count the number of unique line records. A unique line record is defined by distinct combinations of the following data elements: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND. STEP 3: Count duplicatesFrom the records in STEP 1, count unique line records that appear more than onceSTEP 4: PercentageDivide the count of unique line records from STEP 3 by the count in STEP 2	N/A
11/20/2025	4.0.22	ALL-5-005-5	UPDATE	Annotation	Calculate the percentage of unique IP claim line records that appear more than once	N/A
11/20/2025	4.0.22	ALL-5-005-5	UPDATE	Specification	STEP 1: Active paid IP claims during DQ report monthDefine the IP claims universe at the line level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND, and keep all claims, including orphan lines1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines)1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Total CountOf the claims that meet the criteria from STEP 1, count the number of unique line records. A unique line record is defined by distinct combinations of the following data elements: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND. STEP 3: Count duplicatesFrom the records in STEP 1, count unique line records that appear more than onceSTEP 4: PercentageDivide the count of unique line records from STEP 3 by the count in STEP 2	N/A
11/20/2025	4.0.22	ALL-4-004-4	UPDATE	Annotation	Percentage of unique state assigned provider IDs for billing and dispensing prescription drug provider on the RX file that do not match the provider IDs on the provider file	N/A
11/20/2025	4.0.22	ALL-4-004-4	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX claims universe at the line level by importing both headers and lines that satisfy the following criteria: For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Unique state-assigned provider IDsFor each of the RX claims identified in STEP 1, create a list of unique state-assigned provider IDs using the following data elements:1. BILLING-PROV-NUM2. DISPENSING-PRESCRIPTION-DRUG-PROV-NUMSTEP 3: Match state-assigned provider IDs to provider file IDsMatch the unique state assigned provider IDs identified in STEP 2 to the SUBMITTING-STATE-PROV-ID in the PROV-ATTRIBUTES-MAIN-PRV00002 segment OR the PROV-IDENTIFIER in the PROV-IDENTIFIERS-PRV00005 segmentSTEP 4: Number of non-matchesCount the number of unique state assigned provider IDs from STEP 2 that fail to match in STEP 3STEP 5: Percentage of non-matchesDivide the count from STEP 4 by the total number of unique state assigned provider IDs identified in STEP 2	N/A
11/20/2025	4.0.22	ALL-4-003-3	UPDATE	Annotation	Percentage of unique state assigned provider IDs for billing and servicing provider on the OT file that do not match the provider IDs on the provider file	N/A
11/20/2025	4.0.22	ALL-4-003-3	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria: For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Unique state-assigned provider IDsFor each of the OT claims identified in STEP 1, create a list of unique state-assigned provider IDs using the following data elements:1. BILLING-PROV-NUM2. SERVICING-PROV-NUMSTEP 3: Match state-assigned provider IDs to provider file IDsMatch the unique state assigned provider IDs identified in STEP 2 to the SUBMITTING-STATE-PROV-ID in the PROV-ATTRIBUTES-MAIN-PRV00002 segment OR the PROV-IDENTIFIER in the PROV-IDENTIFIERS-PRV00005 segmentSTEP 4: Number of non-matchesCount the number of unique state assigned provider IDs from STEP 2 that fail to match in STEP 3STEP 5: Percentage of non-matchesDivide the count from STEP 4 by the total number of unique state assigned provider IDs identified in STEP 2	N/A
11/20/2025	4.0.22	ALL-4-002-2	UPDATE	Annotation	Percentage of unique state assigned provider IDs for billing and servicing provider on the LT file that do not match the provider IDs on the provider file	N/A
11/20/2025	4.0.22	ALL-4-002-2	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT claims universe at the line level by importing both headers and lines that satisfy the following criteria: For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Unique state-assigned provider IDsFor each of the LT claims identified in STEP 1, create a list of unique state-assigned provider IDs using the following data elements:1. BILLING-PROV-NUM2. SERVICING-PROV-NUMSTEP 3: Match state-assigned provider IDs to provider file IDsMatch the unique state assigned provider IDs identified in STEP 2 to the SUBMITTING-STATE-PROV-ID in the PROV-ATTRIBUTES-MAIN-PRV00002 segment OR the PROV-IDENTIFIER in the PROV-IDENTIFIERS-PRV00005 segmentSTEP 4: Number of non-matchesCount the number of unique state assigned provider IDs from STEP 2 that fail to match in STEP 3STEP 5: Percentage of non-matchesDivide the count from STEP 4 by the total number of unique state assigned provider IDs identified in STEP 2	N/A
11/20/2025	4.0.22	ALL-4-001-1	UPDATE	Annotation	Percentage of unique state assigned provider IDs for billing and servicing provider on the IP file that do not match the provider IDs on the provider file	N/A
11/20/2025	4.0.22	ALL-4-001-1	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP claims universe at the line level by importing both headers and lines that satisfy the following criteria.For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Unique state-assigned provider IDsFor each of the IP claims identified in STEP 1, create a list of unique state-assigned provider IDs using the following data elements:1. BILLING-PROV-NUM2. SERVICING-PROV-NUMSTEP 3: Match state-assigned provider IDs to provider file IDsMatch the unique state assigned provider IDs identified in STEP 2 to the SUBMITTING-STATE-PROV-ID in the PROV-ATTRIBUTES-MAIN-PRV00002 segment OR the PROV-IDENTIFIER in the PROV-IDENTIFIERS-PRV00005 segmentSTEP 4: Number of non-matchesCount the number of unique state assigned provider IDs from STEP 2 that fail to match in STEP 3STEP 5: Percentage of non-matchesDivide the count from STEP 4 by the total number of unique state assigned provider IDs identified in STEP 2	N/A
11/20/2025	4.0.22	ALL-35-004-4	UPDATE	Annotation	Calculate the percentage of S-CHIP FFS and Encounter: original and replacement, paid OT claim lines with non-missing tooth number that do not have a procedure code format indicating a CDT code	N/A
11/20/2025	4.0.22	ALL-35-004-4	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP FFS and Encounter: Original and Replacement Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Non-missing tooth numberOf the claims that meet criteria from STEP 2, keep those with non-missing TOOTH-NUM.STEP 4: Procedure code format does not indicate a CDT codeOf the claims that meet the criteria from STEP 3, keep those that do NOT meet following criteria:1. Length of PROCEDURE-CODE is 52. PROCEDURE-CODE begins with "D"3. PROCEDURE-CODE only contains digits 0-9 in positions 2-5STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 3	N/A
11/20/2025	4.0.22	ALL-35-003-3	UPDATE	Annotation	Calculate the percentage of Medicaid FFS and Encounter: original and replacement, paid OT claim lines with non-missing tooth number that do not have a procedure code format indicating a CDT code	N/A
11/20/2025	4.0.22	ALL-35-003-3	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS and Encounter: Original and Replacement Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Non-missing tooth numberOf the claims that meet criteria from STEP 2, keep those with non-missing TOOTH-NUM.STEP 4: Procedure code format does not indicate a CDT codeOf the claims that meet the criteria from STEP 3, keep those that do NOT meet following criteria:1. Length of PROCEDURE-CODE is 52. PROCEDURE-CODE begins with "D"3. PROCEDURE-CODE only contains digits 0-9 in positions 2-5STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 3	N/A
11/20/2025	4.0.22	ALL-35-002-2	UPDATE	Annotation	Calculate the percentage of S-CHIP FFS and Encounter: original and replacement, paid OT claim lines with procedure codes indicating a sealant, filling, or root canal that are missing tooth number	N/A
11/20/2025	4.0.22	ALL-35-002-2	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP FFS and Encounter: Original and Replacement Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Tooth-related procedure codesOf the claims that meet criteria from STEP 2, keep those with a PROCEDURE-CODE that matches one of the following criteria:1. PROCEDURE-CODE = “D1351” or “D2140” or “D2150” or “D2160” or “D2161” or “D2330” or “D2331” or “D2332” or “D2335” or “D2390” or “D2391” or “D2392” or “D2393” or “D2394” or “D3230” or “D3240” or “D3310” or “D3320” or “D3330”STEP 4: Missing tooth numberOf the claims that meet criteria from STEP 3, keep those with a missing TOOTH-NUMSTEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 3	N/A
11/20/2025	4.0.22	ALL-35-001-1	UPDATE	Annotation	Calculate the percentage of Medicaid FFS and Encounter: original and replacement, paid OT claim lines with procedure codes indicating a sealant, filling, or root canal that are missing tooth number	N/A
11/20/2025	4.0.22	ALL-35-001-1	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS and Encounter: Original and Replacement Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Tooth-related procedure codesOf the claims that meet criteria from STEP 2, keep those with a PROCEDURE-CODE that matches one of the following criteria:1. PROCEDURE-CODE = “D1351” or “D2140” or “D2150” or “D2160” or “D2161” or “D2330” or “D2331” or “D2332” or “D2335” or “D2390” or “D2391” or “D2392” or “D2393” or “D2394” or “D3230” or “D3240” or “D3310” or “D3320” or “D3330”STEP 4: Missing tooth numberOf the claims that meet criteria from STEP 3, keep those with a missing TOOTH-NUMSTEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 3	N/A
11/20/2025	4.0.22	ALL-34-002-2	UPDATE	Annotation	Calculate the percentage of Medicaid FFS and Encounter: original and replacement, paid OT claim lines with non-missing procedure code and either HCBS service code or taxonomy that indicates a CPT or CDT code	N/A
11/20/2025	4.0.22	ALL-34-002-2	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS and Encounter: Original and Replacement Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Non-missing procedure codeOf the claims that meet criteria from STEP 2, keep those with non-missing PROCEDURE-CODESTEP 4: Non-missing HCBS service code or HCBS taxonomyOf the claims that meet criteria from STEP 3, keep those with non-missing HCBS-SERVICE-CODE or non-missing HCBS-TAXONOMYSTEP 5: Procedure code format that indicates a CPT or CDT codeOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. Length of PROCEDURE-CODE is 52. PROCEDURE-CODE begins with "D" or any digit 0-93. PROCEDURE-CODE only contains digit 0-9 in positions 2-5STEP 6: Calculate percentageDivide the count of claim lines from STEP 5 by the count of claim lines from STEP 4	N/A
11/20/2025	4.0.22	ALL-34-001-1	UPDATE	Annotation	Calculate the percentage of Medicaid FFS and Encounter: original and replacement, paid OT claim lines with non-missing HCBS Service Code that have missing HCBS Taxonomy	N/A
11/20/2025	4.0.22	ALL-34-001-1	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS and Encounter: Original and Replacement Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Non-missing HCBS service codeOf the claims that meet criteria from STEP 2, keep those with non-missing HCBS-SERVICE-CODESTEP 4: Missing HCBS taxonomyOf the claims that meet criteria from STEP 3, keep those with missing HCBS-TAXONOMYSTEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 3	N/A
11/20/2025	4.0.22	ALL-21-007-7	UPDATE	Annotation	Calculate the percentage of unique servicing provider numbers on Medicaid and S-CHIP FFS and Encounter: original and adjustment, paid OT claim lines that do not have an active record indicating they are a Medicaid-enrolled provider on a claim line date of service	N/A
11/20/2025	4.0.22	ALL-21-007-7	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS and Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" or "A" or "C"STEP 3: Unique servicing provider numbers on the claim linesFrom the claim lines that meet the criteria from STEP 2, create a list of unique SERVICING-PROV-NUM values where:1. SERVICING-PROV-NUM is not missingSTEP 4: Providers without enrollment on the date of serviceOf the unique provider identifiers from STEP 3, refine the list using PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping providers that do not meet all of the following criteria for all claims:1. SERVICING-PROV-NUM found in SUBMITTING-STATE-PROV-ID2. PROV-MEDICAID-ENROLLMENT-STATUS-CODE = ("1" or "01") or ("2" or "02") or ("3" or "03") or ("4" or "04") or ("5" or "05") or ("6" or "06")3. BEGINNING-DATE-OF-SERVICE from the claim line is greater than or equal to PROV-MEDICAID-EFF-DATE4a. BEGINNING-DATE-OF-SERVICE from the claim line is less than or equal to PROV-MEDICAID-END-DATEOR4b. PROV-MEDICAID-END-DATE is missingSTEP 5: Calculate percentageDivide the count of unique providers from STEP 4 by the count from STEP 3	N/A
11/20/2025	4.0.22	ALL-21-006-6	UPDATE	Annotation	Calculate the percentage of unique servicing provider numbers on Medicaid and S-CHIP FFS and Encounter: original and adjustment, paid LT claim lines that do not have an active record indicating they are a Medicaid-enrolled provider on a claim line date of service	N/A
11/20/2025	4.0.22	ALL-21-006-6	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS and Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" or "A" or "C"STEP 3: Unique servicing provider numbers on the claim linesFrom the claim lines that meet the criteria from STEP 2, create a list of unique SERVICING-PROV-NUM values where:1. SERVICING-PROV-NUM is not missingSTEP 4: Providers without enrollment on the date of serviceOf the unique provider identifiers from STEP 3, refine the list using PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping providers that do not meet all of the following criteria for all claims:1. SERVICING-PROV-NUM found in SUBMITTING-STATE-PROV-ID2. PROV-MEDICAID-ENROLLMENT-STATUS-CODE = ("1" or "01") or ("2" or "02") or ("3" or "03") or ("4" or "04") or ("5" or "05") or ("6" or "06")3. BEGINNING-DATE-OF-SERVICE from the claim line is greater than or equal to PROV-MEDICAID-EFF-DATE4a. BEGINNING-DATE-OF-SERVICE from the claim line is less than or equal to PROV-MEDICAID-END-DATEOR4b. PROV-MEDICAID-END-DATE is missingSTEP 5: Calculate percentageDivide the count of unique providers from STEP 4 by the count from STEP 3	N/A
11/20/2025	4.0.22	ALL-21-005-5	UPDATE	Annotation	Calculate the percentage of unique servicing provider numbers on Medicaid and S-CHIP FFS and Encounter: original and adjustment, paid IP claim lines that do not have an active record indicating they are a Medicaid-enrolled provider on a claim line date of service	N/A
11/20/2025	4.0.22	ALL-21-005-5	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS and Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" or "A" or "C"STEP 3: Unique servicing provider numbers on the claim linesFrom the claim lines that meet the criteria from STEP 2, create a list of unique SERVICING-PROV-NUM values where:1. SERVICING-PROV-NUM is not missingSTEP 4: Providers without enrollment on the date of serviceOf the unique provider identifiers from STEP 3, refine the list using PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping providers that do not meet all of the following criteria for all claims:1. SERVICING-PROV-NUM found in SUBMITTING-STATE-PROV-ID2. PROV-MEDICAID-ENROLLMENT-STATUS-CODE = ("1" or "01") or ("2" or "02") or ("3" or "03") or ("4" or "04") or ("5" or "05") or ("6" or "06")3. BEGINNING-DATE-OF-SERVICE from the claim line is greater than or equal to PROV-MEDICAID-EFF-DATE4a. BEGINNING-DATE-OF-SERVICE from the claim line is less than or equal to PROV-MEDICAID-END-DATEOR4b. PROV-MEDICAID-END-DATE is missingSTEP 5: Calculate percentageDivide the count of unique providers from STEP 4 by the count from STEP 3	N/A
11/20/2025	4.0.22	ALL-2-011-11	UPDATE	Annotation	Calculate the percentage of eligibles enrolled in a 1915(c) waiver that do not have Medicaid FFS and Encounter, original paid OT claims with the corresponding HCBS service code	N/A
11/20/2025	4.0.22	ALL-2-011-11	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Waiver participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment WAIVER-PARTICIPATION-ELG00012 by keeping records that satisfy the following criteria:1a. WAIVER-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. WAIVER-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. WAIVER-ENROLLMENT-EFF-DATE is missing2b. WAIVER-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in 1915(c) waiverOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where WAIVER-TYPE-CODE = ("06" - "20", "33")STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 5: Medicaid FFS and Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" 2. ADJUSTMENT-IND = "0"STEP 6: Link MSIS IDs from EL to OTRetain the MSIS IDs from STEP 3 that link to an OT claim from STEP 5STEP 7: Service under 1915(c) HCBS waiverRetain the MSIS IDs from STEP 6 where the HCBS-SERVICE-CODE = "4"STEP 8: MSIS IDs without service under 1915(c) HCBS waiverSubtract the number of unique MSIS IDs in STEP 7 from the number of unique MSIS IDs in STEP 3STEP 9: Calculate percentageDivide the count of unique MSIS IDs in STEP 8 by the count of unique MSIS IDs in STEP 3	N/A
11/20/2025	4.0.22	ALL-2-006-6	UPDATE	Annotation	The percentage of active 1915(j) eligibles (STATE-PLAN-OPTION-TYPE = '03') with Medicaid FFS and Encounter: original, non-crossover, paid OT claims that are 1915(j) claim records (HCBS-SERVICE-CODE = '2') during the reporting period	N/A
11/20/2025	4.0.22	ALL-2-006-6	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: State plan participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment STATE-PLAN-OPTION-PARTICIPATION-ELG00011 by keeping records that satisfy the following criteria:1a. STATE-PLAN-OPTION-EFF-DATE <= last day of the DQ report month2a. STATE-PLAN-OPTION-END-DATE >= last day of the DQ report month OR missingOR1b. STATE-PLAN-OPTION-EFF-DATE is missing2b. STATE-PLAN-OPTION-END-DATE is missingSTEP 3: 1915(j) eligiblesOf the MSIS-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:STATE-PLAN-OPTION-TYPE = '03'STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 5: Medicaid FFS and Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" 2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 6: HCBS under 1915(j)Of the claims from STEP 5, further restrict by the below criteria1. HCBS-SERVICE-CODE = "2"STEP 7: Eligibles with OT claimsOf the MSIS-IDs from STEP 3, count the number which also appear in the claims from STEP 6STEP 8: Calculate percentage for measureDivide the number of MSIS-IDs from STEP 7 by the number of MSIS-IDs from STEP 3	N/A
11/20/2025	4.0.22	ALL-2-005-5	UPDATE	Annotation	The percentage of active 1915(i) eligibles (STATE-PLAN-OPTION-TYPE = '03') with any Medicaid FFS and Encounter: original, non-crossover, paid OT claims during the reporting period	N/A
11/20/2025	4.0.22	ALL-2-005-5	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: State plan participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment STATE-PLAN-OPTION-PARTICIPATION-ELG00011 by keeping records that satisfy the following criteria:1a. STATE-PLAN-OPTION-EFF-DATE <= last day of the DQ report month2a. STATE-PLAN-OPTION-END-DATE >= last day of the DQ report month OR missingOR1b. STATE-PLAN-OPTION-EFF-DATE is missing2b. STATE-PLAN-OPTION-END-DATE is missingSTEP 3: 1915(j) eligiblesOf the MSIS-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:STATE-PLAN-OPTION-TYPE = '03'STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 5: Medicaid FFS and Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" 2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 6: Eligibles with OT claimsOf the MSIS-IDs from STEP 3, count the number which also appear in the claims from STEP 5STEP 7: Calculate percentage for measureDivide the number of MSIS-IDs from STEP 6 by the number of MSIS-IDs from STEP 3	N/A
11/20/2025	4.0.22	ALL-2-004-4	UPDATE	Annotation	The percentage of active 1915(i) eligibles (STATE-PLAN-OPTION-TYPE = '02') with Medicaid FFS and Encounter: original, non-crossover, paid OT claims that are 1915(i) claim records (HCBS-SERVICE-CODE = '1') during the reporting period	N/A
11/20/2025	4.0.22	ALL-2-004-4	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: State plan participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment STATE-PLAN-OPTION-PARTICIPATION-ELG00011 by keeping records that satisfy the following criteria:1a. STATE-PLAN-OPTION-EFF-DATE <= last day of the DQ report month2a. STATE-PLAN-OPTION-END-DATE >= last day of the DQ report month OR missingOR1b. STATE-PLAN-OPTION-EFF-DATE is missing2b. STATE-PLAN-OPTION-END-DATE is missingSTEP 3: 1915(i) eligiblesOf the MSIS-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:STATE-PLAN-OPTION-TYPE = '02'STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 5: Medicaid FFS and Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" 2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 6: HCBS under 1915(i)Of the claims from STEP 5, further restrict by the below criteria1. HCBS-SERVICE-CODE = "1"STEP 7: Eligibles with OT claimsOf the MSIS-IDs from STEP 3, count the number which also appear in the claims from STEP 6STEP 8: Calculate percentage for measureDivide the number of MSIS-IDs from STEP 7 by the number of MSIS-IDs from STEP 3	N/A
11/20/2025	4.0.22	ALL-2-003-3	UPDATE	Annotation	The percentage of active 1915(i) eligibles (STATE-PLAN-OPTION-TYPE = '02') with any Medicaid FFS and Encounter: original, non-crossover, paid OT claims during the reporting period	N/A
11/20/2025	4.0.22	ALL-2-003-3	UPDATE	Specification	STEP 1: STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: State plan participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment STATE-PLAN-OPTION-PARTICIPATION-ELG00011 by keeping records that satisfy the following criteria:1a. STATE-PLAN-OPTION-EFF-DATE <= last day of the DQ report month2a. STATE-PLAN-OPTION-END-DATE >= last day of the DQ report month OR missingOR1b. STATE-PLAN-OPTION-EFF-DATE is missing2b. STATE-PLAN-OPTION-END-DATE is missingSTEP 3: 1915(i) eligiblesOf the MSIS-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:STATE-PLAN-OPTION-TYPE = '02'STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 5: Medicaid FFS and Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" 2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 6: Eligibles with OT claimsOf the MSIS-IDs from STEP 3, count the number which also appear in the claims from STEP 5STEP 7: Calculate percentage for measureDivide the number of MSIS-IDs from STEP 6 by the number of MSIS-IDs from STEP 3	N/A
11/20/2025	4.0.22	ALL-2-002-2	UPDATE	Annotation	The percentage of eligibles with STATE-PLAN-OPTION-TYPE = ''01' with any Medicaid FFS and Encounter: original, non-crossover, paid OT claims during the reporting period	N/A
11/20/2025	4.0.22	ALL-2-002-2	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: State plan participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment STATE-PLAN-OPTION-PARTICIPATION-ELG00011 by keeping records that satisfy the following criteria:1a. STATE-PLAN-OPTION-EFF-DATE <= last day of the DQ report month2a. STATE-PLAN-OPTION-END-DATE >= last day of the DQ report month OR missingOR1b. STATE-PLAN-OPTION-EFF-DATE is missing2b. STATE-PLAN-OPTION-END-DATE is missingSTEP 3: Community First ChoiceOf the MSIS-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:STATE-PLAN-OPTION-TYPE = '01'STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 5: Medicaid FFS and Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" 2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 6: Eligibles with OT claimsOf the MSIS-IDs from STEP 3, count the number which also appear in the claims from STEP 5STEP 7: Calculate percentage for measureDivide the number of MSIS-IDs from STEP 6 by the number of MSIS-IDs from STEP 3	N/A
11/20/2025	4.0.22	ALL-2-001-1	UPDATE	Annotation	The number of unique HCBS taxonomy valid values on Medicaid FFS and Encounter: original, non-crossover, paid OT claims	N/A
11/20/2025	4.0.22	ALL-2-001-1	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS and Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" 2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Count the number of unique HCBS taxonomy valid valuesOf the claims that meet the criteria from step 2, count the number of unique HCBS-TAXONOMY valid values.Note: HCBS-TAXONOMY valid values are: "01010", "02011", "02012", "02013", "02021", "02022", "02023", "02031", "02032", "02033", "03010", "03021", "03022", "03030", "04010", "04020", "04030", "04040", "04050", "04060", "04070", "04080", "05010", "05020", "06010", "07010", "08010", "08020", "08030", "08040", "08050", "08060", "09011", "09012", "09020", "10010", "10020", "10030", "10040", "10050", "10060", "10070", "10080", "10090", "11010", "11020", "11030", "11040", "11050", "11060", "11070", "11080", "11090", "11100", "11120", "11130", "12010", "12020", "13010", "14010", "14020", "14031", "14032", "15010", "16010", "17010", "17020", "17030", "17990"	N/A
11/20/2025	4.0.22	ALL-19-001-1	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP FFS and encounter: original and adjustment, paid OT claim headers with Home and Community Based Services provided under a 1915(c) Home and Community Based Services Waiver that are missing a waiver ID	N/A
11/20/2025	4.0.22	ALL-19-001-1	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claim lines that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" or "A" or "C"STEP 3: HCBS service under 1915(c) HCBS WaiverOf the claim lines that meet the criteria from STEP 2, restrict to: 1. HCBS-SERVICE-CODE = 4STEP 4: Missing WAIVER-IDOf the claim lines that meet the criteria from STEP 3, restrict to those that satisfy:1. WAIVER-ID is missing STEP 5: Calculate the percentage for the measureDivide the count of claim headers from STEP 4 by the count of claim headers from STEP 3	N/A
11/20/2025	4.0.22	ALL-17-008-8	UPDATE	Annotation	Calculate the percentage of paid RX claim lines that do not link to a claim header	N/A
11/20/2025	4.0.22	ALL-17-008-8	UPDATE	Specification	STEP 1: Active paid RX claims during DQ report monthDefine the RX claims universe at the line level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND, and keep all claims, including orphan lines1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines)1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Drop line duplicatesDuplicates are dropped at the line level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and LINE-ADJUSTMENT-IND.1e. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Orphan linesOf the claim lines that meet the criteria from STEP 1, keep claim lines that did not merge to any claim headerSTEP 3: Calculate percentageDivide the count of claim lines from STEP 2 by the count of claim lines from STEP 1	N/A
11/20/2025	4.0.22	ALL-17-007-7	UPDATE	Annotation	Calculate the percentage of paid OT claim lines that do not link to a claim header	N/A
11/20/2025	4.0.22	ALL-17-007-7	UPDATE	Specification	STEP 1: Active paid OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND, and keep all claims, including orphan lines1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines)1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Drop line duplicatesDuplicates are dropped at the line level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and LINE-ADJUSTMENT-IND.1e. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Orphan linesOf the claim lines that meet the criteria from STEP 1, keep claim lines that did not merge to any claim headerSTEP 3: Calculate percentageDivide the count of claim lines from STEP 2 by the count of claim lines from STEP 1	N/A
11/20/2025	4.0.22	ALL-17-006-6	UPDATE	Annotation	Calculate the percentage of paid LT claim lines that do not link to a claim header	N/A
11/20/2025	4.0.22	ALL-17-006-6	UPDATE	Specification	STEP 1: Active paid LT claims during DQ report monthDefine the LT claims universe at the line level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND, and keep all claims, including orphan lines1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines)1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Drop line duplicatesDuplicates are dropped at the line level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and LINE-ADJUSTMENT-IND.1e. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Orphan linesOf the claim lines that meet the criteria from STEP 1, keep claim lines that did not merge to any claim headerSTEP 3: Calculate percentageDivide the count of claim lines from STEP 2 by the count of claim lines from STEP 1	N/A
11/20/2025	4.0.22	ALL-17-005-5	UPDATE	Annotation	Calculate the percentage of paid IP claim lines that do not link to a claim header	N/A
11/20/2025	4.0.22	ALL-17-005-5	UPDATE	Specification	STEP 1: Active paid IP claims during DQ report monthDefine the IP claims universe at the line level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND, and keep all claims, including orphan lines1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines)1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Drop line duplicatesDuplicates are dropped at the line level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and LINE-ADJUSTMENT-IND.1e. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Orphan linesOf the claim lines that meet the criteria from STEP 1, keep claim lines that did not merge to any claim headerSTEP 3: Calculate percentageDivide the count of claim lines from STEP 2 by the count of claim lines from STEP 1	N/A
11/20/2025	4.0.22	ALL-17-004-4	UPDATE	Annotation	Calculate the percentage of paid RX claim headers that do not have corresponding claim lines	N/A
11/20/2025	4.0.22	ALL-17-004-4	UPDATE	Specification	STEP 1: Active paid RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND, and keep all claims, even if there is no match1c. Keep headers and associated lines if header is not denied1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Drop Header DuplicatesDuplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.1e. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Childless headersOf the claim headers that meet the criteria from STEP 1, keep claim headers that did not merge to any claim lineSTEP 3: Calculate percentageDivide the count of claim headers from STEP 2 by the count of claim headers from STEP 1	N/A
11/20/2025	4.0.22	ALL-17-003-3	UPDATE	Annotation	Calculate the percentage of paid OT claim headers that do not have corresponding claim lines	N/A
11/20/2025	4.0.22	ALL-17-003-3	UPDATE	Specification	STEP 1: Active paid OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND, and keep all claims, even if there is no match1c. Keep headers and associated lines if header is not denied1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Drop Header DuplicatesDuplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.1e. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Childless headersOf the claim headers that meet the criteria from STEP 1, keep claim headers that did not merge to any claim lineSTEP 3: Calculate percentageDivide the count of claim headers from STEP 2 by the count of claim headers from STEP 1	N/A
11/20/2025	4.0.22	ALL-17-002-2	UPDATE	Annotation	Calculate the percentage of paid LT claim headers that do not have corresponding claim lines	N/A
11/20/2025	4.0.22	ALL-17-002-2	UPDATE	Specification	STEP 1: Active paid LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND, and keep all claims, even if there is no match1c. Keep headers and associated lines if header is not denied1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Drop Header DuplicatesDuplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.1e. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Childless headersOf the claim headers that meet the criteria from STEP 1, keep claim headers that did not merge to any claim lineSTEP 3: Calculate percentageDivide the count of claim headers from STEP 2 by the count of claim headers from STEP 1	N/A
11/20/2025	4.0.22	ALL-17-001-1	UPDATE	Annotation	Calculate the percentage of paid IP claim headers that do not have corresponding claim lines	N/A
11/20/2025	4.0.22	ALL-17-001-1	UPDATE	Specification	STEP 1: Active paid IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND, and keep all claims, even if there is no match1c. Keep headers and associated lines if header is not denied1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Drop Header DuplicatesDuplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.1e. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Childless headersOf the claim headers that meet the criteria from STEP 1, keep claim headers that did not merge to any claim lineSTEP 3: Calculate percentageDivide the count of claim headers from STEP 2 by the count of claim headers from STEP 1	N/A
11/20/2025	4.0.22	ALL-16-011-11	UPDATE	Annotation	Calculate the percentage of OT claim lines with TYPE-OF-SERVICE= "025" or "085” that are linked to an MSIS ID where SEX is "M"	N/A
11/20/2025	4.0.22	ALL-16-011-11	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Non-missing beginning date of serviceOf the claim lines that meet the criteria from STEP 1, restrict to non-missing BEGINNING-DATE-OF-SERVICESTEP 3: Link claims to primary demographicsKeep all claims from STEP 2 for which the MSIS ID on the claim is also found on a PRIMARY-DEMOGRAPHICS-ELG00002 segment, where the following is true:1. Claims BEGINNING-DATE-OF-SERVICE>= PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE 2. Claims BEGINNING-DATE-OF-SERVICE <= PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE OR missingSTEP 4: Non-missing SexOf the claims that meet the criteria from STEP 3, restrict to non-missing SEXSTEP 5: Nurse-midwife service or Prenatal care and pre-pregnancy family planning services and supplies type of serviceOf claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-SERVICE = "025" or "085"STEP 6: Sex is "M"Of claims that meet the criteria from STEP 5, further restrict them by the following criteria:1. SEX = "M"STEP 7: Calculate percentageDivide the count of claim lines from STEP 6 by the count of claim lines from STEP 5	N/A
11/20/2025	4.0.22	ALL-16-008-8	UPDATE	Annotation	Calculate the percentage of paid RX claim line record segments containing a missing value for adjudication date	N/A
11/20/2025	4.0.22	ALL-16-008-8	UPDATE	Specification	STEP 1: Active paid RX claims during DQ report monthDefine the RX claims universe at the line level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND, and keep all claims, including orphan lines1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines)1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Missing adjudication dateOf the claim lines that meet the criteria from STEP 2, select those where:1. ADJUDICATION-DATE is missingSTEP 3: Calculate percentageDivide the count of rows from STEP 2 by the count of rows from STEP 1	N/A
11/20/2025	4.0.22	ALL-16-006-6	UPDATE	Annotation	Calculate the percentage of paid OT claim line record segments containing a missing value for adjudication date	N/A
11/20/2025	4.0.22	ALL-16-006-6	UPDATE	Specification	STEP 1: Active paid OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND, and keep all claims, including orphan lines1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines)1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Missing adjudication dateOf the claim lines that meet the criteria from STEP 2, select those where:1. ADJUDICATION-DATE is missingSTEP 3: Calculate percentageDivide the count of rows from STEP 2 by the count of rows from STEP 1	N/A
11/20/2025	4.0.22	ALL-16-004-4	UPDATE	Annotation	Calculate the percentage of paid LT claim line record segments containing a missing value for adjudication date	N/A
11/20/2025	4.0.22	ALL-16-004-4	UPDATE	Specification	STEP 1: Active paid LT claims during DQ report monthDefine the LT claims universe at the line level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND, and keep all claims, including orphan lines1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines)1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Missing adjudication dateOf the claim lines that meet the criteria from STEP 2, select those where:1. ADJUDICATION-DATE is missingSTEP 3: Calculate percentageDivide the count of rows from STEP 2 by the count of rows from STEP 1	N/A
11/20/2025	4.0.22	ALL-16-002-2	UPDATE	Annotation	Calculate the percentage of paid IP claim line record segments containing a missing value for adjudication date	N/A
11/20/2025	4.0.22	ALL-16-002-2	UPDATE	Specification	STEP 1: Active paid IP claims during DQ report monthDefine the IP claims universe at the line level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND, and keep all claims, including orphan lines1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines)1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Missing adjudication dateOf the claim lines that meet the criteria from STEP 2, select those where:1. ADJUDICATION-DATE is missingSTEP 3: Calculate percentageDivide the count of rows from STEP 2 by the count of rows from STEP 1	N/A
11/20/2025	4.0.22	ALL-15-006-6	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP FFS and Encounter: original and adjustment, paid OT claim lines with missing Procedure Code and Revenue Code	N/A
11/20/2025	4.0.22	ALL-15-006-6	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS and Encounter: Original and Adjustment, Paid ClaimsOf the claim lines that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" or "A" or "C"STEP 3: Missing procedure code and revenue codeOf the claim lines that meet the criteria from STEP 2, restrict to claims that meet all of the following criteria: 1. PROCEDURE-CODE is missing2. REVENUE-CODE is missingSTEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
11/20/2025	4.0.22	ALL-15-005-5	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP FFS and Encounter: original and adjustment, paid OT claim lines with non-missing Revenue Code that have missing Type of Bill	N/A
11/20/2025	4.0.22	ALL-15-005-5	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS and Encounter: Original and Adjustment, Paid ClaimsOf the claim lines that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" or "A" or "C"STEP 3: Non-missing revenue codeOf the claim lines that meet the criteria from STEP 2, further restrict by the following criteria: 1. REVENUE-CODE is not missingSTEP 4: Type of bill is missingOf the claim lines that meet the criteria from STEP 3, restrict to claims that meet the following criteria: 1. TYPE-OF-BILL is missingSTEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 3	N/A
11/20/2025	4.0.22	ALL-15-004-4	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP FFS and Encounter: original and adjustment, paid OT claim lines with non-missing Type of Bill that are missing Revenue Code	N/A
11/20/2025	4.0.22	ALL-15-004-4	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS and Encounter: Original and Adjustment, Paid ClaimsOf the claim lines that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" or "A" or "C"STEP 3: Non-missing type of billOf the claim lines that meet the criteria from STEP 2, further restrict by the following criteria: 1. TYPE-OF-BILL is not missingSTEP 4: Revenue code is missingOf the claim lines that meet the criteria from STEP 3, restrict to claims that meet the following criteria: 1. REVENUE-CODE is missingSTEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 3	N/A
11/20/2025	4.0.22	ALL-15-003-3	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP FFS and Encounter: original and adjustment, paid OT claim lines with missing Type of Bill and Place of Service	N/A
11/20/2025	4.0.22	ALL-15-003-3	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS and Encounter: Original and Adjustment, Paid ClaimsOf the claim lines that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" or "A" or "C"STEP 3: Missing type of bill and place of serviceOf the claim lines that meet the criteria from STEP 2, restrict to claims that meet all of the following criteria: 1. TYPE-OF-BILL is missing2. PLACE-OF-SERVICE is missingSTEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
11/20/2025	4.0.22	ALL-15-002-2	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP FFS and Encounter: original and adjustment, paid OT claims that are not missing type of service or place of service	N/A
11/20/2025	4.0.22	ALL-15-002-2	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS and Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" or "A" or "C"STEP 3: Non-missing type of bill and place of serviceOf the claims that meet the criteria from STEP 2, restrict to claims that meet all of the following criteria: 1. TYPE-OF-BILL is not missing2. PLACE-OF-SERVICE is not missingSTEP 4: Calculate percentageDivide the number of claims from STEP 3 by the number of claims from STEP 2	N/A
11/20/2025	4.0.22	ALL-15-001-1	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP FFS and Encounter: original and adjustment, paid OT claims with non-missing place-of-service that are missing a procedure-code	N/A
11/20/2025	4.0.22	ALL-15-001-1	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS and Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" or "A" or "C"STEP 3: Non-missing place of serviceOf the claims that meet the criteria from STEP 2, restrict to non-missing PLACE-OF-SERVICESTEP 4: Procedure code is missingOf the claims that meet the criteria from STEP 3, restrict to claims that meet the following criteria: 1. PROCEDURE-CODE is missingSTEP 5: Calculate percentageDivide the number of claims from STEP 4 by the number of claims from STEP 3	N/A
11/20/2025	4.0.22	ALL-13-003-5	UPDATE	Annotation	The percentage of MSIS IDs with a restricted benefits code of 2 (alien status) that have Medicaid FFS and Encounter: original, paid IP claims that are not emergency room or pregnancy-related services	N/A
11/20/2025	4.0.22	ALL-13-003-5	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the header level by importing headers, lines, and DX segments that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.For DX segments:1. DX segments merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 2: Medicaid FFS and Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3"2. ADJUSTMENT_IND = "0"STEP 3: Non-missing admission dateOf the claims that meet the criteria from STEP 2, restrict to non-missing ADMISSION-DATESTEP 4: Link claims to enrollment time spanKeep all claims from STEP 3 for which the MSIS ID on the claim is also found on an ENROLLMENT-TIME-SPAN-ELG00021 segmentSTEP 5: Alien during date of serviceLink MSIS-IDs from the claims in STEP 4 to the ELIGIBILITY-DETERMINANTS-ELG00005 file segment and keep segments that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12. RESTRICTED-BENEFIT-CODE = "2"3. Claims ADMISSION-DATE>= ELIGIBILITY-DETERMINANT-EFF-DATE4. Claims ADMISSION-DATE <= ELIGIBILITY-DETERMINANT-END-DATE OR ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 6: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 5, limit to unique MSIS-IDsSTEP 7: Non-emergency room and non-pregnancy related servicesOf the claims that meet the criteria from STEP 5, restrict to claims that do NOT have emergency room revenue codes or pregnancy-related diagnosis codes or procedure codes:NOT (1a. REVENUE-CODE equal to ("450", "451", "452", "453", "454", "455", "456", "457", "458", "459", "0450", "0451", "0452", "0453", "0454", "0455", "0456", "0457", "0458", "0459" ,“0981”,“0720”, “0721”, “0722”, “0723”, “0724”, “0729”)OR2a. PROCEDURE-CODE-1 through PROCEDURE-CODE-6 is found in the Pregnancy CodeSet tab for ICD-10-PCM code typesOR2a. has any DX segment where DIAGNOSIS-CODE is found in the Pregnancy CodeSet tab for ICD-10-CM code typesSTEP 8: Calculate percentageDivide the count of unique MSIS-IDs from STEP 7 by the count of MSIS-IDs from STEP 6.	N/A
10/07/2025	4.0.19	Data Quality Measures	UPDATE	Version text	4.0.1	4.0.3
11/07/2025	4.0.21	ELG.005.095	UPDATE	Definition	The reason for a complete loss/termination in an individual's eligibility for Medicaid and CHIP. The end date of the segment in which the value is reported must represent the date that the complete loss/termination of Medicaid and CHIP eligibility occurred. The reason for the termination represents the reason that the segment in which it was reported was closed. If for a single termination in eligibility for a single individual there are multiple distinct co-occurring values in the state's system explaining the reason for the termination, and if one of the multiple co-occurring values maps to T-MSIS ELIGIBILITY-CHANGE-REASON value '21'; (Other) '22'; (Unknown), then the state should not report the co-occurring value '21'; and/or '22'; to T-MSIS. If there are multiple co-occurring distinct values between '01'; and '19', then the state should choose whichever is first in the state's system. Of the values that could logically co-occur in the range of '01'; through '19', CMS does not currently have a preference for any one value over another. Do not populate if at the time someone loses Medicaid eligibility they become eligible for and enrolled in CHIP. Also do not populate if at the time someone loses CHIP eligibility they become eligible for and enrolled in Medicaid.	The reason for a complete loss/termination in an individual's eligibility for Medicaid and CHIP. The end date of the segment in which the value is reported must represent the date that the complete loss/termination of Medicaid and CHIP eligibility occurred. The reason for the termination represents the reason that the segment in which it was reported was closed. If for a single termination in eligibility for a single individual there are multiple distinct co-occurring values in the state's system explaining the reason for the termination, and if one of the multiple co-occurring values maps to T-MSIS ELIGIBILITY-TERMIMNATION-REASON value '21'; (Unknown) '22'; (Other), then the state should not report the co-occurring value '21'; and/or '22'; to T-MSIS. If there are multiple co-occurring distinct values between '01'; and '19', then the state should choose whichever is first in the state's system. Of the values that could logically co-occur in the range of '01'; through '19', CMS does not currently have a preference for any one value over another. Do not populate if at the time someone loses Medicaid eligibility they become eligible for and enrolled in CHIP. Also do not populate if at the time someone loses CHIP eligibility they become eligible for and enrolled in Medicaid.
10/10/2025	4.0.19	COT.003.261	UPDATE	Coding requirement	1. Value must not be more than 28 characters long2. Situational	1. Value must not be more than 28 characters2. Situational
10/10/2025	4.0.19	COT.003.260	UPDATE	Coding requirement	1. Value must not be more than 60 characters long2. SItuational3. Value must not be equal to associated Address Line 14. There must be an Address Line 1 in order to have an Address Line 25. Value must not contain a pipe or asterisk symbols	1. Value must not be more than 60 characters2. SItuational3. Value must not be equal to associated Address Line 14. There must be an Address Line 1 in order to have an Address Line 25. Value must not contain a pipe or asterisk symbols
10/10/2025	4.0.19	COT.003.259	UPDATE	Coding requirement	1. Value must not be more than 60 characters long2. Situational3. Value must not contain a pipe or asterisk symbols	1. Value must not be more than 60 characters2. Situational3. Value must not contain a pipe or asterisk symbols
10/10/2025	4.0.19	COT.003.255	UPDATE	Coding requirement	1. Value must not be more than 76 characters long2. Situational	1. Value must not be more than 76 characters2. Situational
07/31/2025	4.0.15	COT.003.225	UPDATE	De size	S9(9)V(9)	S9(9)V9(9)
10/10/2025	4.0.19	COT.002.244	UPDATE	Coding requirement	1. Value must not be more than 28 characters long2. Situational	1. Value must not be more than 28 characters2. Situational
10/10/2025	4.0.19	COT.002.243	UPDATE	Coding requirement	1. Value must not be more than 60 characters long2. Situational3. Value must not be equal to associated Address Line 14. There must be an Address Line 1 in order to have an Address Line 25. Value must not contain a pipe or asterisk symbols	1. Value must not be more than 60 characters2. Situational3. Value must not be equal to associated Address Line 14. There must be an Address Line 1 in order to have an Address Line 25. Value must not contain a pipe or asterisk symbols
10/10/2025	4.0.19	COT.002.242	UPDATE	Coding requirement	1. Value must not be more than 60 characters long2. Situational3. Value must not contain a pipe or asterisk symbols	1. Value must not be more than 60 characters2. Situational3. Value must not contain a pipe or asterisk symbols
10/10/2025	4.0.19	COT.002.237	UPDATE	Coding requirement	1. Value must not be more than 60 characters long2. Situational3. Value must not be equal to associated Address Line 14. Value must not contain a pipe or asterisk symbols5. There must be an Address Line 1 in order to have an Address Line 2	1. Value must not be more than 60 characters2. Situational3. Value must not be equal to associated Address Line 14. Value must not contain a pipe or asterisk symbols5. There must be an Address Line 1 in order to have an Address Line 2
07/17/2025	4.0.14	FTX.095.401	UPDATE	Necessity	Conditional	Situational
10/23/2025	4.0.20	FTX.004.127	UPDATE	Definition	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique 'key' value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ MSIS-IDENTIFICATION-NUM is conditional in the FTX00004 segment because some members of a private group policy may not be eligible for Medicaid or CHIP, though at least one member of the group policy must be eligible for Medicaid or CHIP. There should be one FTX00004 segment for each member of the group policy for which the premium assistance payment is being paid, regardless of whether the member of the group policy was eligible for and enrolled in Medicaid or CHIP.	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique 'key' value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ MSIS-IDENTIFICATION-NUM is situational in the FTX00004 segment because some members of a private group policy may not be eligible for Medicaid or CHIP, though at least one member of the group policy must be eligible for Medicaid or CHIP. There should be one FTX00004 segment for each member of the group policy for which the premium assistance payment is being paid, regardless of whether the member of the group policy was eligible for and enrolled in Medicaid or CHIP.
10/23/2025	4.0.20	FTX.004.126	UPDATE	Necessity	Situational	Mandatory
10/23/2025	4.0.20	FTX.004.126	UPDATE	Coding requirement	1. Value must not contain a pipe or asterisk symbol2. Value must be 20 characters or less3. Situational	1. Value must not contain a pipe or asterisk symbol2. Value must be 20 characters or less3. Mandatory
10/23/2025	4.0.20	FTX.003.087	UPDATE	Necessity	Situational	Mandatory
10/23/2025	4.0.20	FTX.003.087	UPDATE	Definition	Member identification number as it appears on the card issued by the TPL insurance carrier.	The subscriber’s identification number or a dependent’s identification number as assigned by the TPL insurance carrier (i.e., the IDs that are on the insurance card issued by the TPL insurance carrier). There should be one FTX00003 segment for each covered life on the policy for which the premium assistance payment is made, regardless of whether that specific covered life is eligible for and enrolled in Medicaid or CHIP. This data element should be populated on each of the FTX000003 segments related to the covered lives on the individual market commercial health insurance policy for the coverage period. The insurance policy and coverage period is identified by the following data elements on the FTX.003 transaction: o SUBMITTING-STATE (FTX.003.065) o INSURANCE-CARRIER-ID-NUM (FTX.003.084) o INSURANCE-PLAN-ID (FTX.003.085) o PREMIUM-PERIOD-START-DATE (FTX.003.088) o PREMIUM-PERIOD-END-DATE (FTX.003.089)
10/23/2025	4.0.20	FTX.003.087	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Situational	1. Value must be 20 characters or less2. Mandatory
10/23/2025	4.0.20	FTX.003.085	UPDATE	Necessity	Situational	Mandatory
10/23/2025	4.0.20	FTX.003.085	UPDATE	Coding requirement	1. Value must not contain a pipe or asterisk symbol2. Value must be 20 characters or less3. Situational	1. Value must not contain a pipe or asterisk symbol2. Value must be 20 characters or less3. Mandatory
10/10/2025	4.0.19	CRX.003.179	UPDATE	Coding requirement	1. Value must not be more than 76 characters long2. Situational	1. Value must not be more than 76 characters2. Situational
07/17/2025	4.0.14	CRX.003.171	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situaitional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/31/2025	4.0.15	CRX.003.131	UPDATE	De size	S9(9)V(9)	S9(9)V9(9)
07/17/2025	4.0.14	CRX.003.118	UPDATE	Coding requirement	1. Value must be 12 characters or less2. Situaitional	1. Value must be 12 characters or less2. Situational
10/10/2025	4.0.19	CLT.003.260	UPDATE	Coding requirement	1. Value must not be more than 76 characters long2. Situational	1. Value must not be more than 76 characters2. Situational
07/31/2025	4.0.15	CLT.003.230	UPDATE	De size	S9(9)V(9)	S9(9)V9(9)
10/10/2025	4.0.19	CLT.002.252	UPDATE	Coding requirement	1. Value must not be more than 28 characters long2. Situational	1. Value must not be more than 28 characters2. Situational
10/10/2025	4.0.19	CLT.002.251	UPDATE	Coding requirement	1. Value must not be more than 60 characters long2. Situational3. Value must not be equal to associated Address Line 14. There must be an Address Line 1 in order to have an Address Line 25. Value must not contain a pipe or asterisk symbols	1. Value must not be more than 60 characters2. Situational3. Value must not be equal to associated Address Line 14. There must be an Address Line 1 in order to have an Address Line 25. Value must not contain a pipe or asterisk symbols
10/10/2025	4.0.19	CLT.002.250	UPDATE	Coding requirement	1. Value must not be more than 60 characters long2. Situational3. Value must not contain a pipe or asterisk symbols	1. Value must not be more than 60 characters2. Situational3. Value must not contain a pipe or asterisk symbols
10/10/2025	4.0.19	CLT.002.245	UPDATE	Coding requirement	1. Value must not be more than 60 characters long2. Situational3. Value must not be equal to associated Address Line 14. Value must not contain a pipe or asterisk symbols5. There must be an Address Line 1 in order to have an Address Line 2	1. Value must not be more than 60 characters2. Situational3. Value must not be equal to associated Address Line 14. Value must not contain a pipe or asterisk symbols5. There must be an Address Line 1 in order to have an Address Line 2
10/10/2025	4.0.19	CIP.003.314	UPDATE	Coding requirement	1. Value must not be more than 76 characters long2. Situational	1. Value must not be more than 76 characters2. Situational
07/31/2025	4.0.15	CIP.003.278	UPDATE	De size	S9(9)V(9)	S9(9)V9(9)
10/10/2025	4.0.19	CIP.002.306	UPDATE	Coding requirement	1. Value must not be more than 28 characters long2. Situational	1. Value must not be more than 28 characters2. Situational
10/10/2025	4.0.19	CIP.002.305	UPDATE	Coding requirement	1. Value must not be more than 60 characters long2. Situational3. Value must not be equal to associated Address Line 14. There must be an Address Line 1 in order to have an Address Line 25. Value must not contain a pipe or asterisk symbols	1. Value must not be more than 60 characters2. Situational3. Value must not be equal to associated Address Line 14. There must be an Address Line 1 in order to have an Address Line 25. Value must not contain a pipe or asterisk symbols
10/10/2025	4.0.19	CIP.002.304	UPDATE	Coding requirement	1. Value must not be more than 60 characters long2. Situational3. Value must not contain a pipe or asterisk symbols	1. Value must not be more than 60 characters2. Situational3. Value must not contain a pipe or asterisk symbols
10/10/2025	4.0.19	CIP.002.299	UPDATE	Coding requirement	1. Value must not be more than 60 characters long2. Situational3. Value must not be equal to associated Address Line 14. Value must not contain a pipe or asterisk symbols5. There must be an Address Line 1 in order to have an Address Line 2	1. Value must not be more than 60 characters2. Situational3. Value must not be equal to associated Address Line 14. Value must not contain a pipe or asterisk symbols5. There must be an Address Line 1 in order to have an Address Line 2
07/17/2025	4.0.14	CIP.002.072	UPDATE	Necessity	Situational	Conditional
08/13/2025	4.0.16	Data Quality Measures	UPDATE	Version text	4.0.0	4.0.1
10/23/2025	4.0.20	PRV.006.088	UPDATE	Definition	A code to identify the schema used in the Provider Classification Code field to categorize providers. See T-MSIS Guidance Document, "CMS Guidance: Best Practice for Reporting Provider Classification Type and Provider Classification Code in the T-MSIS Provider File". https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/cms-technical-instructions-provider-classification-requirements-in-tmsis/ A provider may be reported with multiple active record segments with the same Provider Classification Type if different Provider Classification Code values apply.	A code to identify the schema used in the Provider Classification Code field to categorize providers. See T-MSIS Guidance Document, "CMS Technical Instructions: Provider Classification Requirements in T-MSIS". https://www.medicaid.gov/tmsis/dataguide/v4/technical-instructions/cms-technical-instructions-provider-classification-requirements-in-tmsis/ A provider may be reported with multiple active record segments with the same Provider Classification Type if different Provider Classification Code values apply.
07/10/2025	4.0.13	FTX.095.400	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.095.400	UPDATE	Coding requirement	1. Value must be 15 characters or less2. Conditional	1. Value must be 15 characters or less2. Situational
07/10/2025	4.0.13	FTX.095.383	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.095.383	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Conditional3. When populated, value must match MSIS Identification Number (ELG.002.019)4. When populated and Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Payment Period Start Date is equal to or greater than Enrollment Effective Date	1. Value must be 20 characters or less2. Situational3. When populated, value must match MSIS Identification Number (ELG.002.019)4. When populated and Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Payment Period Start Date is equal to or greater than Enrollment Effective Date
10/10/2025	4.0.19	FTX.095.368	UPDATE	Definition	This is the identifier that corresponds with the payer's role in relation to the Medicaid/CHIP system. The payer is the subject taking the action of either making a payment or taking a recoupment, as opposed to the payee who is the object of the transaction. The payer is the entity that is either making a payment or recouping a payment from another entity or individual. The payee is the individual or entity that is either receiving a payment or having a previous payment recouped.	The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.).
07/10/2025	4.0.13	FTX.009.351	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.009.351	UPDATE	Coding requirement	1. Value must be 15 characters or less2. Conditional	1. Value must be 15 characters or less2. Situational
07/10/2025	4.0.13	FTX.008.312	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.008.312	UPDATE	Coding requirement	1. Value must be 15 characters or less2. Conditional	1. Value must be 15 characters or less2. Situational
07/10/2025	4.0.13	FTX.007.272	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.007.272	UPDATE	Coding requirement	1. Value must be 15 characters or less2. Conditional	1. Value must be 15 characters or less2. Situational
07/10/2025	4.0.13	FTX.006.229	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.006.229	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Value Based Payment Model Type List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Value Based Payment Model Type List (VVL)3. Situational
07/10/2025	4.0.13	FTX.006.228	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.006.228	UPDATE	Coding requirement	1. Value must be 15 characters or less2. Conditional	1. Value must be 15 characters or less2. Situational
07/10/2025	4.0.13	FTX.006.215	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.006.215	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Conditional3. When populated, value must match MSIS Identification Number (ELG.002.019)4. When populated and Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Performance Period Start Date is equal to or greater than Enrollment Effective Date	1. Value must be 20 characters or less2. Situational3. When populated, value must match MSIS Identification Number (ELG.002.019)4. When populated and Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Performance Period Start Date is equal to or greater than Enrollment Effective Date
07/10/2025	4.0.13	FTX.005.186	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.005.186	UPDATE	Coding requirement	1. Value must be 15 characters or less2. Conditional	1. Value must be 15 characters or less2. Situational
07/10/2025	4.0.13	FTX.004.143	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.004.143	UPDATE	Coding requirement	1. Value must be 15 characters or less2. Conditional	1. Value must be 15 characters or less2. Situational
07/10/2025	4.0.13	FTX.004.128	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.004.128	UPDATE	Coding requirement	1. Value must be 9-digit number2. Conditional	1. Value must be 9-digit number2. Situational
07/10/2025	4.0.13	FTX.004.127	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.004.127	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Conditional3. When populated, value must match MSIS Identification Number (ELG.002.019)4. When populated and Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Premium Period Start Date is equal to or greater than Enrollment Effective Date	1. Value must be 20 characters or less2. Situational3. When populated, value must match MSIS Identification Number (ELG.002.019)4. When populated and Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Premium Period Start Date is equal to or greater than Enrollment Effective Date
07/10/2025	4.0.13	FTX.003.099	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.003.099	UPDATE	Coding requirement	1. Value must be 15 characters or less2. Conditional	1. Value must be 15 characters or less2. Situational
09/25/2025	4.0.18	FTX.003.086	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.0002.019)4. When Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Payment Period Start Date is equal to or greater than Enrollment Effective Date	1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.002.019)4. When Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Payment Period Start Date is equal to or greater than Enrollment Effective Date
07/10/2025	4.0.13	FTX.002.055	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.002.055	UPDATE	Coding requirement	1. Value must be 15 characters or less2. Conditional	1. Value must be 15 characters or less2. Situational
09/25/2025	4.0.18	FTX.002.047	UPDATE	Coding requirement	1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Value must be populated when Payer ID Type equals "01"6. Conditional	1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Value must be populated when Payer ID Type equals "01"6. Conditional7. If Subcapitation Indicator equals "2", then value must not be populated
07/17/2025	4.0.14	ELG.003.269	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	ELG.003.269	UPDATE	Coding requirement	1. Value must be between 000 and 400 inclusively2. Conditional	1. Value must be between 000 and 400 inclusively2. Situational
07/17/2025	4.0.14	ELG.003.044	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	ELG.003.044	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Conditional3. If Immigration Status (ELG.003.042) equals "8" (U.S. Citizen), then value should not be populated	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Situational3. If Immigration Status (ELG.003.042) equals "8" (U.S. Citizen), then value should not be populated
07/17/2025	4.0.14	ELG.003.038	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	ELG.003.038	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Income Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Income Code List (VVL)3. Situational
07/17/2025	4.0.14	ELG.003.034	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	ELG.003.034	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Marital Status List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Marital Status List (VVL)3. Situational
07/10/2025	4.0.13	CRX.003.136	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.003.136	UPDATE	Coding requirement	1. Value must be 5 characters or less2. Value must be in HCBS Taxonomy Code List (VVL)3. Conditional	1. Value must be 5 characters or less2. Value must be in HCBS Taxonomy Code List (VVL)3. Situational
09/25/2025	4.0.18	CRX.002.041	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals "2", value must equal the sum of line level Medicaid Paid Amounts.6. Conditional7. Value must be populated, when Type of Claim is in [1,A]8. Value must not be populated or equal to "0.00" when associated Claim Status is in [542,585,654]9. Value must not be greater than Total Allowed Amount (CRX.002.040)	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals "2", value must equal the sum of line level Medicaid Paid Amounts6. Conditional7. Value must be populated, when Type of Claim is in [1,A]8. Value must not be populated or equal to "0.00" when associated Claim Status is in [542,585,654]9. Value must not be greater than Total Allowed Amount (CRX.002.040)
07/17/2025	4.0.14	COT.003.188	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.188	UPDATE	Coding requirement	1. Value must be 5 characters or less2. Value must be in HCBS Taxonomy Code List (VVL)3. Conditional	1. Value must be 5 characters or less2. Value must be in HCBS Taxonomy Code List (VVL)3. SItuational
07/17/2025	4.0.14	COT.002.073	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.073	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Healthcare Acquired Condition Indicator List (VVL)3. Conditional	1. Value must be 1 character2. Value must be in Healthcare Acquired Condition Indicator List (VVL)3. Situational
09/25/2025	4.0.18	COT.002.050	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals "2", value must equal the sum of line level Medicaid Paid Amounts.6. Conditional7. Value must not be populated or equal to "0.00" when associated Claim Status is in [542,585,654]8. Value must not be greater than Total Allowed Amount (COT.002.049)	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals "2", value must equal the sum of line level Medicaid Paid Amounts6. Conditional7. Value must not be populated or equal to "0.00" when associated Claim Status is in [542,585,654]8. Value must not be greater than Total Allowed Amount (COT.002.049)
07/10/2025	4.0.13	CLT.002.091	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.091	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Healthcare Acquired Condition Indicator List (VVL)3. Conditional	1. Value must be 1 character2. Value must be in Healthcare Acquired Condition Indicator List (VVL)3. Situational
09/25/2025	4.0.18	CLT.002.065	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals "2", value must equal the sum of line level Medicaid Paid Amounts.6. Conditional7. Value must not be populated or equal to "0.00" when associated Claim Status is in [542,585,654]8. Value must not be greater than Total Allowed Amount (CLT.002.064)	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals "2", value must equal the sum of line level Medicaid Paid Amounts6. Conditional7. Value must not be populated or equal to "0.00" when associated Claim Status is in [542,585,654]8. Value must not be greater than Total Allowed Amount (CLT.002.064)
07/10/2025	4.0.13	CIP.003.261	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.003.261	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. NPPES Entity Type Code associate with this NPI must equal ‘1’ (Individual)	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Situational5. NPPES Entity Type Code associate with this NPI must equal ‘1’ (Individual)
07/10/2025	4.0.13	CIP.002.139	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.139	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Healthcare Acquired Condition Indicator List (VVL)3. Conditional	1. Value must be 1 character2. Value must be in Healthcare Acquired Condition Indicator List (VVL)3. Situational
09/25/2025	4.0.18	CIP.002.114	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals "2", value must equal the sum of line level Medicaid Paid Amounts.6. Conditional7. Value must not be populated or equal to "0.00" when associated Claim Status is in [542,585,654]8. Value must not be greater than Total Allowed Amount (CIP.002.113)	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals "2", value must equal the sum of line level Medicaid Paid Amounts6. Conditional7. Value must not be populated or equal to "0.00" when associated Claim Status is in [542,585,654]8. Value must not be greater than Total Allowed Amount (CIP.002.113)
07/10/2025	4.0.13	FTX.095.394	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.095.394	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Situational
11/07/2025	4.0.21	FTX.095.391	UPDATE	Necessity	Mandatory	Conditional
11/07/2025	4.0.21	FTX.095.391	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Mandatory	1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Conditional6. Value must be populated when Payer ID Type equals "01"
07/10/2025	4.0.13	FTX.009.346	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.009.346	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Situational
09/25/2025	4.0.18	FTX.009.343	UPDATE	Necessity	Mandatory	Conditional
09/25/2025	4.0.18	FTX.009.343	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Mandatory	1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Conditional
07/10/2025	4.0.13	FTX.008.307	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.008.307	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Situational
07/10/2025	4.0.13	FTX.007.267	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.007.267	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Situational
11/07/2025	4.0.21	FTX.007.264	UPDATE	Necessity	Mandatory	Conditional
11/07/2025	4.0.21	FTX.007.264	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Mandatory	1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Conditional6. Value must be populated when Payer ID Type equals "01"
07/10/2025	4.0.13	FTX.006.222	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.006.222	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Situational
10/10/2025	4.0.19	FTX.006.219	UPDATE	Necessity	Mandatory	Conditional
10/10/2025	4.0.19	FTX.006.219	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS Form List (VVL)3. When MBESCBES Form equals "2", value must be in 64.21COS Form List (VVL)4. When MBESCBES Form equals "3", value must be in 21COS Form List (VVL)5. Mandatory	1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS Form List (VVL)3. When MBESCBES Form equals "2", value must be in 64.21COS Form List (VVL)4. When MBESCBES Form equals "3", value must be in 21COS Form List (VVL)5. Conditional6. Value must be populated when Payer ID Type equals "01"
07/10/2025	4.0.13	FTX.005.180	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.005.180	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Situational
06/19/2025	4.0.11	FTX.005.177	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Mandatory6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)	1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Mandatory
07/10/2025	4.0.13	FTX.004.138	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.004.138	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Situational
09/25/2025	4.0.18	FTX.004.135	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. If Policy Owner Code equals "01", then value must be populated6. Conditional7. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated	1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Mandatory
06/19/2025	4.0.11	FTX.004.128	UPDATE	Definition	The SSN of the member of the group insurance policy. Each FTX00004 segment represents a different member of a given group insurance policy. Typically all members of the group insurance policy will have both an MSIS ID and an SSN. Under some circumstances, it's possible that or more members of a group insurance policy do not have an MSIS ID, but do have an SSN, if they are included on the group insurance policy but not eligible for Medicaid or CHIP. It�s also possible that one or more members of a group insurance policy do not have an SSN. If a member of a group insurance policy does not have an SSN, leave this field blank.	The SSN of the member of the group insurance policy. Each FTX00004 segment represents a different member of a given group insurance policy. Typically all members of the group insurance policy will have both an MSIS ID and an SSN. Under some circumstances, it's possible that or more members of a group insurance policy do not have an MSIS ID, but do have an SSN, if they are included on the group insurance policy but not eligible for Medicaid or CHIP. It’s also possible that one or more members of a group insurance policy do not have an SSN. If a member of a group insurance policy does not have an SSN, leave this field blank.
07/10/2025	4.0.13	FTX.003.094	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.003.094	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Situational
07/10/2025	4.0.13	FTX.002.049	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.002.049	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Situational
09/25/2025	4.0.18	FTX.002.046	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. If Subcapitation Indicator equals "1", then value must be populated6. Conditional7. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated	1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. If Subcapitation Indicator equals "1", then value must be populated6. Conditional7. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated8. If Subcapitation Indicator equals "2", then value must not be populated9. When not populated, an associated MBESCBES Form Group and MBESCBES Form must not be populated
06/19/2025	4.0.11	ELG.022.266	UPDATE	Coding requirement	1. Value must be 10 characters or less2. Value must be in Reason for Change List (VVL)3. ConditionalValue must be populated when Eligible Identifier Type (ELG.022.261) equals "2"(Old MSIS Identification Number)	1. Value must be 10 characters or less2. Value must be in Reason for Change List (VVL)3. Conditional4. Value must be populated when Eligible Identifier Type (ELG.022.261) equals "2"(Old MSIS Identification Number)
07/10/2025	4.0.13	CRX.002.069	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.069	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Situational
07/17/2025	4.0.14	COT.003.264	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.264	UPDATE	Coding requirement	1. Value must not be more than 2 characters2. Value must be in Place of Service Code List (VVL)3. Conditional4. If value is populated, then Revenue Code must not be populated	1. Value must not be more than 2 characters2. Value must be in Place of Service Code List (VVL)3. Situational4. If value is populated, then Revenue Code must not be populated
07/17/2025	4.0.14	COT.002.123	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.123	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Place of Service Code List (VVL)3. Conditional4. If value is populated, then Type of Bill must not be populated	1. Value must be 2 characters2. Value must be in Place of Service Code List (VVL)3. Situational4. If value is populated, then Type of Bill must not be populated
07/17/2025	4.0.14	COT.002.111	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.111	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Situational
06/19/2025	4.0.11	CLT.002.148	UPDATE	Coding requirement	1. Value must be numeric2. Value must be 5 digits or less3. ConditionalValue must be populated when Type of Service (CLT.003.211) is in [009,045,046,047,059](Intermediate Care Facility for Individuals with Intellectual Disabilities)	1. Value must be numeric2. Value must be 5 digits or less3. Conditional4. Value must be populated when Type of Service (CLT.003.211) is in [009,045,046,047,059](Intermediate Care Facility for Individuals with Intellectual Disabilities)
07/10/2025	4.0.13	CLT.002.129	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.129	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Situational
06/19/2025	4.0.11	CLT.002.086	UPDATE	Coding requirement	1. Value must be a positive integer2. Value must be between 00000:99999 (inclusive)3. Conditional4. The sum of the value provided here plus the Non Covered Days (CLT.002.084) must be less than or equal to the number of days between Beginning Date of Service (CLT.002.048) and Ending Date of Service (CLT.002.049) plus one day5. Value must be 5 digits or lessValue is required if the associated Type of Service (CLT.003.211) in [044,048,050] (inpatient mental health/psychiatric services)	1. Value must be a positive integer2. Value must be between 00000:99999 (inclusive)3. Conditional4. The sum of the value provided here plus the Non Covered Days (CLT.002.084) must be less than or equal to the number of days between Beginning Date of Service (CLT.002.048) and Ending Date of Service (CLT.002.049) plus one day5. Value must be 5 digits or less6. Value is required if the associated Type of Service (CLT.003.211) in [044,048,050] (inpatient mental health/psychiatric services)
07/10/2025	4.0.13	CIP.002.178	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.178	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Situational
11/20/2025	4.0.22	MCR.010.119	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbol3. Mandatory	1. Value must be 30 characters or less2. Value must be in Managed Care Other ID 3 List3. Mandatory
06/19/2025	4.0.11	Data Quality Measures	UPDATE	Version text	4.0.9	4.0.0
06/05/2025	4.0.10	FTX.095.394	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional
06/05/2025	4.0.10	FTX.095.391	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. Mandatory	1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Mandatory
06/05/2025	4.0.10	FTX.095.383	UPDATE	Definition	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique �key� value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique 'key' value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/
10/10/2025	4.0.19	FTX.095.371	UPDATE	Definition	This describes the type of managed care plan or care coordination model of the payer, when applicable. The valid value list is comprised of the standard managed care plan type list from the MCR and ELG files and a complementary list of care coordination models.	The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.).
10/10/2025	4.0.19	FTX.095.370	UPDATE	Definition	This is a description of what the payer ID represents when the payer ID was reported with a payer type of "Other".	The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.).
10/10/2025	4.0.19	FTX.095.369	UPDATE	Definition	This is a qualifier that indicates what type of ID the payer ID is. For example, if the payer ID represents the state Medicaid or CHIP agency, then the payer ID type will indicate that the payer ID should be interpreted as a submitting state code.	The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.).
07/10/2025	4.0.13	FTX.095.367	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.095.367	UPDATE	Coding requirement	1. Value must be 15 characters or less2. When populated, value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Conditional	1. Value must be 15 characters or less2. When populated, value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Situational
07/10/2025	4.0.13	FTX.095.366	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.095.366	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Conditional4. Value of the CC component must be equal to "20"	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Situational4. Value of the CC component must be equal to "20"
10/10/2025	4.0.19	FTX.095.365	UPDATE	Definition	The dollar amount being paid to the payee or recouped from the payee for a previous payment. A recoupment should be reported as a negative amount.	The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.).
10/10/2025	4.0.19	FTX.095.364	UPDATE	Definition	The date that the payment or recoupment was executed by the payer.	The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.).
10/10/2025	4.0.19	FTX.095.363	UPDATE	Definition	Indicates the type of adjustment record.	The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.).
06/19/2025	4.0.11	FTX.095.361	UPDATE	Definition	A unique claim/transaction number assigned by the state�s payment system that identifies the adjustment claim/transaction for an original item control number.	A unique claim/transaction number assigned by the state’s payment system that identifies the adjustment claim/transaction for an original item control number.
06/05/2025	4.0.10	FTX.009.346	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional
06/05/2025	4.0.10	FTX.009.343	UPDATE	Necessity	Conditional	Mandatory
06/05/2025	4.0.10	FTX.009.343	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. Mandatory	1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Mandatory
06/05/2025	4.0.10	FTX.009.322	UPDATE	Definition	A unique claim/transaction number assigned by the state�s payment system that identifies the adjustment claim/transaction for an original item control number.	A unique claim/transaction number assigned by the state's payment system that identifies the adjustment claim/transaction for an original item control number.
06/05/2025	4.0.10	FTX.008.307	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional
06/05/2025	4.0.10	FTX.008.283	UPDATE	Definition	A unique claim/transaction number assigned by the state�s payment system that identifies the adjustment claim/transaction for an original item control number.	A unique claim/transaction number assigned by the state's payment system that identifies the adjustment claim/transaction for an original item control number.
06/05/2025	4.0.10	FTX.007.267	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional
06/05/2025	4.0.10	FTX.007.264	UPDATE	Necessity	Conditional	Mandatory
06/05/2025	4.0.10	FTX.007.264	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. Mandatory	1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Mandatory
06/05/2025	4.0.10	FTX.007.240	UPDATE	Definition	A unique claim/transaction number assigned by the state�s payment system that identifies the adjustment claim/transaction for an original item control number.	A unique claim/transaction number assigned by the state's payment system that identifies the adjustment claim/transaction for an original item control number.
06/05/2025	4.0.10	FTX.006.229	UPDATE	Definition	This is the type of value-based payment model to which the financial transaction applies. These values come from the �Alternative Payment Model (APM) Framework Final White Paper�, produced by the Healthcare Learning and Action Network. https://hcp-lan.org/work products/apm-whitepaper.pdf	This is the type of value-based payment model to which the financial transaction applies. These values come from the 'Alternative Payment Model (APM) Framework Final White Paper', produced by the Healthcare Learning and Action Network. https://hcp-lan.org/work products/apm-whitepaper.pdf
06/05/2025	4.0.10	FTX.006.222	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional
06/05/2025	4.0.10	FTX.006.215	UPDATE	Definition	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique �key� value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique 'key' value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/
06/05/2025	4.0.10	FTX.006.196	UPDATE	Definition	A unique claim/transaction number assigned by the state�s payment system that identifies the adjustment claim/transaction for an original item control number.	A unique claim/transaction number assigned by the state's payment system that identifies the adjustment claim/transaction for an original item control number.
06/05/2025	4.0.10	FTX.005.180	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional
06/05/2025	4.0.10	FTX.005.177	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. Mandatory6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)	1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Mandatory6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)
06/05/2025	4.0.10	FTX.005.173	UPDATE	Definition	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique �key� value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique 'key' value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/
06/05/2025	4.0.10	FTX.005.153	UPDATE	Definition	A unique claim/transaction number assigned by the state�s payment system that identifies the adjustment claim/transaction for an original item control number.	A unique claim/transaction number assigned by the state's payment system that identifies the adjustment claim/transaction for an original item control number.
06/05/2025	4.0.10	FTX.004.138	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional
06/05/2025	4.0.10	FTX.004.135	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. If Policy Owner Code equals "01", then value must be populated6. Conditional7. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated	1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. If Policy Owner Code equals "01", then value must be populated6. Conditional7. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated
06/05/2025	4.0.10	FTX.004.128	UPDATE	Definition	The SSN of the member of the group insurance policy. Each FTX00004 segment represents a different member of a given group insurance policy. Typically all members of the group insurance policy will have both an MSIS ID and an SSN. Under some circumstances, it�s possible that or more members of a group insurance policy do not have an MSIS ID, but do have an SSN, if they are included on the group insurance policy but not eligible for Medicaid or CHIP. It�s also possible that one or more members of a group insurance policy do not have an SSN. If a member of a group insurance policy does not have an SSN, leave this field blank.	The SSN of the member of the group insurance policy. Each FTX00004 segment represents a different member of a given group insurance policy. Typically all members of the group insurance policy will have both an MSIS ID and an SSN. Under some circumstances, it's possible that or more members of a group insurance policy do not have an MSIS ID, but do have an SSN, if they are included on the group insurance policy but not eligible for Medicaid or CHIP. It�s also possible that one or more members of a group insurance policy do not have an SSN. If a member of a group insurance policy does not have an SSN, leave this field blank.
06/05/2025	4.0.10	FTX.004.127	UPDATE	Definition	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique �key� value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ MSIS-IDENTIFICATION-NUM is conditional in the FTX00004 segment because some members of a private group policy may not be eligible for Medicaid or CHIP, though at least one member of the group policy must be eligible for Medicaid or CHIP. There should be one FTX00004 segment for each member of the group policy for which the premium assistance payment is being paid, regardless of whether the member of the group policy was eligible for and enrolled in Medicaid or CHIP.	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique 'key' value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ MSIS-IDENTIFICATION-NUM is conditional in the FTX00004 segment because some members of a private group policy may not be eligible for Medicaid or CHIP, though at least one member of the group policy must be eligible for Medicaid or CHIP. There should be one FTX00004 segment for each member of the group policy for which the premium assistance payment is being paid, regardless of whether the member of the group policy was eligible for and enrolled in Medicaid or CHIP.
06/05/2025	4.0.10	FTX.004.109	UPDATE	Definition	A unique claim/transaction number assigned by the state�s payment system that identifies the adjustment claim/transaction for an original item control number.	A unique claim/transaction number assigned by the state's payment system that identifies the adjustment claim/transaction for an original item control number.
06/05/2025	4.0.10	FTX.003.094	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional
06/05/2025	4.0.10	FTX.003.091	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. Mandatory	1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Mandatory
06/05/2025	4.0.10	FTX.003.086	UPDATE	Definition	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique �key� value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique 'key' value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/
06/05/2025	4.0.10	FTX.003.068	UPDATE	Definition	A unique claim/transaction number assigned by the state�s payment system that identifies the adjustment claim/transaction for an original item control number.	A unique claim/transaction number assigned by the state's payment system that identifies the adjustment claim/transaction for an original item control number.
06/05/2025	4.0.10	FTX.002.049	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional
06/05/2025	4.0.10	FTX.002.046	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. If Subcapitation Indicator equals "1", then value must be populated6. Conditional7. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated	1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. If Subcapitation Indicator equals "1", then value must be populated6. Conditional7. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated
06/05/2025	4.0.10	FTX.002.021	UPDATE	Definition	A unique claim/transaction number assigned by the state�s payment system that identifies the adjustment claim/transaction for an original item control number.	A unique claim/transaction number assigned by the state's payment system that identifies the adjustment claim/transaction for an original item control number.
06/05/2025	4.0.10	ELG.005.276	UPDATE	Definition	A free-form text field where a state can identify the �other� authority used to extend eligibility; required when 995 is used.	A free-form text field where a state can identify the 'Other' authority used to extend eligibility.
06/19/2025	4.0.11	ELG.003.269	UPDATE	Definition	This data element provides the beneficiary's or their household's income as a percentage of the federal poverty level. Used to assign the beneficiary to the eligibility group that covered their Medicaid or CHIP benefits. If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group. A beneficiary�s income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group.	This data element provides the beneficiary's or their household's income as a percentage of the federal poverty level. Used to assign the beneficiary to the eligibility group that covered their Medicaid or CHIP benefits. If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group. A beneficiary’s income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group.
06/05/2025	4.0.10	ELG.012.172	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Value must have a corresponding value in Waiver Type (ELG.012.173)7. Mandatory	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Value must have a corresponding value in Waiver Type (ELG.012.173)7. Mandatory
06/05/2025	4.0.10	ELG.003.038	UPDATE	Definition	A code indicating the federal poverty level range in which the family income falls. If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group. A beneficiary�s income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group.	A code indicating the federal poverty level range in which the family income falls. If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group. A beneficiary's income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group.
06/05/2025	4.0.10	ELG.003.034	UPDATE	Definition	A code to classify eligible individual's marital/domestic-relationship status. This element should be reported by the state when the information is material to eligibility (i.e., institutionalization). Because there is no specific statutory or regulatory basis for defining marital status codes, they are being defined in a way that is as flexible for states and data users as possible. States can report at whatever level of granularity is available to them in their system and a data user can choose to use them as-is or roll the values up in broader categories depending on whichever approach best meets their needs. CMS periodically reviews the values reported to MARITAL-STATUS-OTHER-EXPLANATION to determine if states are appropriately using it only when there is no existing MARITAL-STATUS value that reflects the state�s marital status description for an individual AND to determine whether it is necessary to add additional T-MSIS MARITAL-STATUS values to reflect commonly used state martial status descriptions for which there is no existing T-MSIS MARITAL-STATUS value.	A code to classify eligible individual's marital/domestic-relationship status. This element should be reported by the state when the information is material to eligibility (i.e., institutionalization). Because there is no specific statutory or regulatory basis for defining marital status codes, they are being defined in a way that is as flexible for states and data users as possible. States can report at whatever level of granularity is available to them in their system and a data user can choose to use them as-is or roll the values up in broader categories depending on whichever approach best meets their needs. CMS periodically reviews the values reported to MARITAL-STATUS-OTHER-EXPLANATION to determine if states are appropriately using it only when there is no existing MARITAL-STATUS value that reflects the state's marital status description for an individual AND to determine whether it is necessary to add additional T-MSIS MARITAL-STATUS values to reflect commonly used state martial status descriptions for which there is no existing T-MSIS MARITAL-STATUS value.
06/05/2025	4.0.10	CRX.003.180	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated	1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated
06/05/2025	4.0.10	CRX.003.136	UPDATE	Definition	A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012. To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting. Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as �extended state plan� services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment. The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a state�s service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc. Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf"	A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012. To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting. Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as 'extended state plan' services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment. The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a state's service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc. Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf
06/19/2025	4.0.11	CRX.002.075	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Mandatory4. Value must exist in the NPPES NPI data file5. NPPES Entity Type Code associated with this NPI must equal �1� (Individual)	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Mandatory4. Value must exist in the NPPES NPI data file5. NPPES Entity Type Code associated with this NPI must equal ‘1’ (Individual)
06/05/2025	4.0.10	CRX.002.069	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional
06/05/2025	4.0.10	CRX.002.058	UPDATE	Definition	The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines� associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.	The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines' associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.
06/05/2025	4.0.10	CRX.002.032	UPDATE	Definition	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = �23� to indicate that the sub-capitated network provider provided the service directly to the enrollee.	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.
06/05/2025	4.0.10	CRX.002.029	UPDATE	Definition	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or �C� for an S-CHIP sub-capitated encounter record.	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or 'C' or an S-CHIP sub-capitated encounter record.
06/05/2025	4.0.10	COT.003.264	UPDATE	Definition	A pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claim form (i.e., 837P or 837D - Place of Service is only captured at the line level of the CMS-1500). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than �B�, then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS-1450 (UB-04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled.	A pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claim form (i.e., 837P or 837D - Place of Service is only captured at the line level of the CMS-1500). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than 'B', then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS-1450 (UB-04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled.
06/05/2025	4.0.10	COT.003.256	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated	1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated
06/19/2025	4.0.11	COT.003.254	UPDATE	Coding requirement	1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Conditional5. If Type of Claim is in [1,3,A,C,U,W] and a CPT-4 code or a CDT code (begins with the letter 'D'), then�value must be populated	1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Conditional5. If Type of Claim is in [1,3,A,C,U,W] and a CPT-4 code or a CDT code (begins with the letter 'D'), then value must be populated
06/19/2025	4.0.11	COT.003.190	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Conditional4. If Type of Claim (COT.002.037) not in [3,C,W], then value must match Provider Identifier (PRV.005.081)5. NPPES Entity Type Code associate with this NPI must equal �1� (Individual)6. Value must exist in the NPPES NPI data file	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Conditional4. If Type of Claim (COT.002.037) not in [3,C,W], then value must match Provider Identifier (PRV.005.081)5. NPPES Entity Type Code associate with this NPI must equal ‘1’ (Individual)6. Value must exist in the NPPES NPI data file
06/05/2025	4.0.10	COT.003.188	UPDATE	Definition	A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012. To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting. Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as �extended state plan� services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment. The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a state�s service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc. Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf"	A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012. To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting. Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as 'extended state plan' services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment. The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a state's service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc. Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf
06/05/2025	4.0.10	COT.002.123	UPDATE	Definition	A pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claim form (i.e., 837P or 837D - Place of Service is only captured at the line level of the CMS-1500). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than �B�, then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS-1450 (UB-04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled.	A pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claim form (i.e., 837P or 837D - Place of Service is only captured at the line level of the CMS-1500). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than 'B', then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS-1450 (UB-04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled.
06/05/2025	4.0.10	COT.002.111	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional
06/05/2025	4.0.10	COT.002.068	UPDATE	Definition	The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines� associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.	The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines' associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.
06/05/2025	4.0.10	COT.002.041	UPDATE	Definition	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = �23� to indicate that the sub-capitated network provider provided the service directly to the enrollee.	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.
06/05/2025	4.0.10	COT.002.037	UPDATE	Definition	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or �C� for an S-CHIP sub-capitated encounter record	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or 'C' or an S-CHIP sub-capitated encounter record
06/05/2025	4.0.10	CLT.003.261	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated	1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated
06/19/2025	4.0.11	CLT.003.213	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Conditional4. If Type of Claim (CLT.002.052) not in [3,C,W], then value must match Provider Identifier (PRV.005.081)5. NPPES Entity Type Code associate with this NPI must equal �1� (Individual)6. Value must exist in the NPPES NPI data file	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Conditional4. If Type of Claim (CLT.002.052) not in [3,C,W], then value must match Provider Identifier (PRV.005.081)5. NPPES Entity Type Code associate with this NPI must equal ‘1’ (Individual)6. Value must exist in the NPPES NPI data file
06/05/2025	4.0.10	CLT.002.129	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional
06/05/2025	4.0.10	CLT.002.082	UPDATE	Definition	The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines� associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.	The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines' associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.
06/05/2025	4.0.10	CLT.002.056	UPDATE	Definition	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = �23� to indicate that the sub-capitated network provider provided the service directly to the enrollee.	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.
06/05/2025	4.0.10	CLT.002.052	UPDATE	Definition	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or �C� for an S-CHIP sub-capitated encounter record.	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or 'C' or an S-CHIP sub-capitated encounter record.
06/05/2025	4.0.10	CIP.003.315	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated	1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated
06/19/2025	4.0.11	CIP.003.261	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. NPPES Entity Type Code associate with this NPI must equal �1� (Individual)	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. NPPES Entity Type Code associate with this NPI must equal ‘1’ (Individual)
06/05/2025	4.0.10	CIP.002.178	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional
06/19/2025	4.0.11	CIP.002.132	UPDATE	Definition	The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines� associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.	The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.
06/05/2025	4.0.10	CIP.002.104	UPDATE	Definition	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = �23� to indicate that the sub-capitated network provider provided the service directly to the enrollee.	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.
06/05/2025	4.0.10	CIP.002.100	UPDATE	Definition	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = "3" for a Medicaid sub-capitated encounter record or �C� for an S-CHIP sub-capitated encounter record.	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or 'C'or an S-CHIP sub-capitated encounter record.
10/07/2025	4.0.19	RULE-884	UPDATE	Grace period expiration date	None	2022-02-28
08/13/2025	4.0.16	RULE-7736	UPDATE	Measure name	% missing: CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT (COT00003)	% missing: CATEGORY-FOR-FEDERAL-REIMBURSEMENT (COT00003)
10/07/2025	4.0.19	RULE-7536	UPDATE	Grace period expiration date	None	2022-11-30
10/07/2025	4.0.19	RULE-335	UPDATE	Grace period expiration date	None	2022-02-28
10/07/2025	4.0.19	RULE-1758	UPDATE	Grace period expiration date	None	2022-02-28
10/07/2025	4.0.19	RULE-7535	UPDATE	Grace period expiration date	None	2022-11-30
10/07/2025	4.0.19	RULE-7534	UPDATE	Grace period expiration date	None	2022-11-30
10/07/2025	4.0.19	RULE-7533	UPDATE	Grace period expiration date	None	2022-11-30
10/07/2025	4.0.19	RULE-7521	UPDATE	Grace period expiration date	None	2023-02-28
10/07/2025	4.0.19	RULE-7406	UPDATE	Grace period expiration date	None	2023-02-28
10/07/2025	4.0.19	RULE-7405	UPDATE	Grace period expiration date	None	2023-02-28
10/07/2025	4.0.19	RULE-7404	UPDATE	Grace period expiration date	None	2023-02-28
10/07/2025	4.0.19	RULE-7403	UPDATE	Grace period expiration date	None	2023-02-28
10/07/2025	4.0.19	RULE-7402	UPDATE	Grace period expiration date	None	2023-02-28
10/07/2025	4.0.19	RULE-7401	UPDATE	Grace period expiration date	None	2023-02-28
10/07/2025	4.0.19	RULE-7400	UPDATE	Grace period expiration date	None	2023-02-28
10/07/2025	4.0.19	RULE-7396	UPDATE	Grace period expiration date	None	2023-02-28
10/07/2025	4.0.19	RULE-7392	UPDATE	Grace period expiration date	None	2023-02-28
10/07/2025	4.0.19	RULE-7391	UPDATE	Grace period expiration date	None	2023-02-28
10/07/2025	4.0.19	RULE-7389	UPDATE	Grace period expiration date	None	2023-02-28
10/07/2025	4.0.19	RULE-7388	UPDATE	Grace period expiration date	None	2023-02-28
10/07/2025	4.0.19	RULE-7386	UPDATE	Grace period expiration date	None	2023-02-28
10/07/2025	4.0.19	RULE-7385	UPDATE	Grace period expiration date	None	2023-02-28
10/07/2025	4.0.19	RULE-7384	UPDATE	Grace period expiration date	None	2023-02-28
10/07/2025	4.0.19	RULE-7379	UPDATE	Grace period expiration date	None	2022-11-30
10/07/2025	4.0.19	RULE-7378	UPDATE	Grace period expiration date	None	2022-11-30
10/07/2025	4.0.19	RULE-7377	UPDATE	Grace period expiration date	None	2022-11-30
10/07/2025	4.0.19	RULE-7376	UPDATE	Grace period expiration date	None	2022-11-30
10/07/2025	4.0.19	RULE-7375	UPDATE	Grace period expiration date	None	2022-11-30
10/07/2025	4.0.19	RULE-7374	UPDATE	Grace period expiration date	None	2022-11-30
10/07/2025	4.0.19	RULE-7373	UPDATE	Grace period expiration date	None	2022-11-30
10/07/2025	4.0.19	RULE-7372	UPDATE	Grace period expiration date	None	2022-11-30
10/07/2025	4.0.19	MCR-9-006_1-18	UPDATE	Specification	STEP 1: Active non-duplicate paid individual capitation payment financial transactions during report monthDefine the FTX universe for the FTX0002 table by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 2: Managed Care Plan Payee ID TypeOf the records that meet the criteria from STEP 1, further restrict them by the following criteria:1. PAYEE-MCR-PLAN-TYPE - "02" or "03"2. PAYEE-ID-TYPE = "02"STEP 3: Non-missing Payee IDOf the records that meet the criteria from STEP 2, further restrict them by the following criteria: 1. PAYEE-ID is not missingSTEP 4: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 5: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 4, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 6: No managed care participation PCCM planOf the records that meet the criteria from STEP 3, further restrict them by attempting to merge them with the data from STEP 5 and keeping those that satisfy the following criteria:1a. PAYEE-ID = MANAGED-CARE-PLAN-ID2a. MSIS-IDENTIFICATION-NUM matches 3a. MANAGED-CARE-PLAN-TYPE does NOT equal "02" or "03" for any records where 1a and 2a are satisfiedORIt is not the case that:1b. PAYEE-ID = MANAGED-CARE-PLAN-ID2b. MSIS-IDENTIFICATION-NUM matches STEP 7: Calculate the percentage for the measureDivide the count of records from STEP 6 by the count of records from STEP 3	STEP 1: Active non-duplicate paid individual capitation payment financial transactions during report monthDefine the FTX universe for the FTX0002 table by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 2: Managed Care Plan Payee ID TypeOf the records that meet the criteria from STEP 1, further restrict them by the following criteria:1. PAYEE-MCR-PLAN-TYPE - "02" or "03"2. PAYEE-ID-TYPE = "02" or "05" or "06"STEP 3: Non-missing Payee IDOf the records that meet the criteria from STEP 2, further restrict them by the following criteria: 1. PAYEE-ID is not missingSTEP 4: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 5: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 4, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 6: No managed care participation PCCM planOf the records that meet the criteria from STEP 3, further restrict them by attempting to merge them with the data from STEP 5 and keeping those that satisfy the following criteria:1a. PAYEE-ID = MANAGED-CARE-PLAN-ID2a. MSIS-IDENTIFICATION-NUM matches 3a. MANAGED-CARE-PLAN-TYPE does NOT equal "02" or "03" for any records where 1a and 2a are satisfiedORIt is not the case that:1b. PAYEE-ID = MANAGED-CARE-PLAN-ID2b. MSIS-IDENTIFICATION-NUM matches STEP 7: Calculate the percentage for the measureDivide the count of records from STEP 6 by the count of records from STEP 3
08/13/2025	4.0.16	MCR-7-004-18	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. DX segments merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-TYPE-CODE, and DIAGNOSIS-SEQUENCE-NUMBERSTEP 4: Non-missing diagnosis codesOf the DX segments that meet the criteria from STEP 3, set Count_Elements equal to the total number of DX segments in STEP 3 where 1. DIAGNOSIS-CODE is not missing2a. DIAGNOSIS-TYPE is not missingAND2b. DIAGNOSIS-TYPE is not equal to ("A")STEP 5: Total number of diagnosesSum Count_Elements for all claims in STEP 4STEP 6: Calculate the average for measureDivide the sum from STEP 5 by the count of claims from STEP 2	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. DX segments merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBERSTEP 4: Non-missing diagnosis codesOf the DX segments that meet the criteria from STEP 3, set Count_Elements equal to the total number of DX segments in STEP 3 where 1. DIAGNOSIS-CODE is not missing2a. DIAGNOSIS-TYPE is not missingAND2b. DIAGNOSIS-TYPE is not equal to ("A")STEP 5: Total number of diagnosesSum Count_Elements for all claims in STEP 4STEP 6: Calculate the average for measureDivide the sum from STEP 5 by the count of claims from STEP 2
08/13/2025	4.0.16	MCR-59P-004-16	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Managed care plans on the last day of DQ report monthDefine the managed care plan population from segment MANAGED-CARE-MAIN-MCR00002 by keeping active records that satisfy the following criteria:1. MANAGED-CARE-MAIN-REC-EFF-DATE <= last day of the reporting month2. MANAGED-CARE-MAIN-REC-END-DATE >= last day of the reporting month OR missingSTEP 4: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 5: Medicaid and S-CHIP Capitation Payment and Encounter: Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = (“2” or "3" or “B” or "C")STEP 6: Define Plan_IdDefine Plan_Id as a unique list of: MANAGED-CARE-PLAN-ID from the EL file that meet the constraints in STEP 2, STATE-PLAN-ID-NUM from the MCR file that meet the constraints in STEP 3, and PLAN-ID-NUMBER from the claims files that meet the constraints in STEP 5. Also, define a blank Plan_Id for missing.STEP 7: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 5, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 8: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 7, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 9: Exclude childless headersOf the claim headers that meet the criteria from STEP 8, drop all headers that do not merge to at least one lineSTEP 10: Claims paid at the line levelOf claims that meet the criteria from STEP 9, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 11: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 10, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 12: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 11 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 13: Calculate the percentage for the measureDivide the count of claims from STEP 12 by the count of claims from STEP 11STEP 14: Repeat for each Plan_IdREPEAT STEPS 7-13 for each Plan_Id identified in STEP 6	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Managed care plans on the last day of DQ report monthDefine the managed care plan population from segment MANAGED-CARE-MAIN-MCR00002 by keeping active records that satisfy the following criteria:1. MANAGED-CARE-MAIN-REC-EFF-DATE <= last day of the reporting month2. MANAGED-CARE-MAIN-REC-END-DATE >= last day of the reporting month OR missingSTEP 4: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 5: Medicaid and S-CHIP Capitation Payment and Encounter: Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = (“2” or "3" or “B” or "C")STEP 6: Define Plan_IdDefine Plan_Id as a unique list of: MANAGED-CARE-PLAN-ID from the EL file that meet the constraints in STEP 2, STATE-PLAN-ID-NUM from the MCR file that meet the constraints in STEP 3, and PLAN-ID-NUMBER from the claims files that meet the constraints in STEP 5. Also, define a blank Plan_Id for missing.STEP 7: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 5, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 8: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 7, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 9: Exclude childless headersOf the claim headers that meet the criteria from STEP 8, drop all headers that do not merge to at least one lineSTEP 10: Claims paid at the line levelOf claims that meet the criteria from STEP 9, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 11: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 10, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 12: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 11 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 13: Calculate the percentage for the measureDivide the count of claims from STEP 12 by the count of claims from STEP 11STEP 14: Repeat for each Plan_IdREPEAT STEPS 7-13 for each Plan_Id identified in STEP 6
08/13/2025	4.0.16	MCR-59P-003-15	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Managed care plans on the last day of DQ report monthDefine the managed care plan population from segment MANAGED-CARE-MAIN-MCR00002 by keeping active records that satisfy the following criteria:1. MANAGED-CARE-MAIN-REC-EFF-DATE <= last day of the reporting month2. MANAGED-CARE-MAIN-REC-END-DATE >= last day of the reporting month OR missingSTEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 5: Medicaid and S-CHIP Capitation Payment and Encounter: Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = (“2” or "3" or “B” or "C")STEP 6: Define Plan_IdDefine Plan_Id as a unique list of: MANAGED-CARE-PLAN-ID from the EL file that meet the constraints in STEP 2, STATE-PLAN-ID-NUM from the MCR file that meet the constraints in STEP 3, and PLAN-ID-NUMBER from the claims files that meet the constraints in STEP 5. Also, define a blank Plan_Id for missing.STEP 7: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 5, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 8: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 7, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 9: Exclude childless headersOf the claim headers that meet the criteria from STEP 8, drop all headers that do not merge to at least one lineSTEP 10: Claims paid at the line levelOf claims that meet the criteria from STEP 9, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 11: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 10, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 12: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 11 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 13: Calculate the percentage for the measureDivide the count of claims from STEP 12 by the count of claims from STEP 11STEP 14: Repeat for each Plan_IdREPEAT STEPS 7-13 for each Plan_Id identified in STEP 6	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Managed care plans on the last day of DQ report monthDefine the managed care plan population from segment MANAGED-CARE-MAIN-MCR00002 by keeping active records that satisfy the following criteria:1. MANAGED-CARE-MAIN-REC-EFF-DATE <= last day of the reporting month2. MANAGED-CARE-MAIN-REC-END-DATE >= last day of the reporting month OR missingSTEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 5: Medicaid and S-CHIP Capitation Payment and Encounter: Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = (“2” or "3" or “B” or "C")STEP 6: Define Plan_IdDefine Plan_Id as a unique list of: MANAGED-CARE-PLAN-ID from the EL file that meet the constraints in STEP 2, STATE-PLAN-ID-NUM from the MCR file that meet the constraints in STEP 3, and PLAN-ID-NUMBER from the claims files that meet the constraints in STEP 5. Also, define a blank Plan_Id for missing.STEP 7: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 5, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 8: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 7, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 9: Exclude childless headersOf the claim headers that meet the criteria from STEP 8, drop all headers that do not merge to at least one lineSTEP 10: Claims paid at the line levelOf claims that meet the criteria from STEP 9, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 11: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 10, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 12: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 11 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 13: Calculate the percentage for the measureDivide the count of claims from STEP 12 by the count of claims from STEP 11STEP 14: Repeat for each Plan_IdREPEAT STEPS 7-13 for each Plan_Id identified in STEP 6
08/13/2025	4.0.16	MCR-59P-002-14	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Managed care plans on the last day of DQ report monthDefine the managed care plan population from segment MANAGED-CARE-MAIN-MCR00002 by keeping active records that satisfy the following criteria:1. MANAGED-CARE-MAIN-REC-EFF-DATE <= last day of the reporting month2. MANAGED-CARE-MAIN-REC-END-DATE >= last day of the reporting month OR missingSTEP 4: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 5: Medicaid and S-CHIP Capitation Payment and Encounter: Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = (“2” or "3" or “B” or "C")STEP 6: Define Plan_IdDefine Plan_Id as a unique list of: MANAGED-CARE-PLAN-ID from the EL file that meet the constraints in STEP 2, STATE-PLAN-ID-NUM from the MCR file that meet the constraints in STEP 3, and PLAN-ID-NUMBER from the claims files that meet the constraints in STEP 5. Also, define a blank Plan_Id for missing.STEP 7: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 5, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 8: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 7, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 9: Exclude childless headersOf the claim headers that meet the criteria from STEP 8, drop all headers that do not merge to at least one lineSTEP 10: Claims paid at the line levelOf claims that meet the criteria from STEP 9, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 11: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 10, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 12: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 11 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 13: Calculate the percentage for the measureDivide the count of claims from STEP 12 by the count of claims from STEP 11STEP 14: Repeat for each Plan_IdREPEAT STEPS 7-13 for each Plan_Id identified in STEP 6	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Managed care plans on the last day of DQ report monthDefine the managed care plan population from segment MANAGED-CARE-MAIN-MCR00002 by keeping active records that satisfy the following criteria:1. MANAGED-CARE-MAIN-REC-EFF-DATE <= last day of the reporting month2. MANAGED-CARE-MAIN-REC-END-DATE >= last day of the reporting month OR missingSTEP 4: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 5: Medicaid and S-CHIP Capitation Payment and Encounter: Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = (“2” or "3" or “B” or "C")STEP 6: Define Plan_IdDefine Plan_Id as a unique list of: MANAGED-CARE-PLAN-ID from the EL file that meet the constraints in STEP 2, STATE-PLAN-ID-NUM from the MCR file that meet the constraints in STEP 3, and PLAN-ID-NUMBER from the claims files that meet the constraints in STEP 5. Also, define a blank Plan_Id for missing.STEP 7: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 5, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 8: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 7, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 9: Exclude childless headersOf the claim headers that meet the criteria from STEP 8, drop all headers that do not merge to at least one lineSTEP 10: Claims paid at the line levelOf claims that meet the criteria from STEP 9, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 11: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 10, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 12: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 11 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 13: Calculate the percentage for the measureDivide the count of claims from STEP 12 by the count of claims from STEP 11STEP 14: Repeat for each Plan_IdREPEAT STEPS 7-13 for each Plan_Id identified in STEP 6
08/13/2025	4.0.16	MCR-59P-001-13	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Managed care plans on the last day of DQ report monthDefine the managed care plan population from segment MANAGED-CARE-MAIN-MCR00002 by keeping active records that satisfy the following criteria:1. MANAGED-CARE-MAIN-REC-EFF-DATE <= last day of the reporting month2. MANAGED-CARE-MAIN-REC-END-DATE >= last day of the reporting month OR missingSTEP 4: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 5: Medicaid and S-CHIP Capitation Payment and Encounter: Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = (“2” or "3" or “B” or "C")STEP 6: Define Plan_IdDefine Plan_Id as a unique list of: MANAGED-CARE-PLAN-ID from the EL file that meet the constraints in STEP 2, STATE-PLAN-ID-NUM from the MCR file that meet the constraints in STEP 3, and PLAN-ID-NUMBER from the claims files that meet the constraints in STEP 5. Also, define a blank Plan_Id for missing.STEP 7: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 5, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 8: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 7, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 9: Exclude childless headersOf the claim headers that meet the criteria from STEP 8, drop all headers that do not merge to at least one lineSTEP 10: Claims paid at the line levelOf claims that meet the criteria from STEP 9, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 11: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 10, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 12: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 11 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 13: Calculate the percentage for the measureDivide the count of claims from STEP 12 by the count of claims from STEP 11STEP 14: Repeat for each Plan_IdREPEAT STEPS 7-13 for each Plan_Id identified in STEP 6	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Managed care plans on the last day of DQ report monthDefine the managed care plan population from segment MANAGED-CARE-MAIN-MCR00002 by keeping active records that satisfy the following criteria:1. MANAGED-CARE-MAIN-REC-EFF-DATE <= last day of the reporting month2. MANAGED-CARE-MAIN-REC-END-DATE >= last day of the reporting month OR missingSTEP 4: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 5: Medicaid and S-CHIP Capitation Payment and Encounter: Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = (“2” or "3" or “B” or "C")STEP 6: Define Plan_IdDefine Plan_Id as a unique list of: MANAGED-CARE-PLAN-ID from the EL file that meet the constraints in STEP 2, STATE-PLAN-ID-NUM from the MCR file that meet the constraints in STEP 3, and PLAN-ID-NUMBER from the claims files that meet the constraints in STEP 5. Also, define a blank Plan_Id for missing.STEP 7: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 5, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 8: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 7, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 9: Exclude childless headersOf the claim headers that meet the criteria from STEP 8, drop all headers that do not merge to at least one lineSTEP 10: Claims paid at the line levelOf claims that meet the criteria from STEP 9, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 11: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 10, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 12: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 11 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 13: Calculate the percentage for the measureDivide the count of claims from STEP 12 by the count of claims from STEP 11STEP 14: Repeat for each Plan_IdREPEAT STEPS 7-13 for each Plan_Id identified in STEP 6
08/13/2025	4.0.16	MCR-5-004-19	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. DX segments merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-TYPE-CODE, and DIAGNOSIS-SEQUENCE-NUMBERSTEP 4: Non-missing diagnosis codesOf the DX segments that meet the criteria from STEP 3, set Count_Elements equal to the total number of DX segments in STEP 3 where 1. DIAGNOSIS-CODE is not missing2a. DIAGNOSIS-TYPE is not missingAND2b. DIAGNOSIS-TYPE is not equal to ("A")STEP 5: Total number of diagnosesSum Count_Elements for all claims in STEP 4STEP 6: Calculate the average for measureDivide the sum from STEP 5 by the count of claims from STEP 2	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. DX segments merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBERSTEP 4: Non-missing diagnosis codesOf the DX segments that meet the criteria from STEP 3, set Count_Elements equal to the total number of DX segments in STEP 3 where 1. DIAGNOSIS-CODE is not missing2a. DIAGNOSIS-TYPE is not missingAND2b. DIAGNOSIS-TYPE is not equal to ("A")STEP 5: Total number of diagnosesSum Count_Elements for all claims in STEP 4STEP 6: Calculate the average for measureDivide the sum from STEP 5 by the count of claims from STEP 2
08/13/2025	4.0.16	MCR-3-004-16	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. DX segments merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-TYPE-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Non-missing diagnosis codesOf the DX segments that meet the criteria from STEP 3, set Count_Elements equal to the total number of DX segments in STEP 3 where 1. DIAGNOSIS-CODE is not missing2a. DIAGNOSIS-TYPE is not missingAND2b. DIAGNOSIS-TYPE is not equal to ("A")STEP 5: Total number of diagnosesSum Count_Elements for all claims in STEP 4STEP 6: Calculate the average for measureDivide the sum from STEP 5 by the count of claims from STEP 2	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. DX segments merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Non-missing diagnosis codesOf the DX segments that meet the criteria from STEP 3, set Count_Elements equal to the total number of DX segments in STEP 3 where 1. DIAGNOSIS-CODE is not missing2a. DIAGNOSIS-TYPE is not missingAND2b. DIAGNOSIS-TYPE is not equal to ("A")STEP 5: Total number of diagnosesSum Count_Elements for all claims in STEP 4STEP 6: Calculate the average for measureDivide the sum from STEP 5 by the count of claims from STEP 2
10/07/2025	4.0.19	MCR-13-006_1-18	UPDATE	Specification	STEP 1: Active non-duplicate paid individual capitation payment financial transactions during report monthDefine the FTX universe for the FTX0002 table by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 2: Managed Care Plan Payee ID TypeOf the records that meet the criteria from STEP 1, further restrict them by the following criteria:1. PAYEE-MCR-PLAN-TYPE - "02" or "03"2. PAYEE-ID-TYPE = "02"STEP 3: Non-missing Payee IDOf the records that meet the criteria from STEP 2, further restrict them by the following criteria: 1. PAYEE-ID is not missingSTEP 4: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 5: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 4, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 6: No managed care participation PCCM planOf the records that meet the criteria from STEP 3, further restrict them by attempting to merge them with the data from STEP 5 and keeping those that satisfy the following criteria:1a. PAYEE-ID = MANAGED-CARE-PLAN-ID2a. MSIS-IDENTIFICATION-NUM matches 3a. MANAGED-CARE-PLAN-TYPE does NOT equal "02" or "03" for any records where 1a and 2a are satisfiedORIt is not the case that:1b. PAYEE-ID = MANAGED-CARE-PLAN-ID2b. MSIS-IDENTIFICATION-NUM matches STEP 7: Calculate the percentage for the measureDivide the count of records from STEP 6 by the count of records from STEP 3	STEP 1: Active non-duplicate paid individual capitation payment financial transactions during report monthDefine the FTX universe for the FTX0002 table by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 2: Managed Care Plan Payee ID TypeOf the records that meet the criteria from STEP 1, further restrict them by the following criteria:1. PAYEE-MCR-PLAN-TYPE = "02" or "03"2. PAYEE-ID-TYPE = "02"or "05" or "06"STEP 3: Non-missing Payee IDOf the records that meet the criteria from STEP 2, further restrict them by the following criteria: 1. PAYEE-ID is not missingSTEP 4: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 5: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 4, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 6: No managed care participation PCCM planOf the records that meet the criteria from STEP 3, further restrict them by attempting to merge them with the data from STEP 5 and keeping those that satisfy the following criteria:1a. PAYEE-ID = MANAGED-CARE-PLAN-ID2a. MSIS-IDENTIFICATION-NUM matches 3a. MANAGED-CARE-PLAN-TYPE does NOT equal "02" or "03" for any records where 1a and 2a are satisfiedORIt is not the case that:1b. PAYEE-ID = MANAGED-CARE-PLAN-ID2b. MSIS-IDENTIFICATION-NUM matches STEP 7: Calculate the percentage for the measureDivide the count of records from STEP 6 by the count of records from STEP 3
08/13/2025	4.0.16	MCR-1-004-16	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. DX segments merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-TYPE-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Non-missing diagnosis codesOf the DX segments that meet the criteria from STEP 3, set Count_Elements equal to the total number of DX segments in STEP 3 where 1. DIAGNOSIS-CODE is not missing2a. DIAGNOSIS-TYPE is not missingAND2b. DIAGNOSIS-TYPE is not equal to ("A")STEP 5: Total number of diagnosesSum Count_Elements for all claims in STEP 4 STEP 6: Calculate the average for measureDivide the sum from STEP 5 by the count of claims from STEP 2	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. DX segments merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Non-missing diagnosis codesOf the DX segments that meet the criteria from STEP 3, set Count_Elements equal to the total number of DX segments in STEP 3 where 1. DIAGNOSIS-CODE is not missing2a. DIAGNOSIS-TYPE is not missingAND2b. DIAGNOSIS-TYPE is not equal to ("A")STEP 5: Total number of diagnosesSum Count_Elements for all claims in STEP 4 STEP 6: Calculate the average for measureDivide the sum from STEP 5 by the count of claims from STEP 2
08/13/2025	4.0.16	FFS-7-004-18	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. DX segments merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-TYPE-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Non-missing diagnosis codesOf the DX segments that meet the criteria from STEP 3, set Count_Elements equal to the total number of DX segments in STEP 3 where 1. DIAGNOSIS-CODE is not missing2a. DIAGNOSIS-TYPE is not missingAND2b. DIAGNOSIS-TYPE is not equal to ("A")STEP 5: Total number of diagnosesSum Count_Elements for all claims in STEP 4STEP 6: Calculate the average for measureDivide the sum from STEP 5 by the count of claims from STEP 2	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. DX segments merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Non-missing diagnosis codesOf the DX segments that meet the criteria from STEP 3, set Count_Elements equal to the total number of DX segments in STEP 3 where 1. DIAGNOSIS-CODE is not missing2a. DIAGNOSIS-TYPE is not missingAND2b. DIAGNOSIS-TYPE is not equal to ("A")STEP 5: Total number of diagnosesSum Count_Elements for all claims in STEP 4STEP 6: Calculate the average for measureDivide the sum from STEP 5 by the count of claims from STEP 2
08/13/2025	4.0.16	FFS-5-004-28	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. DX segments merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-TYPE-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Non-missing diagnosis codesOf the DX segments that meet the criteria from STEP 3, set Count_Elements equal to the total number of DX segments in STEP 3 where 1. DIAGNOSIS-CODE is not missing2a. DIAGNOSIS-TYPE is not missingAND2b. DIAGNOSIS-TYPE is not equal to ("A")STEP 5: Total number of diagnosesSum Count_Elements for all claims in STEP 4STEP 6: Calculate the average for measureDivide the sum from STEP 5 by the count of claims from STEP 2	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. DX segments merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Non-missing diagnosis codesOf the DX segments that meet the criteria from STEP 3, set Count_Elements equal to the total number of DX segments in STEP 3 where 1. DIAGNOSIS-CODE is not missing2a. DIAGNOSIS-TYPE is not missingAND2b. DIAGNOSIS-TYPE is not equal to ("A")STEP 5: Total number of diagnosesSum Count_Elements for all claims in STEP 4STEP 6: Calculate the average for measureDivide the sum from STEP 5 by the count of claims from STEP 2
08/13/2025	4.0.16	FFS-3-004-16	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. DX segments merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-TYPE-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Non-missing diagnosis codesOf the DX segments that meet the criteria from STEP 3, set Count_Elements equal to the total number of DX segments in STEP 3 where 1. DIAGNOSIS-CODE is not missing2a. DIAGNOSIS-TYPE is not missingAND2b. DIAGNOSIS-TYPE is not equal to ("A")STEP 5: Total number of diagnosesSum Count_Elements for all claims in STEP 4 STEP 6: Calculate the average for measureDivide the sum from STEP 5 by the count of claims from STEP 2	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. DX segments merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Non-missing diagnosis codesOf the DX segments that meet the criteria from STEP 3, set Count_Elements equal to the total number of DX segments in STEP 3 where 1. DIAGNOSIS-CODE is not missing2a. DIAGNOSIS-TYPE is not missingAND2b. DIAGNOSIS-TYPE is not equal to ("A")STEP 5: Total number of diagnosesSum Count_Elements for all claims in STEP 4 STEP 6: Calculate the average for measureDivide the sum from STEP 5 by the count of claims from STEP 2
08/13/2025	4.0.16	FFS-1-004-28	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-TYPE-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Non-missing diagnosis codesOf the DX segments that meet the criteria from STEP 3, set Count_Elements equal to the total number of DX segments in STEP 3 where 1. DIAGNOSIS-CODE is not missing2a. DIAGNOSIS-TYPE is not missingAND2b. DIAGNOSIS-TYPE is not equal to ("A")STEP 5: Total number of diagnosesSum Count_Elements for all claims in STEP 4 STEP 6: Calculate the average for measureDivide the sum from STEP 5 by the count of claims from STEP 2	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Non-missing diagnosis codesOf the DX segments that meet the criteria from STEP 3, set Count_Elements equal to the total number of DX segments in STEP 3 where 1. DIAGNOSIS-CODE is not missing2a. DIAGNOSIS-TYPE is not missingAND2b. DIAGNOSIS-TYPE is not equal to ("A")STEP 5: Total number of diagnosesSum Count_Elements for all claims in STEP 4 STEP 6: Calculate the average for measureDivide the sum from STEP 5 by the count of claims from STEP 2
10/07/2025	4.0.19	EL-6-041-41	UPDATE	Grace period expiration date	None	2025-08-28
10/07/2025	4.0.19	EL-6-040-40	UPDATE	Grace period expiration date	None	2025-08-28
10/07/2025	4.0.19	EL-3-034-43	UPDATE	Grace period expiration date	None	2025-08-28
10/07/2025	4.0.19	EL-3-033-42	UPDATE	Grace period expiration date	None	2025-08-28
06/05/2025	4.0.10	FTX.006.219	UPDATE	Necessity	Conditional	Mandatory
06/05/2025	4.0.10	FTX.006.219	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. Mandatory	1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS Form List (VVL)3. When MBESCBES Form equals "2", value must be in 64.21COS Form List (VVL)4. When MBESCBES Form equals "3", value must be in 21COS Form List (VVL)5. Mandatory
05/29/2025	4.0.9	COT.003.254	UPDATE	Coding requirement	1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Conditional5. If Type of Claim is in [1,3,A,C,U,W] and a CPT-4 code or a CDT code (begins with the letter 'D'), then value must be populated	1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Conditional5. If Type of Claim is in [1,3,A,C,U,W] and a CPT-4 code or a CDT code (begins with the letter 'D'), then�value must be populated
05/29/2025	4.0.9	COT.003.190	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Conditional4. If Type of Claim (COT.002.037) not in [3,C,W], then value must match Provider Identifier (PRV.005.081)5. NPPES Entity Type Code associate with this NPI must equal ‘1’ (Individual)6. Value must exist in the NPPES NPI data file	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Conditional4. If Type of Claim (COT.002.037) not in [3,C,W], then value must match Provider Identifier (PRV.005.081)5. NPPES Entity Type Code associate with this NPI must equal �1� (Individual)6. Value must exist in the NPPES NPI data file
05/29/2025	4.0.9	CLT.003.213	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Conditional4. If Type of Claim (CLT.002.052) not in [3,C,W], then value must match Provider Identifier (PRV.005.081)5. NPPES Entity Type Code associate with this NPI must equal ‘1’ (Individual)6. Value must exist in the NPPES NPI data file	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Conditional4. If Type of Claim (CLT.002.052) not in [3,C,W], then value must match Provider Identifier (PRV.005.081)5. NPPES Entity Type Code associate with this NPI must equal �1� (Individual)6. Value must exist in the NPPES NPI data file
05/29/2025	4.0.9	CIP.003.261	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. NPPES Entity Type Code associate with this NPI must equal ‘1’ (Individual)	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. NPPES Entity Type Code associate with this NPI must equal �1� (Individual)
05/27/2025	4.0.9	MCR-59P-004-16	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Managed care plans on the last day of DQ report monthDefine the managed care plan population from segment MANAGED-CARE-MAIN-MCR00002 by keeping active records that satisfy the following criteria:1. MANAGED-CARE-MAIN-REC-EFF-DATE <= last day of the reporting month2. MANAGED-CARE-MAIN-REC-END-DATE >= last day of the reporting month OR missingSTEP 4: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 5: Medicaid and S-CHIP Capitation Payment and Encounter: Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = (“2” or "3" or “B” or "C")STEP 6: Define Plan_IdDefine Plan_Id as a unique list of: MANAGED-CARE-PLAN-ID from the EL file that meet the constraints in STEP 2, STATE-PLAN-ID-NUM from the MCR file that meet the constraints in STEP 3, and PLAN-ID-NUMBER from the claims files that meet the constraints in STEP 5. Also, define a blank Plan_Id for missing.STEP 7: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 6, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 8: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 7, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 9: Exclude childless headersOf the claim headers that meet the criteria from STEP 8, drop all headers that do not merge to at least one lineSTEP 10: Claims paid at the line levelOf claims that meet the criteria from STEP 9, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 11: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 8, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 12: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 11 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 13: Calculate the percentage for the measureDivide the count of claims from STEP 12 by the count of claims from STEP 11STEP 14: Repeat for each Plan_IdREPEAT STEPS 7-13 for each Plan_Id identified in STEP 6	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Managed care plans on the last day of DQ report monthDefine the managed care plan population from segment MANAGED-CARE-MAIN-MCR00002 by keeping active records that satisfy the following criteria:1. MANAGED-CARE-MAIN-REC-EFF-DATE <= last day of the reporting month2. MANAGED-CARE-MAIN-REC-END-DATE >= last day of the reporting month OR missingSTEP 4: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 5: Medicaid and S-CHIP Capitation Payment and Encounter: Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = (“2” or "3" or “B” or "C")STEP 6: Define Plan_IdDefine Plan_Id as a unique list of: MANAGED-CARE-PLAN-ID from the EL file that meet the constraints in STEP 2, STATE-PLAN-ID-NUM from the MCR file that meet the constraints in STEP 3, and PLAN-ID-NUMBER from the claims files that meet the constraints in STEP 5. Also, define a blank Plan_Id for missing.STEP 7: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 5, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 8: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 7, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 9: Exclude childless headersOf the claim headers that meet the criteria from STEP 8, drop all headers that do not merge to at least one lineSTEP 10: Claims paid at the line levelOf claims that meet the criteria from STEP 9, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 11: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 10, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 12: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 11 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 13: Calculate the percentage for the measureDivide the count of claims from STEP 12 by the count of claims from STEP 11STEP 14: Repeat for each Plan_IdREPEAT STEPS 7-13 for each Plan_Id identified in STEP 6
05/27/2025	4.0.9	MCR-59P-003-15	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Managed care plans on the last day of DQ report monthDefine the managed care plan population from segment MANAGED-CARE-MAIN-MCR00002 by keeping active records that satisfy the following criteria:1. MANAGED-CARE-MAIN-REC-EFF-DATE <= last day of the reporting month2. MANAGED-CARE-MAIN-REC-END-DATE >= last day of the reporting month OR missingSTEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 5: Medicaid and S-CHIP Capitation Payment and Encounter: Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = (“2” or "3" or “B” or "C")STEP 6: Define Plan_IdDefine Plan_Id as a unique list of: MANAGED-CARE-PLAN-ID from the EL file that meet the constraints in STEP 2, STATE-PLAN-ID-NUM from the MCR file that meet the constraints in STEP 3, and PLAN-ID-NUMBER from the claims files that meet the constraints in STEP 5. Also, define a blank Plan_Id for missing.STEP 7: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 6, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 8: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 7, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 9: Exclude childless headersOf the claim headers that meet the criteria from STEP 8, drop all headers that do not merge to at least one lineSTEP 10: Claims paid at the line levelOf claims that meet the criteria from STEP 9, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 11: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 8, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 12: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 11 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 13: Calculate the percentage for the measureDivide the count of claims from STEP 12 by the count of claims from STEP 11STEP 14: Repeat for each Plan_IdREPEAT STEPS 7-13 for each Plan_Id identified in STEP 6	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Managed care plans on the last day of DQ report monthDefine the managed care plan population from segment MANAGED-CARE-MAIN-MCR00002 by keeping active records that satisfy the following criteria:1. MANAGED-CARE-MAIN-REC-EFF-DATE <= last day of the reporting month2. MANAGED-CARE-MAIN-REC-END-DATE >= last day of the reporting month OR missingSTEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 5: Medicaid and S-CHIP Capitation Payment and Encounter: Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = (“2” or "3" or “B” or "C")STEP 6: Define Plan_IdDefine Plan_Id as a unique list of: MANAGED-CARE-PLAN-ID from the EL file that meet the constraints in STEP 2, STATE-PLAN-ID-NUM from the MCR file that meet the constraints in STEP 3, and PLAN-ID-NUMBER from the claims files that meet the constraints in STEP 5. Also, define a blank Plan_Id for missing.STEP 7: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 5, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 8: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 7, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 9: Exclude childless headersOf the claim headers that meet the criteria from STEP 8, drop all headers that do not merge to at least one lineSTEP 10: Claims paid at the line levelOf claims that meet the criteria from STEP 9, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 11: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 10, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 12: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 11 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 13: Calculate the percentage for the measureDivide the count of claims from STEP 12 by the count of claims from STEP 11STEP 14: Repeat for each Plan_IdREPEAT STEPS 7-13 for each Plan_Id identified in STEP 6
05/27/2025	4.0.9	MCR-59P-002-14	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Managed care plans on the last day of DQ report monthDefine the managed care plan population from segment MANAGED-CARE-MAIN-MCR00002 by keeping active records that satisfy the following criteria:1. MANAGED-CARE-MAIN-REC-EFF-DATE <= last day of the reporting month2. MANAGED-CARE-MAIN-REC-END-DATE >= last day of the reporting month OR missingSTEP 4: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 5: Medicaid and S-CHIP Capitation Payment and Encounter: Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = (“2” or "3" or “B” or "C")STEP 6: Define Plan_IdDefine Plan_Id as a unique list of: MANAGED-CARE-PLAN-ID from the EL file that meet the constraints in STEP 2, STATE-PLAN-ID-NUM from the MCR file that meet the constraints in STEP 3, and PLAN-ID-NUMBER from the claims files that meet the constraints in STEP 5. Also, define a blank Plan_Id for missing.STEP 7: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 6, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 8: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 7, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 9: Exclude childless headersOf the claim headers that meet the criteria from STEP 8, drop all headers that do not merge to at least one lineSTEP 10: Claims paid at the line levelOf claims that meet the criteria from STEP 9, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 11: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 8, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 12: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 11 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 13: Calculate the percentage for the measureDivide the count of claims from STEP 12 by the count of claims from STEP 11STEP 14: Repeat for each Plan_IdREPEAT STEPS 7-13 for each Plan_Id identified in STEP 6	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Managed care plans on the last day of DQ report monthDefine the managed care plan population from segment MANAGED-CARE-MAIN-MCR00002 by keeping active records that satisfy the following criteria:1. MANAGED-CARE-MAIN-REC-EFF-DATE <= last day of the reporting month2. MANAGED-CARE-MAIN-REC-END-DATE >= last day of the reporting month OR missingSTEP 4: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 5: Medicaid and S-CHIP Capitation Payment and Encounter: Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = (“2” or "3" or “B” or "C")STEP 6: Define Plan_IdDefine Plan_Id as a unique list of: MANAGED-CARE-PLAN-ID from the EL file that meet the constraints in STEP 2, STATE-PLAN-ID-NUM from the MCR file that meet the constraints in STEP 3, and PLAN-ID-NUMBER from the claims files that meet the constraints in STEP 5. Also, define a blank Plan_Id for missing.STEP 7: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 5, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 8: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 7, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 9: Exclude childless headersOf the claim headers that meet the criteria from STEP 8, drop all headers that do not merge to at least one lineSTEP 10: Claims paid at the line levelOf claims that meet the criteria from STEP 9, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 11: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 10, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 12: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 11 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 13: Calculate the percentage for the measureDivide the count of claims from STEP 12 by the count of claims from STEP 11STEP 14: Repeat for each Plan_IdREPEAT STEPS 7-13 for each Plan_Id identified in STEP 6
05/27/2025	4.0.9	MCR-59P-001-13	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Managed care plans on the last day of DQ report monthDefine the managed care plan population from segment MANAGED-CARE-MAIN-MCR00002 by keeping active records that satisfy the following criteria:1. MANAGED-CARE-MAIN-REC-EFF-DATE <= last day of the reporting month2. MANAGED-CARE-MAIN-REC-END-DATE >= last day of the reporting month OR missingSTEP 4: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 5: Medicaid and S-CHIP Capitation Payment and Encounter: Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = (“2” or "3" or “B” or "C")STEP 6: Define Plan_IdDefine Plan_Id as a unique list of: MANAGED-CARE-PLAN-ID from the EL file that meet the constraints in STEP 2, STATE-PLAN-ID-NUM from the MCR file that meet the constraints in STEP 3, and PLAN-ID-NUMBER from the claims files that meet the constraints in STEP 5. Also, define a blank Plan_Id for missing.STEP 7: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 6, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 8: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 7, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 9: Exclude childless headersOf the claim headers that meet the criteria from STEP 8, drop all headers that do not merge to at least one lineSTEP 10: Claims paid at the line levelOf claims that meet the criteria from STEP 9, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 11: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 8, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 12: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 11 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 13: Calculate the percentage for the measureDivide the count of claims from STEP 12 by the count of claims from STEP 11STEP 14: Repeat for each Plan_IdREPEAT STEPS 7-13 for each Plan_Id identified in STEP 6	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Managed care plans on the last day of DQ report monthDefine the managed care plan population from segment MANAGED-CARE-MAIN-MCR00002 by keeping active records that satisfy the following criteria:1. MANAGED-CARE-MAIN-REC-EFF-DATE <= last day of the reporting month2. MANAGED-CARE-MAIN-REC-END-DATE >= last day of the reporting month OR missingSTEP 4: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 5: Medicaid and S-CHIP Capitation Payment and Encounter: Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = (“2” or "3" or “B” or "C")STEP 6: Define Plan_IdDefine Plan_Id as a unique list of: MANAGED-CARE-PLAN-ID from the EL file that meet the constraints in STEP 2, STATE-PLAN-ID-NUM from the MCR file that meet the constraints in STEP 3, and PLAN-ID-NUMBER from the claims files that meet the constraints in STEP 5. Also, define a blank Plan_Id for missing.STEP 7: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 5, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 8: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 7, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 9: Exclude childless headersOf the claim headers that meet the criteria from STEP 8, drop all headers that do not merge to at least one lineSTEP 10: Claims paid at the line levelOf claims that meet the criteria from STEP 9, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 11: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 10, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 12: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 11 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 13: Calculate the percentage for the measureDivide the count of claims from STEP 12 by the count of claims from STEP 11STEP 14: Repeat for each Plan_IdREPEAT STEPS 7-13 for each Plan_Id identified in STEP 6
11/20/2025	4.0.22	MCR-56P-001-1	UPDATE	Annotation	For each unique Plan ID, calculate the percentage of claims that are Medicaid Encounter: original and adjustment, and paid where patient status is not "Still a patient" and the discharge date is missing	N/A
11/20/2025	4.0.22	MCR-56P-001-1	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Managed care plans on the last day of DQ report monthDefine the managed care plan population from segment MANAGED-CARE-MAIN-MCR00002 by keeping active records that satisfy the following criteria:1. MANAGED-CARE-MAIN-REC-EFF-DATE <= last day of the reporting month2. MANAGED-CARE-MAIN-REC-END-DATE >= last day of the reporting month OR missingSTEP 4: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid and S-CHIP Capitation Payment and Encounter: Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = (“2” or "3" or “B” or "C")STEP 6: Define Plan_IdDefine Plan_Id as a unique list of: MANAGED-CARE-PLAN-ID from the EL file that meet the constraints in STEP 2, STATE-PLAN-ID-NUM from the MCR file that meet the constraints in STEP 3, and PLAN-ID-NUMBER from the claims files that meet the constraints in STEP 5. Also, define a blank Plan_Id for missing.STEP 7: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 8: Patient status is not "Still a Patient"Of the claims that meet the criteria from STEP 7, further restrict them by the following criteria: 1. PATIENT-STATUS is not equal to "30"2. PATIENT-STATUS is not missingSTEP 9: Missing discharge dateOf the claims from STEP 8, select records where:1. DISCHARGE-DATE is missingSTEP 10: Calculate the percentage for the measureDivide the count of claims from STEP 9 by the count of claims from STEP 8STEP 11: Repeat for each Plan_IdREPEAT STEPS 7-10 for each Plan_Id identified in STEP 6	N/A
11/20/2025	4.0.22	EXP-41P-001-1	UPDATE	Annotation	For each unique Plan ID, calculate the percentage of Medicaid Encounter: original, non-crossover, paid RX claims that have total Medicaid paid amount equal to $0 or missing	N/A
11/20/2025	4.0.22	EXP-41P-001-1	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Managed care plans on the last day of DQ report monthDefine the managed care plan population from segment MANAGED-CARE-MAIN-MCR00002 by keeping active records that satisfy the following criteria:1. MANAGED-CARE-MAIN-REC-EFF-DATE <= last day of the reporting month2. MANAGED-CARE-MAIN-REC-END-DATE >= last day of the reporting month OR missingSTEP 4: Active non-duplicate RX records during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid and S-CHIP Capitation Payment and Encounter: Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = (“2” or "3" or “B” or "C")STEP 6: Define Plan_IdDefine Plan_Id as a unique list of: MANAGED-CARE-PLAN-ID from the EL file that meet the constraints in STEP 2, STATE-PLAN-ID-NUM from the MCR file that meet the constraints in STEP 3, and PLAN-ID-NUMBER from the claims files that meet the constraints in STEP 5. Also, define a blank Plan_Id for missing.STEP 7: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 5, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 8: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 7, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 9: Total Medicaid paid $0 or missingOf the claims from STEP 8, select records where:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 10: Calculate the percentage for the measureDivide the count of claims from STEP 9 by the count of claims from STEP 8STEP 11: Repeat for each Plan_IdREPEAT STEPS 7-10 for each Plan_Id identified in STEP 6	N/A
08/13/2025	4.0.16	EXP-37P-001-1-2	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Managed care plans on the last day of DQ report monthDefine the managed care plan population from segment MANAGED-CARE-MAIN-MCR00002 by keeping active records that satisfy the following criteria:1. MANAGED-CARE-MAIN-REC-EFF-DATE <= last day of the reporting month2. MANAGED-CARE-MAIN-REC-END-DATE >= last day of the reporting month OR missingSTEP 4: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 5: Medicaid and S-CHIP Capitation Payment and Encounter: Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = (“2” or "3" or “B” or "C")STEP 6: Define Plan_IdDefine Plan_Id as a unique list of: MANAGED-CARE-PLAN-ID from the EL file that meet the constraints in STEP 2, STATE-PLAN-ID-NUM from the MCR file that meet the constraints in STEP 3, and PLAN-ID-NUMBER from the claims files that meet the constraints in STEP 5. Also, define a blank Plan_Id for missing.STEP 7: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 5, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 8: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 7, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 9: Payment at the line levelOf the claims from STEP 8, select records where:1. PAYMENT-LEVEL-IND = "2"STEP 10: Total Medicaid paid $0 or missingOf the claims from STEP 9, select records where:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 11: Calculate the percentage for the measureDivide the count of claims from STEP 10 by the count of claims from STEP 9STEP 12: Repeat for each Plan_IdREPEAT STEPS 7-11 for each Plan_Id identified in STEP 6	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Managed care plans on the last day of DQ report monthDefine the managed care plan population from segment MANAGED-CARE-MAIN-MCR00002 by keeping active records that satisfy the following criteria:1. MANAGED-CARE-MAIN-REC-EFF-DATE <= last day of the reporting month2. MANAGED-CARE-MAIN-REC-END-DATE >= last day of the reporting month OR missingSTEP 4: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 5: Medicaid and S-CHIP Capitation Payment and Encounter: Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = (“2” or "3" or “B” or "C")STEP 6: Define Plan_IdDefine Plan_Id as a unique list of: MANAGED-CARE-PLAN-ID from the EL file that meet the constraints in STEP 2, STATE-PLAN-ID-NUM from the MCR file that meet the constraints in STEP 3, and PLAN-ID-NUMBER from the claims files that meet the constraints in STEP 5. Also, define a blank Plan_Id for missing.STEP 7: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 5, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 8: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 7, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 9: Payment at the line levelOf the claims from STEP 8, select records where:1. PAYMENT-LEVEL-IND = "2"STEP 10: Total Medicaid paid $0 or missingOf the claims from STEP 9, select records where:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 11: Calculate the percentage for the measureDivide the count of claims from STEP 10 by the count of claims from STEP 9STEP 12: Repeat for each Plan_IdREPEAT STEPS 7-11 for each Plan_Id identified in STEP 6
11/20/2025	4.0.22	EXP-33P-001-1	UPDATE	Annotation	For each unique Plan ID, calculate the percentage of Medicaid Encounter: original, non-crossover, paid LT claims that have total Medicaid paid amount equal to $0 or missing	N/A
11/20/2025	4.0.22	EXP-33P-001-1	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Managed care plans on the last day of DQ report monthDefine the managed care plan population from segment MANAGED-CARE-MAIN-MCR00002 by keeping active records that satisfy the following criteria:1. MANAGED-CARE-MAIN-REC-EFF-DATE <= last day of the reporting month2. MANAGED-CARE-MAIN-REC-END-DATE >= last day of the reporting month OR missingSTEP 4: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level by importing headers that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid and S-CHIP Capitation Payment and Encounter: Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = (“2” or "3" or “B” or "C")STEP 6: Define Plan_IdDefine Plan_Id as a unique list of: MANAGED-CARE-PLAN-ID from the EL file that meet the constraints in STEP 2, STATE-PLAN-ID-NUM from the MCR file that meet the constraints in STEP 3, and PLAN-ID-NUMBER from the claims files that meet the constraints in STEP 5. Also, define a blank Plan_Id for missing.STEP 7: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 5, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 8: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 7, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 9: Total Medicaid paid $0 or missingOf the claims from STEP 8, select records where:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 10: Calculate the percentage for the measureDivide the count of claims from STEP 9 by the count of claims from STEP 8STEP 11: Repeat for each Plan_IdREPEAT STEPS 7-10 for each Plan_Id identified in STEP 6	N/A
11/20/2025	4.0.22	EXP-29P-001-1	UPDATE	Annotation	For each unique Plan ID, calculate the percentage of Medicaid Encounter: original, non-crossover, paid IP claims that have total Medicaid paid amount equal to $0 or missing	N/A
11/20/2025	4.0.22	EXP-29P-001-1	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Managed care plans on the last day of DQ report monthDefine the managed care plan population from segment MANAGED-CARE-MAIN-MCR00002 by keeping active records that satisfy the following criteria:1. MANAGED-CARE-MAIN-REC-EFF-DATE <= last day of the reporting month2. MANAGED-CARE-MAIN-REC-END-DATE >= last day of the reporting month OR missingSTEP 4: Active non-duplicate IP claims during DQ report monthDefine the claims universe for IP at the header level by importing headers that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid and S-CHIP Capitation Payment and Encounter: Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = (“2” or "3" or “B” or "C")STEP 6: Define Plan_IdDefine Plan_Id as a unique list of: MANAGED-CARE-PLAN-ID from the EL file that meet the constraints in STEP 2, STATE-PLAN-ID-NUM from the MCR file that meet the constraints in STEP 3, and PLAN-ID-NUMBER from the claims files that meet the constraints in STEP 5. Also, define a blank Plan_Id for missing.STEP 7: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 5, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 8: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 7, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 9: Total Medicaid paid $0 or missingOf the claims from STEP 8, select records where:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 10: Calculate the percentage for the measureDivide the count of claims from STEP 9 by the count of claims from STEP 8STEP 11: Repeat for each Plan_IdREPEAT STEPS 7-10 for each Plan_Id identified in STEP 6	N/A
08/13/2025	4.0.16	RULE-8682	UPDATE	Measure name	% missing: CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT (FTX00095 )	% missing: CATEGORY-FOR-FEDERAL-REIMBURSEMENT (FTX00095)
04/24/2025	4.0.7	RULE-8682	ADD	N/A		Created
08/13/2025	4.0.16	RULE-8681	UPDATE	Measure name	% missing: CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT (FTX00009)	% missing: CATEGORY-FOR-FEDERAL-REIMBURSEMENT (FTX00009)
04/24/2025	4.0.7	RULE-8681	ADD	N/A		Created
08/13/2025	4.0.16	RULE-8680	UPDATE	Measure name	% missing: CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT (FTX00008)	% missing: CATEGORY-FOR-FEDERAL-REIMBURSEMENT (FTX00008)
04/24/2025	4.0.7	RULE-8680	ADD	N/A		Created
08/13/2025	4.0.16	RULE-8679	UPDATE	Measure name	% missing: CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT (FTX00007)	% missing: CATEGORY-FOR-FEDERAL-REIMBURSEMENT (FTX00007)
04/24/2025	4.0.7	RULE-8679	ADD	N/A		Created
08/13/2025	4.0.16	RULE-8678	UPDATE	Measure name	% missing: CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT (FTX00006)	% missing: CATEGORY-FOR-FEDERAL-REIMBURSEMENT (FTX00006)
04/24/2025	4.0.7	RULE-8678	ADD	N/A		Created
08/13/2025	4.0.16	RULE-8677	UPDATE	Measure name	% missing: CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT (FTX00005)	% missing: CATEGORY-FOR-FEDERAL-REIMBURSEMENT (FTX00005)
04/24/2025	4.0.7	RULE-8677	ADD	N/A		Created
08/13/2025	4.0.16	RULE-8676	UPDATE	Measure name	% missing: CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT (FTX00004)	% missing: CATEGORY-FOR-FEDERAL-REIMBURSEMENT (FTX00004)
04/24/2025	4.0.7	RULE-8676	ADD	N/A		Created
08/13/2025	4.0.16	RULE-8675	UPDATE	Measure name	% missing: CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT (FTX00003)	% missing: CATEGORY-FOR-FEDERAL-REIMBURSEMENT (FTX00003)
04/24/2025	4.0.7	RULE-8675	ADD	N/A		Created
08/13/2025	4.0.16	RULE-8674	UPDATE	Measure name	% missing: CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT (FTX00002)	% missing: CATEGORY-FOR-FEDERAL-REIMBURSEMENT (FTX00002)
04/24/2025	4.0.7	RULE-8674	ADD	N/A		Created
08/13/2025	4.0.16	RULE-8655	UPDATE	Measure name	% missing: PAYMENT-PERIOD-BEGIN-DATE (FTX00095 )	% missing: PAYMENT-PERIOD-BEGIN-DATE (FTX00095)
04/24/2025	4.0.7	RULE-8655	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8654	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8654	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8653	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8653	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8652	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8652	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8651	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8651	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8650	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8648	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8647	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8647	ADD	N/A		Created
08/13/2025	4.0.16	RULE-8664	UPDATE	Priority	Critical	High
04/24/2025	4.0.7	RULE-8664	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8663	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8663	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8662	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8662	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8661	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8661	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8660	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8660	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8659	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8657	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8656	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8766	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8766	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8765	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8765	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8764	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8764	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8763	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8763	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8762	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8762	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8761	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8761	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8760	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8760	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8759	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8759	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8758	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8758	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8757	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8757	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8756	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8756	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8755	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8755	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8754	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8754	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8753	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8753	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8752	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8752	ADD	N/A		Created
04/24/2025	4.0.7	RULE-9226	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8637	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8637	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8636	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8636	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8635	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8635	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8634	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8634	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8633	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8633	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8632	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8631	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8630	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8629	ADD	N/A		Created
08/13/2025	4.0.16	RULE-8658	UPDATE	Priority	Critical	High
04/24/2025	4.0.7	RULE-8658	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8649	ADD	N/A		Created
08/13/2025	4.0.16	RULE-8673	UPDATE	Measure name	% missing: MBESCBES-CATEGORY-OF-SERVICE (FTX00095 )	% missing: MBESCBES-CATEGORY-OF-SERVICE (FTX00095)
04/24/2025	4.0.7	RULE-8673	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8672	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8672	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8671	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8671	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8670	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8670	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8669	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8669	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8668	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8668	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8667	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8667	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8666	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8666	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8665	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8665	ADD	N/A		Created
04/24/2025	4.0.7	RULE-9221	ADD	N/A		Created
04/24/2025	4.0.7	RULE-9207	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8646	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8645	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8644	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8643	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8642	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8641	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8640	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8639	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8638	ADD	N/A		Created
04/24/2025	4.0.7	RULE-9188	ADD	N/A		Created
04/24/2025	4.0.7	RULE-9170	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8718	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8718	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8717	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8717	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8716	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8716	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8715	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8715	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8714	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8714	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8713	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8712	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8711	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8710	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8745	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8744	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8743	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8742	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8741	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8737	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8736	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8735	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8734	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8733	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8732	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8731	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8730	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8729	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8728	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8727	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8726	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8725	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8724	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8723	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8722	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8721	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8720	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8719	ADD	N/A		Created
04/24/2025	4.0.7	RULE-9126	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8751	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8751	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8750	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8750	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8749	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8749	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8748	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8748	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8747	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8747	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8746	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8746	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8547	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8547	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8530	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8530	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8513	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8513	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8494	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8494	ADD	N/A		Created
10/07/2025	4.0.19	RULE-8475	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	RULE-8475	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8458	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8441	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8425	ADD	N/A		Created
04/24/2025	4.0.7	RULE-8405	ADD	N/A		Created
04/24/2025	4.0.7	MCR-31-008_8-16	ADD	N/A		Created
04/24/2025	4.0.7	MCR-31-008_8-15	ADD	N/A		Created
04/24/2025	4.0.7	MCR-31-008_8-14	ADD	N/A		Created
04/24/2025	4.0.7	MCR-31-003_3-13	ADD	N/A		Created
04/24/2025	4.0.7	MCR-31-003_3-12	ADD	N/A		Created
04/24/2025	4.0.7	MCR-31-003_3-11	ADD	N/A		Created
04/24/2025	4.0.7	MIS-98-001-2	ADD	N/A		Created
04/24/2025	4.0.7	MIS-98-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-97-001-2	ADD	N/A		Created
04/24/2025	4.0.7	MIS-97-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-96-001-3	ADD	N/A		Created
04/24/2025	4.0.7	MIS-96-001-2	ADD	N/A		Created
04/24/2025	4.0.7	MIS-96-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-95-001-3	ADD	N/A		Created
04/24/2025	4.0.7	MIS-95-001-2	ADD	N/A		Created
04/24/2025	4.0.7	MIS-95-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-94-001-2	ADD	N/A		Created
04/24/2025	4.0.7	MIS-94-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-93-001-2	ADD	N/A		Created
04/24/2025	4.0.7	MIS-93-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-92-001-3	ADD	N/A		Created
04/24/2025	4.0.7	MIS-92-001-2	ADD	N/A		Created
04/24/2025	4.0.7	MIS-92-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-91-001-3	ADD	N/A		Created
04/24/2025	4.0.7	MIS-91-001-2	ADD	N/A		Created
04/24/2025	4.0.7	MIS-91-001-1	ADD	N/A		Created
08/13/2025	4.0.16	RULE-7785	UPDATE	File type	CRX	Multiple Files
04/24/2025	4.0.7	RULE-7785	ADD	N/A		Created
08/13/2025	4.0.16	RULE-7784	UPDATE	File type	COT	Multiple Files
04/24/2025	4.0.7	RULE-7784	ADD	N/A		Created
08/13/2025	4.0.16	RULE-7783	UPDATE	File type	CLT	Multiple Files
04/24/2025	4.0.7	RULE-7783	ADD	N/A		Created
08/13/2025	4.0.16	RULE-7782	UPDATE	File type	CIP	Multiple Files
04/24/2025	4.0.7	RULE-7782	ADD	N/A		Created
08/13/2025	4.0.16	RULE-7936	UPDATE	File type	CRX	Multiple Files
04/24/2025	4.0.7	RULE-7936	ADD	N/A		Created
08/13/2025	4.0.16	RULE-7935	UPDATE	File type	COT	Multiple Files
04/24/2025	4.0.7	RULE-7935	ADD	N/A		Created
08/13/2025	4.0.16	RULE-7934	UPDATE	File type	CLT	Multiple Files
04/24/2025	4.0.7	RULE-7934	ADD	N/A		Created
08/13/2025	4.0.16	RULE-7933	UPDATE	File type	CIP	Multiple Files
04/24/2025	4.0.7	RULE-7933	ADD	N/A		Created
08/13/2025	4.0.16	RULE-7928	UPDATE	File type	CRX	Multiple Files
04/24/2025	4.0.7	RULE-7928	ADD	N/A		Created
08/13/2025	4.0.16	RULE-7927	UPDATE	File type	COT	Multiple Files
04/24/2025	4.0.7	RULE-7927	ADD	N/A		Created
08/13/2025	4.0.16	RULE-7926	UPDATE	File type	CLT	Multiple Files
04/24/2025	4.0.7	RULE-7926	ADD	N/A		Created
08/13/2025	4.0.16	RULE-7925	UPDATE	File type	CIP	Multiple Files
04/24/2025	4.0.7	RULE-7925	ADD	N/A		Created
08/13/2025	4.0.16	RULE-7932	UPDATE	File type	CRX	Multiple Files
04/24/2025	4.0.7	RULE-7932	ADD	N/A		Created
08/13/2025	4.0.16	RULE-7931	UPDATE	File type	COT	Multiple Files
04/24/2025	4.0.7	RULE-7931	ADD	N/A		Created
08/13/2025	4.0.16	RULE-7930	UPDATE	File type	CLT	Multiple Files
04/24/2025	4.0.7	RULE-7930	ADD	N/A		Created
08/13/2025	4.0.16	RULE-7929	UPDATE	File type	CIP	Multiple Files
04/24/2025	4.0.7	RULE-7929	ADD	N/A		Created
08/13/2025	4.0.16	RULE-7924	UPDATE	File type	CRX	Multiple Files
04/24/2025	4.0.7	RULE-7924	ADD	N/A		Created
08/13/2025	4.0.16	RULE-7923	UPDATE	File type	COT	Multiple Files
04/24/2025	4.0.7	RULE-7923	ADD	N/A		Created
08/13/2025	4.0.16	RULE-7922	UPDATE	File type	CLT	Multiple Files
04/24/2025	4.0.7	RULE-7922	ADD	N/A		Created
08/13/2025	4.0.16	RULE-7921	UPDATE	File type	CIP	Multiple Files
04/24/2025	4.0.7	RULE-7921	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7975	UPDATE	Grace period expiration date	None	2025-04-11
04/24/2025	4.0.7	RULE-7975	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7974	UPDATE	Grace period expiration date	None	2025-04-11
04/24/2025	4.0.7	RULE-7974	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7979	UPDATE	Grace period expiration date	None	2025-04-11
04/24/2025	4.0.7	RULE-7979	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7978	UPDATE	Grace period expiration date	None	2025-04-11
04/24/2025	4.0.7	RULE-7978	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7977	UPDATE	Grace period expiration date	None	2025-04-11
04/24/2025	4.0.7	RULE-7977	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7976	UPDATE	Grace period expiration date	None	2025-04-11
04/24/2025	4.0.7	RULE-7976	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7636	UPDATE	Grace period expiration date	None	2025-04-11
04/24/2025	4.0.7	RULE-7636	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7635	UPDATE	Grace period expiration date	None	2025-04-11
04/24/2025	4.0.7	RULE-7635	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7634	UPDATE	Grace period expiration date	None	2025-04-11
04/24/2025	4.0.7	RULE-7634	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7633	UPDATE	Grace period expiration date	None	2025-04-11
04/24/2025	4.0.7	RULE-7633	ADD	N/A		Created
08/13/2025	4.0.16	RULE-7900	UPDATE	File type	CRX	Multiple Files
04/24/2025	4.0.7	RULE-7900	ADD	N/A		Created
08/13/2025	4.0.16	RULE-7899	UPDATE	File type	COT	Multiple Files
04/24/2025	4.0.7	RULE-7899	ADD	N/A		Created
08/13/2025	4.0.16	RULE-7898	UPDATE	File type	CLT	Multiple Files
04/24/2025	4.0.7	RULE-7898	ADD	N/A		Created
08/13/2025	4.0.16	RULE-7897	UPDATE	File type	CIP	Multiple Files
04/24/2025	4.0.7	RULE-7897	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7421	UPDATE	Grace period expiration date	None	2024-12-21
04/24/2025	4.0.7	RULE-7421	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7420	UPDATE	Grace period expiration date	None	2024-12-21
04/24/2025	4.0.7	RULE-7420	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7419	UPDATE	Grace period expiration date	None	2024-12-21
04/24/2025	4.0.7	RULE-7419	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7912	UPDATE	Grace period expiration date	None	2024-12-21
04/24/2025	4.0.7	RULE-7912	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7908	UPDATE	Grace period expiration date	None	2024-12-21
04/24/2025	4.0.7	RULE-7908	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7824	UPDATE	Grace period expiration date	None	2024-12-21
04/24/2025	4.0.7	RULE-7824	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7759	UPDATE	Grace period expiration date	None	2024-12-21
04/24/2025	4.0.7	RULE-7759	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7827	UPDATE	Grace period expiration date	None	2024-12-21
04/24/2025	4.0.7	RULE-7827	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7763	UPDATE	Grace period expiration date	None	2024-12-21
04/24/2025	4.0.7	RULE-7763	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7911	UPDATE	Grace period expiration date	None	2024-12-21
04/24/2025	4.0.7	RULE-7911	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7907	UPDATE	Grace period expiration date	None	2024-12-21
04/24/2025	4.0.7	RULE-7907	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7919	UPDATE	Grace period expiration date	None	2024-12-21
04/24/2025	4.0.7	RULE-7919	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7914	UPDATE	Grace period expiration date	None	2024-12-21
04/24/2025	4.0.7	RULE-7914	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7823	UPDATE	Grace period expiration date	None	2024-12-21
04/24/2025	4.0.7	RULE-7823	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7758	UPDATE	Grace period expiration date	None	2024-12-21
04/24/2025	4.0.7	RULE-7758	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7910	UPDATE	Grace period expiration date	None	2024-12-21
04/24/2025	4.0.7	RULE-7910	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7906	UPDATE	Grace period expiration date	None	2024-12-21
04/24/2025	4.0.7	RULE-7906	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7918	UPDATE	Grace period expiration date	None	2024-12-21
04/24/2025	4.0.7	RULE-7918	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7913	UPDATE	Grace period expiration date	None	2024-12-21
04/24/2025	4.0.7	RULE-7913	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7822	UPDATE	Grace period expiration date	None	2024-12-21
04/24/2025	4.0.7	RULE-7822	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7757	UPDATE	Grace period expiration date	None	2024-12-21
04/24/2025	4.0.7	RULE-7757	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7820	UPDATE	Grace period expiration date	None	2024-12-21
04/24/2025	4.0.7	RULE-7820	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7762	UPDATE	Grace period expiration date	None	2024-12-21
04/24/2025	4.0.7	RULE-7762	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7909	UPDATE	Grace period expiration date	None	2024-12-21
04/24/2025	4.0.7	RULE-7909	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7905	UPDATE	Grace period expiration date	None	2024-12-21
04/24/2025	4.0.7	RULE-7905	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7917	UPDATE	Grace period expiration date	None	2024-12-21
04/24/2025	4.0.7	RULE-7917	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7916	UPDATE	Grace period expiration date	None	2024-12-21
04/24/2025	4.0.7	RULE-7916	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7821	UPDATE	Grace period expiration date	None	2024-12-21
04/24/2025	4.0.7	RULE-7821	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7756	UPDATE	Grace period expiration date	None	2024-12-21
04/24/2025	4.0.7	RULE-7756	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7818	UPDATE	Grace period expiration date	None	2024-12-21
04/24/2025	4.0.7	RULE-7818	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7760	UPDATE	Grace period expiration date	None	2024-12-21
04/24/2025	4.0.7	RULE-7760	ADD	N/A		Created
05/27/2025	4.0.9	EL-6-041-41	UPDATE	Priority	N/A	High
05/27/2025	4.0.9	EL-6-041-41	UPDATE	Category	N/A	Beneficiary eligibility
05/27/2025	4.0.9	EL-6-041-41	UPDATE	For ta comprehensive	No	TA- Inferential
05/27/2025	4.0.9	EL-6-041-41	UPDATE	For ta inferential	No	Yes
05/27/2025	4.0.9	EL-6-041-41	UPDATE	Ta min		0
05/27/2025	4.0.9	EL-6-041-41	UPDATE	Ta max		0.05
05/27/2025	4.0.9	EL-6-041-41	UPDATE	Threshold minimum	TBD	0
05/27/2025	4.0.9	EL-6-041-41	UPDATE	Threshold maximum	TBD	0.05
05/27/2025	4.0.9	EL-6-041-41	UPDATE	Focus area	N/A	Enrollment monitoring
04/24/2025	4.0.7	EL-6-041-41	ADD	N/A		Created
05/27/2025	4.0.9	EL-3-034-43	UPDATE	Priority	N/A	High
05/27/2025	4.0.9	EL-3-034-43	UPDATE	Category	N/A	Beneficiary eligibility
05/27/2025	4.0.9	EL-3-034-43	UPDATE	For ta comprehensive	No	TA- Inferential
05/27/2025	4.0.9	EL-3-034-43	UPDATE	For ta inferential	No	Yes
05/27/2025	4.0.9	EL-3-034-43	UPDATE	Ta min		0
05/27/2025	4.0.9	EL-3-034-43	UPDATE	Ta max		0.3
05/27/2025	4.0.9	EL-3-034-43	UPDATE	Threshold minimum	TBD	0
05/27/2025	4.0.9	EL-3-034-43	UPDATE	Threshold maximum	TBD	0.3
04/24/2025	4.0.7	EL-3-034-43	ADD	N/A		Created
05/27/2025	4.0.9	EL-3-033-42	UPDATE	Priority	N/A	High
05/27/2025	4.0.9	EL-3-033-42	UPDATE	Category	N/A	Beneficiary eligibility
05/27/2025	4.0.9	EL-3-033-42	UPDATE	For ta comprehensive	No	TA- Inferential
05/27/2025	4.0.9	EL-3-033-42	UPDATE	For ta inferential	No	Yes
05/27/2025	4.0.9	EL-3-033-42	UPDATE	Ta min		0
05/27/2025	4.0.9	EL-3-033-42	UPDATE	Ta max		0.05
05/27/2025	4.0.9	EL-3-033-42	UPDATE	Threshold minimum	TBD	0
05/27/2025	4.0.9	EL-3-033-42	UPDATE	Threshold maximum	TBD	0.05
04/24/2025	4.0.7	EL-3-033-42	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7381	UPDATE	Grace period expiration date	None	2024-09-29
04/24/2025	4.0.7	RULE-7381	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7380	UPDATE	Grace period expiration date	None	2024-09-29
04/24/2025	4.0.7	RULE-7380	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7528	UPDATE	Grace period expiration date	None	2024-09-29
04/24/2025	4.0.7	RULE-7528	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7529	UPDATE	Grace period expiration date	None	2024-09-29
04/24/2025	4.0.7	RULE-7529	ADD	N/A		Created
10/07/2025	4.0.19	RULE-2157	UPDATE	Grace period expiration date	None	2024-09-29
04/24/2025	4.0.7	RULE-2157	ADD	N/A		Created
10/07/2025	4.0.19	RULE-2051	UPDATE	Grace period expiration date	None	2024-09-29
04/24/2025	4.0.7	RULE-2051	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7980	UPDATE	Grace period expiration date	None	2024-09-29
04/24/2025	4.0.7	RULE-7980	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7532	UPDATE	Grace period expiration date	None	2024-09-29
04/24/2025	4.0.7	RULE-7532	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7364	UPDATE	Grace period expiration date	None	2024-09-29
04/24/2025	4.0.7	RULE-7364	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7363	UPDATE	Grace period expiration date	None	2024-09-29
04/24/2025	4.0.7	RULE-7363	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7362	UPDATE	Grace period expiration date	None	2024-09-29
04/24/2025	4.0.7	RULE-7362	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7361	UPDATE	Grace period expiration date	None	2024-09-29
04/24/2025	4.0.7	RULE-7361	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7360	UPDATE	Grace period expiration date	None	2024-09-29
04/24/2025	4.0.7	RULE-7360	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7359	UPDATE	Grace period expiration date	None	2024-09-29
04/24/2025	4.0.7	RULE-7359	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7358	UPDATE	Grace period expiration date	None	2024-09-29
04/24/2025	4.0.7	RULE-7358	ADD	N/A		Created
04/24/2025	4.0.7	EL-3-032-41	ADD	N/A		Created
04/24/2025	4.0.7	EL-3-031-40	ADD	N/A		Created
04/24/2025	4.0.7	EL-3-030-39	ADD	N/A		Created
04/24/2025	4.0.7	EL-6-047-47	ADD	N/A		Created
04/24/2025	4.0.7	EL-6-046-46	ADD	N/A		Created
04/24/2025	4.0.7	EL-6-045-45	ADD	N/A		Created
05/27/2025	4.0.9	EL-6-044-44	UPDATE	Priority	N/A	Medium
05/27/2025	4.0.9	EL-6-044-44	UPDATE	Category	N/A	Beneficiary eligibility
05/27/2025	4.0.9	EL-6-044-44	UPDATE	For ta comprehensive	No	TA- Inferential
05/27/2025	4.0.9	EL-6-044-44	UPDATE	For ta inferential	No	Yes
05/27/2025	4.0.9	EL-6-044-44	UPDATE	Ta min		0.001
05/27/2025	4.0.9	EL-6-044-44	UPDATE	Ta max		0.7
05/27/2025	4.0.9	EL-6-044-44	UPDATE	Threshold minimum	TBD	0.001
05/27/2025	4.0.9	EL-6-044-44	UPDATE	Threshold maximum	TBD	0.7
04/24/2025	4.0.7	EL-6-044-44	ADD	N/A		Created
05/27/2025	4.0.9	EL-6-043-43	UPDATE	Priority	N/A	Medium
05/27/2025	4.0.9	EL-6-043-43	UPDATE	Category	N/A	Beneficiary eligibility
05/27/2025	4.0.9	EL-6-043-43	UPDATE	For ta comprehensive	No	TA- Inferential
05/27/2025	4.0.9	EL-6-043-43	UPDATE	For ta inferential	No	Yes
05/27/2025	4.0.9	EL-6-043-43	UPDATE	Ta min		0.001
05/27/2025	4.0.9	EL-6-043-43	UPDATE	Ta max		0.4
05/27/2025	4.0.9	EL-6-043-43	UPDATE	Threshold minimum	TBD	0.001
05/27/2025	4.0.9	EL-6-043-43	UPDATE	Threshold maximum	TBD	0.4
04/24/2025	4.0.7	EL-6-043-43	ADD	N/A		Created
05/27/2025	4.0.9	EL-6-042-42	UPDATE	Priority	N/A	Medium
05/27/2025	4.0.9	EL-6-042-42	UPDATE	Category	N/A	Beneficiary eligibility
05/27/2025	4.0.9	EL-6-042-42	UPDATE	For ta comprehensive	No	TA- Inferential
05/27/2025	4.0.9	EL-6-042-42	UPDATE	For ta inferential	No	Yes
05/27/2025	4.0.9	EL-6-042-42	UPDATE	Ta min		0
05/27/2025	4.0.9	EL-6-042-42	UPDATE	Ta max		0.05
05/27/2025	4.0.9	EL-6-042-42	UPDATE	Threshold minimum	TBD	0
05/27/2025	4.0.9	EL-6-042-42	UPDATE	Threshold maximum	TBD	0.05
04/24/2025	4.0.7	EL-6-042-42	ADD	N/A		Created
05/27/2025	4.0.9	EL-6-040-40	UPDATE	Priority	N/A	High
05/27/2025	4.0.9	EL-6-040-40	UPDATE	Category	N/A	Beneficiary eligibility
05/27/2025	4.0.9	EL-6-040-40	UPDATE	For ta comprehensive	No	TA- Inferential
05/27/2025	4.0.9	EL-6-040-40	UPDATE	For ta inferential	No	Yes
05/27/2025	4.0.9	EL-6-040-40	UPDATE	Ta min		0.001
05/27/2025	4.0.9	EL-6-040-40	UPDATE	Ta max		0.1
05/27/2025	4.0.9	EL-6-040-40	UPDATE	Threshold minimum	TBD	0.001
05/27/2025	4.0.9	EL-6-040-40	UPDATE	Threshold maximum	TBD	0.1
05/27/2025	4.0.9	EL-6-040-40	UPDATE	Focus area	N/A	Enrollment monitoring
04/24/2025	4.0.7	EL-6-040-40	ADD	N/A		Created
05/27/2025	4.0.9	EL-6-039-39	UPDATE	Threshold minimum	TBD	N/A
05/27/2025	4.0.9	EL-6-039-39	UPDATE	Threshold maximum	TBD	N/A
04/24/2025	4.0.7	EL-6-039-39	ADD	N/A		Created
04/24/2025	4.0.7	EL-6-038-38	ADD	N/A		Created
04/24/2025	4.0.7	ALL-16-023-23	ADD	N/A		Created
04/24/2025	4.0.7	ALL-16-022-22	ADD	N/A		Created
04/24/2025	4.0.7	ALL-16-021-21	ADD	N/A		Created
04/24/2025	4.0.7	ALL-16-020-20	ADD	N/A		Created
05/27/2025	4.0.9	ALL-16-019-19	UPDATE	Priority	N/A	Medium
05/27/2025	4.0.9	ALL-16-019-19	UPDATE	Category	N/A	Utilization
05/27/2025	4.0.9	ALL-16-019-19	UPDATE	For ta comprehensive	No	TA- Inferential
05/27/2025	4.0.9	ALL-16-019-19	UPDATE	For ta inferential	No	Yes
05/27/2025	4.0.9	ALL-16-019-19	UPDATE	Ta min		0
05/27/2025	4.0.9	ALL-16-019-19	UPDATE	Ta max		0.1
05/27/2025	4.0.9	ALL-16-019-19	UPDATE	Threshold minimum	TBD	0
05/27/2025	4.0.9	ALL-16-019-19	UPDATE	Threshold maximum	TBD	0.1
04/24/2025	4.0.7	ALL-16-019-19	ADD	N/A		Created
05/27/2025	4.0.9	ALL-16-018-18	UPDATE	Priority	N/A	Medium
05/27/2025	4.0.9	ALL-16-018-18	UPDATE	Category	N/A	Utilization
05/27/2025	4.0.9	ALL-16-018-18	UPDATE	For ta comprehensive	No	TA- Inferential
05/27/2025	4.0.9	ALL-16-018-18	UPDATE	For ta inferential	No	Yes
05/27/2025	4.0.9	ALL-16-018-18	UPDATE	Ta min		0
05/27/2025	4.0.9	ALL-16-018-18	UPDATE	Ta max		0.1
05/27/2025	4.0.9	ALL-16-018-18	UPDATE	Threshold minimum	TBD	0
05/27/2025	4.0.9	ALL-16-018-18	UPDATE	Threshold maximum	TBD	0.1
04/24/2025	4.0.7	ALL-16-018-18	ADD	N/A		Created
05/27/2025	4.0.9	ALL-16-017-17	UPDATE	Priority	N/A	Medium
05/27/2025	4.0.9	ALL-16-017-17	UPDATE	Category	N/A	Utilization
05/27/2025	4.0.9	ALL-16-017-17	UPDATE	For ta comprehensive	No	TA- Inferential
05/27/2025	4.0.9	ALL-16-017-17	UPDATE	For ta inferential	No	Yes
05/27/2025	4.0.9	ALL-16-017-17	UPDATE	Ta min		0
05/27/2025	4.0.9	ALL-16-017-17	UPDATE	Ta max		0.1
05/27/2025	4.0.9	ALL-16-017-17	UPDATE	Threshold minimum	TBD	0
05/27/2025	4.0.9	ALL-16-017-17	UPDATE	Threshold maximum	TBD	0.1
04/24/2025	4.0.7	ALL-16-017-17	ADD	N/A		Created
05/27/2025	4.0.9	ALL-16-016-16	UPDATE	Priority	N/A	Medium
05/27/2025	4.0.9	ALL-16-016-16	UPDATE	Category	N/A	Utilization
05/27/2025	4.0.9	ALL-16-016-16	UPDATE	For ta comprehensive	No	TA- Inferential
05/27/2025	4.0.9	ALL-16-016-16	UPDATE	For ta inferential	No	Yes
05/27/2025	4.0.9	ALL-16-016-16	UPDATE	Ta min		0
05/27/2025	4.0.9	ALL-16-016-16	UPDATE	Ta max		0.1
05/27/2025	4.0.9	ALL-16-016-16	UPDATE	Threshold minimum	TBD	0
05/27/2025	4.0.9	ALL-16-016-16	UPDATE	Threshold maximum	TBD	0.1
04/24/2025	4.0.7	ALL-16-016-16	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-024_43	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-024_42	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7753	UPDATE	Grace period expiration date	None	2024-07-02
04/24/2025	4.0.7	RULE-7753	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7754	UPDATE	Grace period expiration date	None	2024-07-02
04/24/2025	4.0.7	RULE-7754	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7755	UPDATE	Grace period expiration date	None	2024-07-02
04/24/2025	4.0.7	RULE-7755	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7752	UPDATE	Grace period expiration date	None	2024-07-02
04/24/2025	4.0.7	RULE-7752	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7902	UPDATE	Grace period expiration date	None	2024-07-02
04/24/2025	4.0.7	RULE-7902	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7903	UPDATE	Grace period expiration date	None	2024-07-02
04/24/2025	4.0.7	RULE-7903	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7904	UPDATE	Grace period expiration date	None	2024-07-02
04/24/2025	4.0.7	RULE-7904	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7901	UPDATE	Grace period expiration date	None	2024-07-02
04/24/2025	4.0.7	RULE-7901	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7320	UPDATE	Grace period expiration date	None	2024-07-02
04/24/2025	4.0.7	RULE-7320	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7316	UPDATE	Grace period expiration date	None	2024-07-02
04/24/2025	4.0.7	RULE-7316	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7319	UPDATE	Grace period expiration date	None	2024-07-02
04/24/2025	4.0.7	RULE-7319	ADD	N/A		Created
04/24/2025	4.0.7	RULE-7315	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7318	UPDATE	Grace period expiration date	None	2024-07-02
04/24/2025	4.0.7	RULE-7318	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7314	UPDATE	Grace period expiration date	None	2024-07-02
04/24/2025	4.0.7	RULE-7314	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7317	UPDATE	Grace period expiration date	None	2024-07-02
04/24/2025	4.0.7	RULE-7317	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7313	UPDATE	Grace period expiration date	None	2024-07-02
04/24/2025	4.0.7	RULE-7313	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7751	UPDATE	Grace period expiration date	None	2024-07-02
04/24/2025	4.0.7	RULE-7751	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7817	UPDATE	Grace period expiration date	None	2024-07-02
04/24/2025	4.0.7	RULE-7817	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7750	UPDATE	Grace period expiration date	None	2024-07-02
04/24/2025	4.0.7	RULE-7750	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7816	UPDATE	Grace period expiration date	None	2024-07-02
04/24/2025	4.0.7	RULE-7816	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7354	UPDATE	Grace period expiration date	None	2024-07-02
04/24/2025	4.0.7	RULE-7354	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7353	UPDATE	Grace period expiration date	None	2024-07-02
04/24/2025	4.0.7	RULE-7353	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7352	UPDATE	Grace period expiration date	None	2024-07-02
04/24/2025	4.0.7	RULE-7352	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7351	UPDATE	Grace period expiration date	None	2024-07-02
04/24/2025	4.0.7	RULE-7351	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7349	UPDATE	Grace period expiration date	None	2024-07-02
04/24/2025	4.0.7	RULE-7349	ADD	N/A		Created
08/13/2025	4.0.16	RULE-7265	UPDATE	Measure name	% missing: CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT (CRX00003)	% missing: CATEGORY-FOR-FEDERAL-REIMBURSEMENT (CRX00003)
04/24/2025	4.0.7	RULE-7265	ADD	N/A		Created
05/27/2025	4.0.9	RULE-7736	UPDATE	Category	Expenditures	N/A
05/27/2025	4.0.9	RULE-7736	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-7736	UPDATE	Ta max	0.02
04/24/2025	4.0.7	RULE-7736	ADD	N/A		Created
08/13/2025	4.0.16	RULE-7892	UPDATE	Measure name	% missing: CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT (COT00003)	% missing: CATEGORY-FOR-FEDERAL-REIMBURSEMENT (COT00003)
04/24/2025	4.0.7	RULE-7892	ADD	N/A		Created
08/13/2025	4.0.16	RULE-7263	UPDATE	Measure name	% missing: CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT (CLT00003)	% missing: CATEGORY-FOR-FEDERAL-REIMBURSEMENT (CLT00003)
04/24/2025	4.0.7	RULE-7263	ADD	N/A		Created
08/13/2025	4.0.16	RULE-7262	UPDATE	Measure name	% missing: CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT (CIP00003)	% missing: CATEGORY-FOR-FEDERAL-REIMBURSEMENT (CIP00003)
04/24/2025	4.0.7	RULE-7262	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7257	UPDATE	Grace period expiration date	None	2024-07-02
04/24/2025	4.0.7	RULE-7257	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7256	UPDATE	Grace period expiration date	None	2024-07-02
04/24/2025	4.0.7	RULE-7256	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7255	UPDATE	Grace period expiration date	None	2024-07-02
04/24/2025	4.0.7	RULE-7255	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7254	UPDATE	Grace period expiration date	None	2024-07-02
04/24/2025	4.0.7	RULE-7254	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7740	UPDATE	Grace period expiration date	None	2024-07-02
04/24/2025	4.0.7	RULE-7740	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7896	UPDATE	Grace period expiration date	None	2024-07-02
04/24/2025	4.0.7	RULE-7896	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7739	UPDATE	Grace period expiration date	None	2024-07-02
04/24/2025	4.0.7	RULE-7739	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7895	UPDATE	Grace period expiration date	None	2024-07-02
04/24/2025	4.0.7	RULE-7895	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7738	UPDATE	Grace period expiration date	None	2024-07-02
04/24/2025	4.0.7	RULE-7738	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7894	UPDATE	Grace period expiration date	None	2024-07-02
04/24/2025	4.0.7	RULE-7894	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7737	UPDATE	Grace period expiration date	None	2024-07-02
04/24/2025	4.0.7	RULE-7737	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7893	UPDATE	Grace period expiration date	None	2024-07-02
04/24/2025	4.0.7	RULE-7893	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7718	UPDATE	Grace period expiration date	None	2024-05-17
04/24/2025	4.0.7	RULE-7718	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7719	UPDATE	Grace period expiration date	None	2024-05-17
04/24/2025	4.0.7	RULE-7719	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7720	UPDATE	Grace period expiration date	None	2024-05-17
04/24/2025	4.0.7	RULE-7720	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7721	UPDATE	Grace period expiration date	None	2024-05-17
04/24/2025	4.0.7	RULE-7721	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7722	UPDATE	Grace period expiration date	None	2024-05-17
04/24/2025	4.0.7	RULE-7722	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7711	UPDATE	Grace period expiration date	None	2024-05-17
04/24/2025	4.0.7	RULE-7711	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7710	UPDATE	Grace period expiration date	None	2024-05-17
04/24/2025	4.0.7	RULE-7710	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7713	UPDATE	Grace period expiration date	None	2024-05-17
04/24/2025	4.0.7	RULE-7713	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7712	UPDATE	Grace period expiration date	None	2024-05-17
04/24/2025	4.0.7	RULE-7712	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7717	UPDATE	Grace period expiration date	None	2024-05-17
04/24/2025	4.0.7	RULE-7717	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7716	UPDATE	Grace period expiration date	None	2024-05-17
04/24/2025	4.0.7	RULE-7716	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7715	UPDATE	Grace period expiration date	None	2024-05-17
04/24/2025	4.0.7	RULE-7715	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7723	UPDATE	Active	True	False
10/07/2025	4.0.19	RULE-7723	UPDATE	Priority	Critical	N/A
10/07/2025	4.0.19	RULE-7723	UPDATE	Category	File integrity	N/A
10/07/2025	4.0.19	RULE-7723	UPDATE	For ta comprehensive	TA- Inferential	No
10/07/2025	4.0.19	RULE-7723	UPDATE	For ta inferential	Yes	No
10/07/2025	4.0.19	RULE-7723	UPDATE	Ta min	0
10/07/2025	4.0.19	RULE-7723	UPDATE	Ta max	0.02
10/07/2025	4.0.19	RULE-7723	UPDATE	Grace period expiration date	None	2024-05-17
04/24/2025	4.0.7	RULE-7723	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7724	UPDATE	Active	True	False
10/07/2025	4.0.19	RULE-7724	UPDATE	Priority	High	N/A
10/07/2025	4.0.19	RULE-7724	UPDATE	Category	Utilization	N/A
10/07/2025	4.0.19	RULE-7724	UPDATE	For ta comprehensive	TA- Inferential	No
10/07/2025	4.0.19	RULE-7724	UPDATE	For ta inferential	Yes	No
10/07/2025	4.0.19	RULE-7724	UPDATE	Ta min	0
10/07/2025	4.0.19	RULE-7724	UPDATE	Ta max	0.02
10/07/2025	4.0.19	RULE-7724	UPDATE	Grace period expiration date	None	2024-05-17
04/24/2025	4.0.7	RULE-7724	ADD	N/A		Created
05/27/2025	4.0.9	RULE-7725	UPDATE	Category	Utilization	N/A
05/27/2025	4.0.9	RULE-7725	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-7725	UPDATE	Ta max	0.02
04/24/2025	4.0.7	RULE-7725	ADD	N/A		Created
05/27/2025	4.0.9	RULE-7726	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-7726	UPDATE	Ta max	0.02
04/24/2025	4.0.7	RULE-7726	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7809	UPDATE	Grace period expiration date	None	2024-05-17
04/24/2025	4.0.7	RULE-7809	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7801	UPDATE	Grace period expiration date	None	2024-05-17
04/24/2025	4.0.7	RULE-7801	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7802	UPDATE	Grace period expiration date	None	2024-05-17
04/24/2025	4.0.7	RULE-7802	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7803	UPDATE	Grace period expiration date	None	2024-05-17
04/24/2025	4.0.7	RULE-7803	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7804	UPDATE	Grace period expiration date	None	2024-05-17
04/24/2025	4.0.7	RULE-7804	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7797	UPDATE	Grace period expiration date	None	2024-05-17
04/24/2025	4.0.7	RULE-7797	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7798	UPDATE	Grace period expiration date	None	2024-05-17
04/24/2025	4.0.7	RULE-7798	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7799	UPDATE	Grace period expiration date	None	2024-05-17
04/24/2025	4.0.7	RULE-7799	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7800	UPDATE	Grace period expiration date	None	2024-05-17
04/24/2025	4.0.7	RULE-7800	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7808	UPDATE	Grace period expiration date	None	2024-05-17
04/24/2025	4.0.7	RULE-7808	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7807	UPDATE	Grace period expiration date	None	2024-05-17
04/24/2025	4.0.7	RULE-7807	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7806	UPDATE	Grace period expiration date	None	2024-05-17
04/24/2025	4.0.7	RULE-7806	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7805	UPDATE	Grace period expiration date	None	2024-05-17
04/24/2025	4.0.7	RULE-7805	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7793	UPDATE	Grace period expiration date	None	2024-05-17
04/24/2025	4.0.7	RULE-7793	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7792	UPDATE	Grace period expiration date	None	2024-05-17
04/24/2025	4.0.7	RULE-7792	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7791	UPDATE	Grace period expiration date	None	2024-05-17
04/24/2025	4.0.7	RULE-7791	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7790	UPDATE	Grace period expiration date	None	2024-05-17
04/24/2025	4.0.7	RULE-7790	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7411	UPDATE	Grace period expiration date	None	2024-03-11
04/24/2025	4.0.7	RULE-7411	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7408	UPDATE	Grace period expiration date	None	2024-03-11
04/24/2025	4.0.7	RULE-7408	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7407	UPDATE	Grace period expiration date	None	2024-03-11
04/24/2025	4.0.7	RULE-7407	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7371	UPDATE	Grace period expiration date	None	2024-03-11
04/24/2025	4.0.7	RULE-7371	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7370	UPDATE	Grace period expiration date	None	2024-03-11
04/24/2025	4.0.7	RULE-7370	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7369	UPDATE	Grace period expiration date	None	2024-03-11
04/24/2025	4.0.7	RULE-7369	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7368	UPDATE	Grace period expiration date	None	2024-03-11
04/24/2025	4.0.7	RULE-7368	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7367	UPDATE	Grace period expiration date	None	2024-03-11
04/24/2025	4.0.7	RULE-7367	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7366	UPDATE	Grace period expiration date	None	2024-03-11
04/24/2025	4.0.7	RULE-7366	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7423	UPDATE	Grace period expiration date	None	2024-03-11
04/24/2025	4.0.7	RULE-7423	ADD	N/A		Created
04/24/2025	4.0.7	ALL-40-001-1	ADD	N/A		Created
04/24/2025	4.0.7	ALL-39-001-1	ADD	N/A		Created
04/24/2025	4.0.7	ALL-38-001-1	ADD	N/A		Created
04/24/2025	4.0.7	ALL-37-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-163-163	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-162-162	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-161-161	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-160-160	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-159-159	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-158-158	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-157-157	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-156-156	ADD	N/A		Created
11/20/2025	4.0.22	MIS-11-010_10-58	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-11-010_10-58	UPDATE	Specification	Review Reference DQ Measure ID MIS-11-XXX-X (alphanumeric format) for detailed specifications.Note: Only applies when FACILITY-GROUP-INDIVIDUAL-CODE <> 03	N/A
04/24/2025	4.0.7	MIS-11-010_10-58	ADD	N/A		Created
04/24/2025	4.0.7	MCR-59R-004-16	ADD	N/A		Created
04/24/2025	4.0.7	MCR-59R-003-15	ADD	N/A		Created
04/24/2025	4.0.7	MCR-59R-002-14	ADD	N/A		Created
04/24/2025	4.0.7	MCR-59R-001-13	ADD	N/A		Created
04/24/2025	4.0.7	MCR-56R-001-1	ADD	N/A		Created
04/24/2025	4.0.7	EXP-41R-001-1	ADD	N/A		Created
04/24/2025	4.0.7	EXP-22R-009-9	ADD	N/A		Created
04/24/2025	4.0.7	EXP-37R-001-1-2	ADD	N/A		Created
04/24/2025	4.0.7	EXP-33R-001-1	ADD	N/A		Created
04/24/2025	4.0.7	EXP-29R-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-59P-004-16	ADD	N/A		Created
04/24/2025	4.0.7	MCR-59P-003-15	ADD	N/A		Created
04/24/2025	4.0.7	MCR-59P-002-14	ADD	N/A		Created
04/24/2025	4.0.7	MCR-59P-001-13	ADD	N/A		Created
04/24/2025	4.0.7	MCR-56P-001-1	ADD	N/A		Created
04/24/2025	4.0.7	EXP-41P-001-1	ADD	N/A		Created
04/24/2025	4.0.7	EXP-22P-009-9	ADD	N/A		Created
04/24/2025	4.0.7	EXP-37P-001-1-2	ADD	N/A		Created
04/24/2025	4.0.7	EXP-33P-001-1	ADD	N/A		Created
04/24/2025	4.0.7	EXP-29P-001-1	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7641	UPDATE	Grace period expiration date	None	2024-03-11
04/24/2025	4.0.7	RULE-7641	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7247	UPDATE	Grace period expiration date	None	2023-12-02
04/24/2025	4.0.7	RULE-7247	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7251	UPDATE	Grace period expiration date	None	2023-12-02
04/24/2025	4.0.7	RULE-7251	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7250	UPDATE	Grace period expiration date	None	2023-12-02
04/24/2025	4.0.7	RULE-7250	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7249	UPDATE	Grace period expiration date	None	2023-12-02
04/24/2025	4.0.7	RULE-7249	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7248	UPDATE	Grace period expiration date	None	2023-12-02
04/24/2025	4.0.7	RULE-7248	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7246	UPDATE	Grace period expiration date	None	2023-12-02
04/24/2025	4.0.7	RULE-7246	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7245	UPDATE	Grace period expiration date	None	2023-12-02
04/24/2025	4.0.7	RULE-7245	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7244	UPDATE	Grace period expiration date	None	2023-12-02
04/24/2025	4.0.7	RULE-7244	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7243	UPDATE	Grace period expiration date	None	2023-12-02
04/24/2025	4.0.7	RULE-7243	ADD	N/A		Created
04/24/2025	4.0.7	ALL-16-015-15	ADD	N/A		Created
04/24/2025	4.0.7	ALL-16-014-14	ADD	N/A		Created
04/24/2025	4.0.7	ALL-16-013-13	ADD	N/A		Created
04/24/2025	4.0.7	ALL-16-012-12	ADD	N/A		Created
08/13/2025	4.0.16	ALL-16-011-11	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Non-missing beginning date of serviceOf the claim lines that meet the criteria from STEP 1, restrict to non-missing BEGINNING-DATE-OF-SERVICESTEP 3: Link claims to primary demographicsKeep all claims from STEP 2 for which the MSIS ID on the claim is also found on a PRIMARY-DEMOGRAPHICS-ELG00002 segment, where the following is true:1. Claims BEGINNING-DATE-OF-SERVICE>= PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE 2. Claims BEGINNING-DATE-OF-SERVICE <= PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE OR missingSTEP 4: Non-missing SexOf the claims that meet the criteria from STEP 3, restrict to non-missing SEXSTEP 5: Nurse-midwife service or Prenatal care and pre-pregnancy family planning services and supplies type of serviceOf claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-SERVICE = "025" or "085"STEP 6: Sex is "M"Of claims that meet the criteria from STEP 5, further restrict them by the following criteria:1. SEX = "M"STEP 7: Calculate percentageDivide the count of claim lines from STEP 6 by the count of claim lines from STEP 5	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Non-missing beginning date of serviceOf the claim lines that meet the criteria from STEP 1, restrict to non-missing BEGINNING-DATE-OF-SERVICESTEP 3: Link claims to primary demographicsKeep all claims from STEP 2 for which the MSIS ID on the claim is also found on a PRIMARY-DEMOGRAPHICS-ELG00002 segment, where the following is true:1. Claims BEGINNING-DATE-OF-SERVICE>= PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE 2. Claims BEGINNING-DATE-OF-SERVICE <= PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE OR missingSTEP 4: Non-missing SexOf the claims that meet the criteria from STEP 3, restrict to non-missing SEXSTEP 5: Nurse-midwife service or Prenatal care and pre-pregnancy family planning services and supplies type of serviceOf claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-SERVICE = "025" or "085"STEP 6: Sex is "M"Of claims that meet the criteria from STEP 5, further restrict them by the following criteria:1. SEX = "M"STEP 7: Calculate percentageDivide the count of claim lines from STEP 6 by the count of claim lines from STEP 5
04/24/2025	4.0.7	ALL-16-011-11	ADD	N/A		Created
04/24/2025	4.0.7	ALL-16-010-10	ADD	N/A		Created
04/24/2025	4.0.7	ALL-16-009-9	ADD	N/A		Created
10/07/2025	4.0.19	EL-3-029-38	UPDATE	Grace period expiration date	None	2024-12-21
04/24/2025	4.0.7	EL-3-029-38	ADD	N/A		Created
10/07/2025	4.0.19	EL-3-028-37	UPDATE	Grace period expiration date	None	2024-12-21
04/24/2025	4.0.7	EL-3-028-37	ADD	N/A		Created
08/13/2025	4.0.16	EXP-13-004_1-7	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Payment at the line levelOf the claims that meet the criteria from STEP 2, count records where:1. PAYMENT-LEVEL-IND = "2"STEP 4: Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 3, restrict to claims that meet the following criteria:1. MEDICAID-PAID-AMT = "0" or is missingSTEP 5: Calculate percentageDivide the number of claims from STEP 4 by the number of claims from STEP 3.	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Payment at the line levelOf the claims that meet the criteria from STEP 2, count records where:1. PAYMENT-LEVEL-IND = "2"STEP 4: Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 3, restrict to claims that meet the following criteria:1. MEDICAID-PAID-AMT = "0" or is missingSTEP 5: Calculate percentageDivide the number of claims from STEP 4 by the number of claims from STEP 3.
04/24/2025	4.0.7	EXP-13-004_1-7	ADD	N/A		Created
08/13/2025	4.0.16	EXP-13-003_1-6	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Payment at the line levelOf the claims that meet the criteria from STEP 2, count records where:1. PAYMENT-LEVEL-IND = "2"STEP 4: Billed amount $0Of the claims that meet the criteria from STEP 3, count records with1. BILLED-AMT = "0"STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Payment at the line levelOf the claims that meet the criteria from STEP 2, count records where:1. PAYMENT-LEVEL-IND = "2"STEP 4: Billed amount $0Of the claims that meet the criteria from STEP 3, count records with1. BILLED-AMT = "0"STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3
04/24/2025	4.0.7	EXP-13-003_1-6	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7781	UPDATE	Grace period expiration date	None	2023-10-31
04/24/2025	4.0.7	RULE-7781	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7780	UPDATE	Grace period expiration date	None	2023-10-31
04/24/2025	4.0.7	RULE-7780	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7779	UPDATE	Grace period expiration date	None	2023-10-31
04/24/2025	4.0.7	RULE-7779	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7778	UPDATE	Grace period expiration date	None	2023-10-31
04/24/2025	4.0.7	RULE-7778	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7777	UPDATE	Grace period expiration date	None	2023-10-31
04/24/2025	4.0.7	RULE-7777	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7776	UPDATE	Grace period expiration date	None	2023-10-31
04/24/2025	4.0.7	RULE-7776	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7775	UPDATE	Grace period expiration date	None	2023-10-31
04/24/2025	4.0.7	RULE-7775	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7774	UPDATE	Grace period expiration date	None	2023-10-31
04/24/2025	4.0.7	RULE-7774	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7735	UPDATE	Grace period expiration date	None	2023-10-31
04/24/2025	4.0.7	RULE-7735	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7734	UPDATE	Grace period expiration date	None	2023-10-31
04/24/2025	4.0.7	RULE-7734	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7733	UPDATE	Grace period expiration date	None	2023-10-31
04/24/2025	4.0.7	RULE-7733	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7732	UPDATE	Grace period expiration date	None	2023-10-31
04/24/2025	4.0.7	RULE-7732	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7731	UPDATE	Grace period expiration date	None	2023-10-31
04/24/2025	4.0.7	RULE-7731	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7729	UPDATE	Grace period expiration date	None	2023-10-31
04/24/2025	4.0.7	RULE-7729	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7728	UPDATE	Grace period expiration date	None	2023-10-31
04/24/2025	4.0.7	RULE-7728	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7706	UPDATE	Active	True	False
10/07/2025	4.0.19	RULE-7706	UPDATE	Priority	High	N/A
10/07/2025	4.0.19	RULE-7706	UPDATE	Category	Program participation	N/A
10/07/2025	4.0.19	RULE-7706	UPDATE	For ta comprehensive	TA- Inferential	No
10/07/2025	4.0.19	RULE-7706	UPDATE	For ta inferential	Yes	No
10/07/2025	4.0.19	RULE-7706	UPDATE	Ta min	0
10/07/2025	4.0.19	RULE-7706	UPDATE	Ta max	0.02
10/07/2025	4.0.19	RULE-7706	UPDATE	Grace period expiration date	None	2023-10-31
04/24/2025	4.0.7	RULE-7706	ADD	N/A		Created
05/27/2025	4.0.9	RULE-7702	UPDATE	Category	Program participation	N/A
05/27/2025	4.0.9	RULE-7702	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-7702	UPDATE	Ta max	0.02
04/24/2025	4.0.7	RULE-7702	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7666	UPDATE	Active	True	False
04/24/2025	4.0.7	RULE-7666	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7665	UPDATE	Grace period expiration date	None	2023-10-31
04/24/2025	4.0.7	RULE-7665	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7664	UPDATE	Grace period expiration date	None	2023-10-31
04/24/2025	4.0.7	RULE-7664	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7663	UPDATE	Grace period expiration date	None	2023-10-31
04/24/2025	4.0.7	RULE-7663	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7662	UPDATE	Grace period expiration date	None	2023-10-31
04/24/2025	4.0.7	RULE-7662	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7540	UPDATE	Grace period expiration date	None	2023-10-31
04/24/2025	4.0.7	RULE-7540	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7539	UPDATE	Grace period expiration date	None	2023-10-31
04/24/2025	4.0.7	RULE-7539	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7538	UPDATE	Grace period expiration date	None	2023-10-31
04/24/2025	4.0.7	RULE-7538	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7427	UPDATE	Grace period expiration date	None	2023-10-31
04/24/2025	4.0.7	RULE-7427	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7201	UPDATE	Grace period expiration date	None	2023-10-31
04/24/2025	4.0.7	RULE-7201	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7200	UPDATE	Grace period expiration date	None	2023-10-31
04/24/2025	4.0.7	RULE-7200	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7199	UPDATE	Grace period expiration date	None	2023-10-31
04/24/2025	4.0.7	RULE-7199	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7198	UPDATE	Grace period expiration date	None	2023-10-31
04/24/2025	4.0.7	RULE-7198	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7197	UPDATE	Grace period expiration date	None	2023-10-31
04/24/2025	4.0.7	RULE-7197	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7196	UPDATE	Grace period expiration date	None	2023-10-31
04/24/2025	4.0.7	RULE-7196	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7195	UPDATE	Grace period expiration date	None	2023-10-31
04/24/2025	4.0.7	RULE-7195	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7194	UPDATE	Grace period expiration date	None	2023-10-31
04/24/2025	4.0.7	RULE-7194	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7182	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-7182	ADD	N/A		Created
04/24/2025	4.0.7	MCR-9-019-21	ADD	N/A		Created
04/24/2025	4.0.7	MCR-9-018-20	ADD	N/A		Created
04/24/2025	4.0.7	MCR-13-019-21	ADD	N/A		Created
04/24/2025	4.0.7	MCR-13-018-20	ADD	N/A		Created
04/24/2025	4.0.7	EL-20-001-1	ADD	N/A		Created
10/07/2025	4.0.19	MIS-1-013-13	UPDATE	Grace period expiration date	None	2024-03-11
04/24/2025	4.0.7	MIS-1-013-13	ADD	N/A		Created
08/13/2025	4.0.16	EXP-39-001_1-2	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Payment at the line levelOf the claims from STEP 3, select records where:1. PAYMENT-LEVEL-IND = "2"STEP 5: Medicaid paid $0 or missingOf the claims from STEP 4, select records where:1. MEDICAID-PAID-AMT = "0" or is missingSTEP 6: Calculate the percentage for the measureDivide the count of claim lines from STEP 5 by the count of claims lines from STEP 4.	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Payment at the line levelOf the claims from STEP 3, select records where:1. PAYMENT-LEVEL-IND = "2"STEP 5: Medicaid paid $0 or missingOf the claims from STEP 4, select records where:1. MEDICAID-PAID-AMT = "0" or is missingSTEP 6: Calculate the percentage for the measureDivide the count of claim lines from STEP 5 by the count of claims lines from STEP 4.
04/24/2025	4.0.7	EXP-39-001_1-2	ADD	N/A		Created
08/13/2025	4.0.16	EXP-37-001_1-2	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Payment at the line levelOf the claims from STEP 3, select records where:1. PAYMENT-LEVEL-IND = "2"STEP 5: Medicaid paid $0 or missingOf the claims from STEP 4, select records where:1. MEDICAID-PAID-AMT = "0" or is missingSTEP 6: Calculate the percentage for the measureDivide the count of claim lines from STEP 5 by the count of claims lines from STEP 4.	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Payment at the line levelOf the claims from STEP 3, select records where:1. PAYMENT-LEVEL-IND = "2"STEP 5: Medicaid paid $0 or missingOf the claims from STEP 4, select records where:1. MEDICAID-PAID-AMT = "0" or is missingSTEP 6: Calculate the percentage for the measureDivide the count of claim lines from STEP 5 by the count of claims lines from STEP 4.
04/24/2025	4.0.7	EXP-37-001_1-2	ADD	N/A		Created
08/13/2025	4.0.16	EXP-11-161_1-164	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Payment at the line levelOf the claims that meet the criteria from STEP 2, count records where:1. PAYMENT-LEVEL-IND = "2"STEP 4: Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 3, select records with 1. MEDICAID-PAID-AMT = "0" or is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Payment at the line levelOf the claims that meet the criteria from STEP 2, count records where:1. PAYMENT-LEVEL-IND = "2"STEP 4: Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 3, select records with 1. MEDICAID-PAID-AMT = "0" or is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3
04/24/2025	4.0.7	EXP-11-161_1-164	ADD	N/A		Created
08/13/2025	4.0.16	EXP-11-160_1-163	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Payment at the line levelOf the claims that meet the criteria from STEP 2, count records where:1. PAYMENT-LEVEL-IND = "2"STEP 4: Billed amount $0Of the claims that meet the criteria from STEP 3, count records with1. BILLED-AMT = "0"STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Payment at the line levelOf the claims that meet the criteria from STEP 2, count records where:1. PAYMENT-LEVEL-IND = "2"STEP 4: Billed amount $0Of the claims that meet the criteria from STEP 3, count records with1. BILLED-AMT = "0"STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3
04/24/2025	4.0.7	EXP-11-160_1-163	ADD	N/A		Created
11/20/2025	4.0.22	EL-6-037-37	UPDATE	Annotation	Calculate the percentage of eligibles with an immigration status indicating eligibility only for payment for emergency services, that do not have a restricted benefits code indicating either alien status or eligibility only for pregnancy-related services	N/A
11/20/2025	4.0.22	EL-6-037-37	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: U.S. citizen immigration statusOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping MSIS IDs where:1. IMMIGRATION-STATUS = "3"STEP 4: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missing"STEP 5: Restricted Benefits Code designationOf the MSIS IDs that meet the criteria from STEP 4, restrict to those where:1. RESTRICTED-BENEFITS-CODE is not “2” or "4"STEP 6: Calculate percentageDivide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 3	N/A
04/24/2025	4.0.7	EL-6-037-37	ADD	N/A		Created
04/24/2025	4.0.7	EL-1-040-47	ADD	N/A		Created
04/24/2025	4.0.7	EL-1-039-46	ADD	N/A		Created
10/07/2025	4.0.19	EL-1-038-45	UPDATE	Grace period expiration date	None	2024-03-11
04/24/2025	4.0.7	EL-1-038-45	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7569	UPDATE	Grace period expiration date	None	2023-07-31
04/24/2025	4.0.7	RULE-7569	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7460	UPDATE	Grace period expiration date	None	2023-07-31
04/24/2025	4.0.7	RULE-7460	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7459	UPDATE	Grace period expiration date	None	2023-07-31
04/24/2025	4.0.7	RULE-7459	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7458	UPDATE	Grace period expiration date	None	2023-07-31
04/24/2025	4.0.7	RULE-7458	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7446	UPDATE	Grace period expiration date	None	2023-07-31
04/24/2025	4.0.7	RULE-7446	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7445	UPDATE	Grace period expiration date	None	2023-07-31
04/24/2025	4.0.7	RULE-7445	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7444	UPDATE	Grace period expiration date	None	2023-07-31
04/24/2025	4.0.7	RULE-7444	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7443	UPDATE	Grace period expiration date	None	2023-07-31
04/24/2025	4.0.7	RULE-7443	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7442	UPDATE	Grace period expiration date	None	2023-07-31
04/24/2025	4.0.7	RULE-7442	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7441	UPDATE	Grace period expiration date	None	2023-07-31
04/24/2025	4.0.7	RULE-7441	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7440	UPDATE	Grace period expiration date	None	2023-07-31
04/24/2025	4.0.7	RULE-7440	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7439	UPDATE	Grace period expiration date	None	2023-07-31
04/24/2025	4.0.7	RULE-7439	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7239	UPDATE	Grace period expiration date	None	2023-07-31
04/24/2025	4.0.7	RULE-7239	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7220	UPDATE	Grace period expiration date	None	2023-07-31
04/24/2025	4.0.7	RULE-7220	ADD	N/A		Created
11/20/2025	4.0.22	PRV-2-011-11	UPDATE	Annotation	Calculate the percent of providers that require NPI (are not atypical) and are missing NPI	N/A
11/20/2025	4.0.22	PRV-2-011-11	UPDATE	Specification	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 2: Provider taxonomy is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROVIDER-TAXONOMY-CLASSIFICATION-PRV00006 by keeping records that satisfy the following criteria:1a. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= last day of the reporting month2a. PROV-TAXONOMY-CLASSIFICATION-END-DATE >= last day of the reporting month OR missingOR1b. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE is missing2b. PROV-TAXONOMY-CLASSIFICATION-END-DATE is missingSTEP 3: Provider Classification Lookup Designation indicates NPI is required (non-atypical providers)Of the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 2, further refine the population by keeping records that meet the following criteria:1. PROV-CLASSIFICATION-TYPE and PROVIDER-CLASSIFICATION-CODE match values in Atypical Provider Lookup table2. 'NPI Required' is "YES"STEP 4: Provider identifier is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 3, further refine the population using segment PROV-IDENTIFIER-PRV00005 by keeping records that satisfy the following criteria:1a. PROV-IDENTIFIER-EFF-DATE <= last day of the reporting month2a. PROV-IDENTIFIER-END-DATE >= last day of the reporting month OR missingOR1b. PROV-IDENTIFIER-EFF-DATE is missing2b. PROV-IDENTIFIER-END-DATE is missingSTEP 5: NPI is presentOf the records that meet the criteria from STEP 4, restrict to segments that meet the following criteria:1. PROV-IDENTIFIER-TYPE = 22. SUBMITTING-STATE-PROV-ID is not NULLSTEP 6: NPI is not presentSubtract the count of unique SUBMITTING-STATE-PROV-IDs from STEP 5 from the count from STEP 3STEP 7: Calculate percent that do not have an NPIDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 6 by the count from STEP 3	N/A
04/24/2025	4.0.7	PRV-2-011-11	ADD	N/A		Created
11/20/2025	4.0.22	EL-1-037-44	UPDATE	Annotation	Calculate the percentage of eligibles with a Other race where ethnicity is missing, unspecified, or invalid	N/A
11/20/2025	4.0.22	EL-1-037-44	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION ELG00016 by keeping records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Race is OtherOf the MSIS IDs that meet the criteria from STEP 2, further restrict the population by keeping MSIS IDs where:1. RACE equals “018”on any record segmentSTEP 4: Ethnicity information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment ETHNICITY-INFORMATION-ELG00015 by keeping active records that satisfy the following criteria:1a. ETHNICITY-DECLARATION-EFF-DATE <= last day of the DQ report month2a. ETHNICITY-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. ETHNICITY-DECLARATION-EFF-DATE is missing2b. ETHNICITY-DECLARATION-END-DATE is missingSTEP 5 : MSIS IDs where ethnicity is missing, unspecified, or invalidOf the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping MSIS IDs where:1a. ETHNICITY-CODE is not “0,” “1,” “2,” “3,” “4,” or “5”OR1b. ETHNICITY-CODE is missingSTEP 6: Calculate percentage Divide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 3	N/A
04/24/2025	4.0.7	EL-1-037-44	ADD	N/A		Created
11/20/2025	4.0.22	EL-1-036-43	UPDATE	Annotation	Calculate the percentage of eligibles with a Native Hawaiian or Other Pacific Islander race where ethnicity is missing, unspecified, or invalid	N/A
11/20/2025	4.0.22	EL-1-036-43	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION ELG00016 by keeping records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Race is Native Hawaiian or Other Pacific IslanderOf the MSIS IDs that meet the criteria from STEP 2, further restrict the population by keeping MSIS IDs where:1. RACE = “012,” "013," "014," "015," or "016" on any record segmentSTEP 4: Ethnicity information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment ETHNICITY-INFORMATION-ELG00015 by keeping active records that satisfy the following criteria:1a. ETHNICITY-DECLARATION-EFF-DATE <= last day of the DQ report month2a. ETHNICITY-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. ETHNICITY-DECLARATION-EFF-DATE is missing2b. ETHNICITY-DECLARATION-END-DATE is missingSTEP 5 : MSIS IDs where ethnicity is missing, unspecified, or invalidOf the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping MSIS IDs where:1a. ETHNICITY-CODE is not “0,” “1,” “2,” “3,” “4,” or “5”OR1b. ETHNICITY-CODE is missingSTEP 6: Calculate percentage Divide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 3	N/A
04/24/2025	4.0.7	EL-1-036-43	ADD	N/A		Created
11/20/2025	4.0.22	EL-1-035-42	UPDATE	Annotation	Calculate the percentage of eligibles with an Asian race where ethnicity is missing, unspecified, or invalid	N/A
11/20/2025	4.0.22	EL-1-035-42	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION ELG00016 by keeping records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Race is AsianOf the MSIS IDs that meet the criteria from STEP 2, further restrict the population by keeping MSIS IDs where:1. RACE = “004,” "005," "006," "007," "008," "009," "010," or "011" on any record segmentSTEP 4: Ethnicity information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment ETHNICITY-INFORMATION-ELG00015 by keeping active records that satisfy the following criteria:1a. ETHNICITY-DECLARATION-EFF-DATE <= last day of the DQ report month2a. ETHNICITY-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. ETHNICITY-DECLARATION-EFF-DATE is missing2b. ETHNICITY-DECLARATION-END-DATE is missingSTEP 5 : MSIS IDs where ethnicity is missing, unspecified, or invalidOf the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping MSIS IDs where:1a. ETHNICITY-CODE is not “0,” “1,” “2,” “3,” “4,” or “5”OR1b. ETHNICITY-CODE is missingSTEP 6: Calculate percentage Divide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 3	N/A
04/24/2025	4.0.7	EL-1-035-42	ADD	N/A		Created
11/20/2025	4.0.22	EL-1-034-41	UPDATE	Annotation	Calculate the percentage of eligibles with American Indian or Alaska Native race where ethnicity is missing, unspecified, or invalid	N/A
11/20/2025	4.0.22	EL-1-034-41	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION ELG00016 by keeping records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Race is American Indian or Alaska NativeOf the MSIS IDs that meet the criteria from STEP 2, further restrict the population by keeping MSIS IDs where:1. RACE equals “003”on any record segmentSTEP 4: Ethnicity information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment ETHNICITY-INFORMATION-ELG00015 by keeping active records that satisfy the following criteria:1a. ETHNICITY-DECLARATION-EFF-DATE <= last day of the DQ report month2a. ETHNICITY-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. ETHNICITY-DECLARATION-EFF-DATE is missing2b. ETHNICITY-DECLARATION-END-DATE is missingSTEP 5 : MSIS IDs where ethnicity is missing, unspecified, or invalidOf the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping MSIS IDs where:1a. ETHNICITY-CODE is not “0,” “1,” “2,” “3,” “4,” or “5”OR1b. ETHNICITY-CODE is missingSTEP 6: Calculate percentage Divide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 3	N/A
04/24/2025	4.0.7	EL-1-034-41	ADD	N/A		Created
11/20/2025	4.0.22	EL-1-033-40	UPDATE	Annotation	Calculate the percentage of eligibles with Black or African American race where ethnicity is missing, unspecified, or invalid	N/A
11/20/2025	4.0.22	EL-1-033-40	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION ELG00016 by keeping records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Race is Black or African AmericanOf the MSIS IDs that meet the criteria from STEP 2, further restrict the population by keeping MSIS IDs where:1. RACE equals “002”on any record segmentSTEP 4: Ethnicity information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment ETHNICITY-INFORMATION-ELG00015 by keeping active records that satisfy the following criteria:1a. ETHNICITY-DECLARATION-EFF-DATE <= last day of the DQ report month2a. ETHNICITY-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. ETHNICITY-DECLARATION-EFF-DATE is missing2b. ETHNICITY-DECLARATION-END-DATE is missingSTEP 5 : MSIS IDs where ethnicity is missing, unspecified, or invalidOf the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping MSIS IDs where:1a. ETHNICITY-CODE is not “0,” “1,” “2,” “3,” “4,” or “5”OR1b. ETHNICITY-CODE is missingSTEP 6: Calculate percentage Divide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 3	N/A
04/24/2025	4.0.7	EL-1-033-40	ADD	N/A		Created
11/20/2025	4.0.22	EL-1-032-39	UPDATE	Annotation	Calculate the percentage of eligibles with a White race where ethnicity is missing, unspecified, or invalid	N/A
11/20/2025	4.0.22	EL-1-032-39	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION ELG00016 by keeping records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Race is WhiteOf the MSIS IDs that meet the criteria from STEP 2, further restrict the population by keeping MSIS IDs where:1. RACE equals “001”on any record segmentSTEP 4: Ethnicity information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment ETHNICITY-INFORMATION-ELG00015 by keeping active records that satisfy the following criteria:1a. ETHNICITY-DECLARATION-EFF-DATE <= last day of the DQ report month2a. ETHNICITY-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. ETHNICITY-DECLARATION-EFF-DATE is missing2b. ETHNICITY-DECLARATION-END-DATE is missingSTEP 5 : MSIS IDs where ethnicity is missing, unspecified, or invalidOf the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping MSIS IDs where:1a. ETHNICITY-CODE is not “0,” “1,” “2,” “3,” “4,” or “5”OR1b. ETHNICITY-CODE is missingSTEP 6: Calculate percentage Divide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 3	N/A
04/24/2025	4.0.7	EL-1-032-39	ADD	N/A		Created
10/07/2025	4.0.19	MCR-65-012-12	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	MCR-65-012-12	ADD	N/A		Created
10/07/2025	4.0.19	MCR-65-011-11	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	MCR-65-011-11	ADD	N/A		Created
10/07/2025	4.0.19	MCR-65-010-10	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	MCR-65-010-10	ADD	N/A		Created
10/07/2025	4.0.19	MCR-65-009-9	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in Disease ManagementOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("02", "03", or "16")STEP 4: Active non-duplicate paid capitation payment financial transactions during report monthDefine the FTX universe for the FTX0002, FTX0003, and FTX0005 tables respectively by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid & S-CHIP Capitation PaymentOf the records that meet the criteria from STEP 4, further restrict them by the following criteria:1. PAYEE-ID-TYPE = "02"STEP 6: Cost-Sharing Offset Transaction TypeOf the records that meet the criteria from STEP 5, for those in FTX0005 only, further restrict them by the following criteria:1. OFFSET-TRANS-TYPE is not "03"STEP 7: Link MSIS IDs from EL to FTXRetain the MSIS IDs from STEP 3 that link to an FTX record from STEP 6 using the Plan ID (PAYEE-ID in the FTX record)STEP 8: Count MSIS IDs without Disease ManagementSubtract the number of unique MSIS IDs in STEP 7 from the number of unique MSIS IDs in STEP 3STEP 9: Calculate percentageDivide the count of unique MSIS IDs in STEP 8 by the count of unique MSIS IDs in STEP 3	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in Disease ManagementOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("02", "03", or "16")STEP 4: Active non-duplicate paid capitation payment financial transactions during report monthDefine the FTX universe for the FTX0002, FTX0003, and FTX0005 tables respectively by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid & S-CHIP Capitation PaymentOf the records that meet the criteria from STEP 4, further restrict them by the following criteria:1. PAYEE-ID-TYPE = "02" or "05" or "06"STEP 6: Cost-Sharing Offset Transaction TypeOf the records that meet the criteria from STEP 5, for those in FTX0005 only, further restrict them by the following criteria:1. OFFSET-TRANS-TYPE is not "03"STEP 7: Link MSIS IDs from EL to FTXRetain the MSIS IDs from STEP 3 that link to an FTX record from STEP 6 using the Plan ID (PAYEE-ID in the FTX record)STEP 8: Count MSIS IDs without Disease ManagementSubtract the number of unique MSIS IDs in STEP 7 from the number of unique MSIS IDs in STEP 3STEP 9: Calculate percentageDivide the count of unique MSIS IDs in STEP 8 by the count of unique MSIS IDs in STEP 3
10/07/2025	4.0.19	MCR-65-009-9	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	MCR-65-009-9	ADD	N/A		Created
10/07/2025	4.0.19	MCR-65-008-8	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	MCR-65-008-8	ADD	N/A		Created
10/07/2025	4.0.19	MCR-65-007-7	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	MCR-65-007-7	ADD	N/A		Created
10/07/2025	4.0.19	MCR-65-006-6	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	MCR-65-006-6	ADD	N/A		Created
10/07/2025	4.0.19	MCR-65-005-5	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	MCR-65-005-5	ADD	N/A		Created
10/07/2025	4.0.19	MCR-65-004-4	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	MCR-65-004-4	ADD	N/A		Created
10/07/2025	4.0.19	MCR-65-003-3	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	MCR-65-003-3	ADD	N/A		Created
10/07/2025	4.0.19	MCR-65-002-2	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	MCR-65-002-2	ADD	N/A		Created
10/07/2025	4.0.19	MCR-65-001-1	UPDATE	Grace period expiration date	None	2026-01-30
04/24/2025	4.0.7	MCR-65-001-1	ADD	N/A		Created
10/07/2025	4.0.19	EL-1-031-38	UPDATE	Grace period expiration date	None	2024-12-21
04/24/2025	4.0.7	EL-1-031-38	ADD	N/A		Created
04/24/2025	4.0.7	EL-1-030-37	ADD	N/A		Created
04/24/2025	4.0.7	EL-1-029-36	ADD	N/A		Created
04/24/2025	4.0.7	EL-1-028-35	ADD	N/A		Created
10/07/2025	4.0.19	EL-1-027-34	UPDATE	Grace period expiration date	None	2024-12-21
04/24/2025	4.0.7	EL-1-027-34	ADD	N/A		Created
10/07/2025	4.0.19	EL-1-026-33	UPDATE	Grace period expiration date	None	2024-12-21
04/24/2025	4.0.7	EL-1-026-33	ADD	N/A		Created
05/27/2025	4.0.9	RULE-7646	UPDATE	Category	File integrity	N/A
05/27/2025	4.0.9	RULE-7646	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-7646	UPDATE	Ta max	0.02
04/24/2025	4.0.7	RULE-7646	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7645	UPDATE	Grace period expiration date	None	2023-04-30
04/24/2025	4.0.7	RULE-7645	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7644	UPDATE	Grace period expiration date	None	2023-04-30
04/24/2025	4.0.7	RULE-7644	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7643	UPDATE	Grace period expiration date	None	2023-04-30
04/24/2025	4.0.7	RULE-7643	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7642	UPDATE	Grace period expiration date	None	2023-04-30
04/24/2025	4.0.7	RULE-7642	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7593	UPDATE	Active	True	False
10/07/2025	4.0.19	RULE-7593	UPDATE	Priority	Medium	N/A
10/07/2025	4.0.19	RULE-7593	UPDATE	Category	Expenditures	N/A
10/07/2025	4.0.19	RULE-7593	UPDATE	For ta comprehensive	TA- Inferential	No
10/07/2025	4.0.19	RULE-7593	UPDATE	For ta inferential	Yes	No
10/07/2025	4.0.19	RULE-7593	UPDATE	Ta min	0
10/07/2025	4.0.19	RULE-7593	UPDATE	Ta max	0.001
04/24/2025	4.0.7	RULE-7593	ADD	N/A		Created
04/24/2025	4.0.7	RULE-7582	ADD	N/A		Created
04/24/2025	4.0.7	RULE-7581	ADD	N/A		Created
04/24/2025	4.0.7	RULE-7580	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7579	UPDATE	Active	True	False
10/07/2025	4.0.19	RULE-7579	UPDATE	Priority	Medium	N/A
10/07/2025	4.0.19	RULE-7579	UPDATE	Category	Expenditures	N/A
10/07/2025	4.0.19	RULE-7579	UPDATE	For ta comprehensive	TA- Inferential	No
10/07/2025	4.0.19	RULE-7579	UPDATE	For ta inferential	Yes	No
10/07/2025	4.0.19	RULE-7579	UPDATE	Ta min	0
10/07/2025	4.0.19	RULE-7579	UPDATE	Ta max	0.001
04/24/2025	4.0.7	RULE-7579	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7577	UPDATE	Grace period expiration date	None	2023-04-30
04/24/2025	4.0.7	RULE-7577	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7576	UPDATE	Grace period expiration date	None	2023-04-30
04/24/2025	4.0.7	RULE-7576	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7575	UPDATE	Grace period expiration date	None	2023-04-30
04/24/2025	4.0.7	RULE-7575	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7574	UPDATE	Grace period expiration date	None	2023-04-30
04/24/2025	4.0.7	RULE-7574	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7573	UPDATE	Grace period expiration date	None	2023-04-30
04/24/2025	4.0.7	RULE-7573	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7572	UPDATE	Grace period expiration date	None	2023-04-30
04/24/2025	4.0.7	RULE-7572	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7571	UPDATE	Grace period expiration date	None	2023-04-30
04/24/2025	4.0.7	RULE-7571	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7570	UPDATE	Grace period expiration date	None	2023-04-30
04/24/2025	4.0.7	RULE-7570	ADD	N/A		Created
04/24/2025	4.0.7	RULE-7568	ADD	N/A		Created
04/24/2025	4.0.7	RULE-7567	ADD	N/A		Created
04/24/2025	4.0.7	RULE-7566	ADD	N/A		Created
04/24/2025	4.0.7	RULE-7565	ADD	N/A		Created
05/27/2025	4.0.9	RULE-7564	UPDATE	Category	Utilization	N/A
05/27/2025	4.0.9	RULE-7564	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-7564	UPDATE	Ta max	0.001
04/24/2025	4.0.7	RULE-7564	ADD	N/A		Created
04/24/2025	4.0.7	RULE-7563	ADD	N/A		Created
04/24/2025	4.0.7	RULE-7562	ADD	N/A		Created
04/24/2025	4.0.7	RULE-7561	ADD	N/A		Created
04/24/2025	4.0.7	RULE-7560	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7559	UPDATE	Grace period expiration date	None	2023-04-30
04/24/2025	4.0.7	RULE-7559	ADD	N/A		Created
04/24/2025	4.0.7	RULE-7558	ADD	N/A		Created
04/24/2025	4.0.7	RULE-7557	ADD	N/A		Created
04/24/2025	4.0.7	RULE-7556	ADD	N/A		Created
04/24/2025	4.0.7	RULE-7555	ADD	N/A		Created
04/24/2025	4.0.7	RULE-7554	ADD	N/A		Created
04/24/2025	4.0.7	RULE-7553	ADD	N/A		Created
08/13/2025	4.0.16	MCR-64-004_1-8	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers: 1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Non-void, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. CROSSOVER-IND = "1"3. ADJUSTMENT-IND not equal to "1" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: No Medicare AmountsOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria: 1. MEDICARE-PAID-AMT = 0 or is missing on all lines2. TOT-MEDICARE-COINS-AMT = 0 or is missing3. TOT-MEDICARE-DEDUCTIBLE-AMT = 0 or is missingSTEP 5: Calculate percentageDivide the count of claim headers from STEP 4 by the count of claim headers from STEP 3.	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers: 1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Non-void, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. CROSSOVER-IND = "1"3. ADJUSTMENT-IND not equal to "1" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: No Medicare AmountsOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria: 1. MEDICARE-PAID-AMT = 0 or is missing on all lines2. TOT-MEDICARE-COINS-AMT = 0 or is missing3. TOT-MEDICARE-DEDUCTIBLE-AMT = 0 or is missingSTEP 5: Calculate percentageDivide the count of claim headers from STEP 4 by the count of claim headers from STEP 3.
04/24/2025	4.0.7	MCR-64-004_1-8	ADD	N/A		Created
08/13/2025	4.0.16	MCR-64-003_1-7	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers: 1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Non-void, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. CROSSOVER-IND = "1"3. ADJUSTMENT-IND not equal to "1" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: No Medicare AmountsOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria: 1. MEDICARE-PAID-AMT = 0 or is missing on all lines2. TOT-MEDICARE-COINS-AMT = 0 or is missing3. TOT-MEDICARE-DEDUCTIBLE-AMT = 0 or is missingSTEP 5: Calculate percentageDivide the count of claim headers from STEP 4 by the count of claim headers from STEP 3.	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers: 1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Non-void, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. CROSSOVER-IND = "1"3. ADJUSTMENT-IND not equal to "1" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: No Medicare AmountsOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria: 1. MEDICARE-PAID-AMT = 0 or is missing on all lines2. TOT-MEDICARE-COINS-AMT = 0 or is missing3. TOT-MEDICARE-DEDUCTIBLE-AMT = 0 or is missingSTEP 5: Calculate percentageDivide the count of claim headers from STEP 4 by the count of claim headers from STEP 3.
04/24/2025	4.0.7	MCR-64-003_1-7	ADD	N/A		Created
10/07/2025	4.0.19	MCR-64-002_1-6	UPDATE	Grace period expiration date	None	2023-04-30
04/24/2025	4.0.7	MCR-64-002_1-6	ADD	N/A		Created
10/07/2025	4.0.19	MCR-64-001_1-5	UPDATE	Grace period expiration date	None	2023-04-30
04/24/2025	4.0.7	MCR-64-001_1-5	ADD	N/A		Created
10/07/2025	4.0.19	FFS-54-004_1-8	UPDATE	Grace period expiration date	None	2023-04-30
04/24/2025	4.0.7	FFS-54-004_1-8	ADD	N/A		Created
10/07/2025	4.0.19	FFS-54-003_1-7	UPDATE	Grace period expiration date	None	2023-04-30
04/24/2025	4.0.7	FFS-54-003_1-7	ADD	N/A		Created
10/07/2025	4.0.19	FFS-54-002_1-6	UPDATE	Grace period expiration date	None	2023-04-30
04/24/2025	4.0.7	FFS-54-002_1-6	ADD	N/A		Created
10/07/2025	4.0.19	FFS-54-001_1-5	UPDATE	Grace period expiration date	None	2023-04-30
04/24/2025	4.0.7	FFS-54-001_1-5	ADD	N/A		Created
10/07/2025	4.0.19	EL-3-027-36	UPDATE	Grace period expiration date	None	2023-04-30
04/24/2025	4.0.7	EL-3-027-36	ADD	N/A		Created
10/07/2025	4.0.19	EL-3-026-35	UPDATE	Grace period expiration date	None	2023-04-30
04/24/2025	4.0.7	EL-3-026-35	ADD	N/A		Created
10/07/2025	4.0.19	EL-3-019_1-34	UPDATE	Grace period expiration date	None	2023-04-30
04/24/2025	4.0.7	EL-3-019_1-34	ADD	N/A		Created
10/07/2025	4.0.19	EL-3-016_1-33	UPDATE	Grace period expiration date	None	2023-04-30
04/24/2025	4.0.7	EL-3-016_1-33	ADD	N/A		Created
11/20/2025	4.0.22	EL-1-014-32	UPDATE	Annotation	Calculate the percentage of eligibles with a citizen status whose Medicaid enrollment is pending citizenship verification	N/A
11/20/2025	4.0.22	EL-1-014-32	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: U.S. citizenOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping MSIS IDs where:1. CITIZENSHIP-IND = "1"STEP 4: Enrollment in Medicaid is pending citizenship verificationOf the MSIS IDs that meet the criteria from STEP 3, restrict to those pending citizenship verification: 1. CITIZENSHIP-VERIFICATION-FLAG = "1"STEP 5: Calculate percentageDivide the count of unique MSIS IDs from STEP 4 by the count of unique MSIS IDs from STEP 3	N/A
04/24/2025	4.0.7	EL-1-014-32	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7524	UPDATE	Active	True	False
10/07/2025	4.0.19	RULE-7524	UPDATE	Priority	High	N/A
10/07/2025	4.0.19	RULE-7524	UPDATE	Category	Expenditures	N/A
10/07/2025	4.0.19	RULE-7524	UPDATE	For ta comprehensive	TA- Inferential	No
10/07/2025	4.0.19	RULE-7524	UPDATE	For ta inferential	Yes	No
10/07/2025	4.0.19	RULE-7524	UPDATE	Ta min	0
10/07/2025	4.0.19	RULE-7524	UPDATE	Ta max	0.1
10/07/2025	4.0.19	RULE-7524	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	RULE-7524	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7523	UPDATE	Active	True	False
10/07/2025	4.0.19	RULE-7523	UPDATE	Priority	High	N/A
10/07/2025	4.0.19	RULE-7523	UPDATE	Category	Expenditures	N/A
10/07/2025	4.0.19	RULE-7523	UPDATE	For ta comprehensive	TA- Inferential	No
10/07/2025	4.0.19	RULE-7523	UPDATE	For ta inferential	Yes	No
10/07/2025	4.0.19	RULE-7523	UPDATE	Ta min	0
10/07/2025	4.0.19	RULE-7523	UPDATE	Ta max	0.1
10/07/2025	4.0.19	RULE-7523	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	RULE-7523	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7522	UPDATE	Active	True	False
10/07/2025	4.0.19	RULE-7522	UPDATE	Priority	High	N/A
10/07/2025	4.0.19	RULE-7522	UPDATE	Category	Expenditures	N/A
10/07/2025	4.0.19	RULE-7522	UPDATE	For ta comprehensive	TA- Inferential	No
10/07/2025	4.0.19	RULE-7522	UPDATE	For ta inferential	Yes	No
10/07/2025	4.0.19	RULE-7522	UPDATE	Ta min	0
10/07/2025	4.0.19	RULE-7522	UPDATE	Ta max	0.1
10/07/2025	4.0.19	RULE-7522	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	RULE-7522	ADD	N/A		Created
05/27/2025	4.0.9	RULE-7521	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-7521	UPDATE	Priority	High	N/A
05/27/2025	4.0.9	RULE-7521	UPDATE	Category	Expenditures	N/A
05/27/2025	4.0.9	RULE-7521	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-7521	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-7521	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-7521	UPDATE	Ta max	0.02
04/24/2025	4.0.7	RULE-7521	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7438	UPDATE	Active	True	False
10/07/2025	4.0.19	RULE-7438	UPDATE	Priority	High	N/A
10/07/2025	4.0.19	RULE-7438	UPDATE	Category	Expenditures	N/A
10/07/2025	4.0.19	RULE-7438	UPDATE	For ta comprehensive	TA- Inferential	No
10/07/2025	4.0.19	RULE-7438	UPDATE	For ta inferential	Yes	No
10/07/2025	4.0.19	RULE-7438	UPDATE	Ta min	0
10/07/2025	4.0.19	RULE-7438	UPDATE	Ta max	0.001
10/07/2025	4.0.19	RULE-7438	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	RULE-7438	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7437	UPDATE	Active	True	False
10/07/2025	4.0.19	RULE-7437	UPDATE	Priority	High	N/A
10/07/2025	4.0.19	RULE-7437	UPDATE	Category	Expenditures	N/A
10/07/2025	4.0.19	RULE-7437	UPDATE	For ta comprehensive	TA- Inferential	No
10/07/2025	4.0.19	RULE-7437	UPDATE	For ta inferential	Yes	No
10/07/2025	4.0.19	RULE-7437	UPDATE	Ta min	0
10/07/2025	4.0.19	RULE-7437	UPDATE	Ta max	0.001
10/07/2025	4.0.19	RULE-7437	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	RULE-7437	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7436	UPDATE	Active	True	False
10/07/2025	4.0.19	RULE-7436	UPDATE	Priority	High	N/A
10/07/2025	4.0.19	RULE-7436	UPDATE	Category	Expenditures	N/A
10/07/2025	4.0.19	RULE-7436	UPDATE	For ta comprehensive	TA- Inferential	No
10/07/2025	4.0.19	RULE-7436	UPDATE	For ta inferential	Yes	No
10/07/2025	4.0.19	RULE-7436	UPDATE	Ta min	0
10/07/2025	4.0.19	RULE-7436	UPDATE	Ta max	0.001
10/07/2025	4.0.19	RULE-7436	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	RULE-7436	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7435	UPDATE	Active	True	False
10/07/2025	4.0.19	RULE-7435	UPDATE	Priority	High	N/A
10/07/2025	4.0.19	RULE-7435	UPDATE	Category	Expenditures	N/A
10/07/2025	4.0.19	RULE-7435	UPDATE	For ta comprehensive	TA- Inferential	No
10/07/2025	4.0.19	RULE-7435	UPDATE	For ta inferential	Yes	No
10/07/2025	4.0.19	RULE-7435	UPDATE	Ta min	0
10/07/2025	4.0.19	RULE-7435	UPDATE	Ta max	0.001
10/07/2025	4.0.19	RULE-7435	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	RULE-7435	ADD	N/A		Created
05/27/2025	4.0.9	RULE-7406	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-7406	UPDATE	Priority	High	N/A
05/27/2025	4.0.9	RULE-7406	UPDATE	Category	Expenditures	N/A
05/27/2025	4.0.9	RULE-7406	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-7406	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-7406	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-7406	UPDATE	Ta max	0.02
04/24/2025	4.0.7	RULE-7406	ADD	N/A		Created
05/27/2025	4.0.9	RULE-7405	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-7405	UPDATE	Priority	High	N/A
05/27/2025	4.0.9	RULE-7405	UPDATE	Category	Expenditures	N/A
05/27/2025	4.0.9	RULE-7405	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-7405	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-7405	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-7405	UPDATE	Ta max	0.02
04/24/2025	4.0.7	RULE-7405	ADD	N/A		Created
05/27/2025	4.0.9	RULE-7404	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-7404	UPDATE	Priority	High	N/A
05/27/2025	4.0.9	RULE-7404	UPDATE	Category	Expenditures	N/A
05/27/2025	4.0.9	RULE-7404	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-7404	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-7404	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-7404	UPDATE	Ta max	0.02
04/24/2025	4.0.7	RULE-7404	ADD	N/A		Created
05/27/2025	4.0.9	RULE-7403	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-7403	UPDATE	Priority	High	N/A
05/27/2025	4.0.9	RULE-7403	UPDATE	Category	Expenditures	N/A
05/27/2025	4.0.9	RULE-7403	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-7403	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-7403	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-7403	UPDATE	Ta max	0.02
04/24/2025	4.0.7	RULE-7403	ADD	N/A		Created
05/27/2025	4.0.9	RULE-7402	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-7402	UPDATE	Priority	High	N/A
05/27/2025	4.0.9	RULE-7402	UPDATE	Category	Expenditures	N/A
05/27/2025	4.0.9	RULE-7402	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-7402	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-7402	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-7402	UPDATE	Ta max	0.02
04/24/2025	4.0.7	RULE-7402	ADD	N/A		Created
05/27/2025	4.0.9	RULE-7401	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-7401	UPDATE	Priority	High	N/A
05/27/2025	4.0.9	RULE-7401	UPDATE	Category	Expenditures	N/A
05/27/2025	4.0.9	RULE-7401	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-7401	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-7401	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-7401	UPDATE	Ta max	0.02
04/24/2025	4.0.7	RULE-7401	ADD	N/A		Created
05/27/2025	4.0.9	RULE-7400	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-7400	UPDATE	Priority	High	N/A
05/27/2025	4.0.9	RULE-7400	UPDATE	Category	Expenditures	N/A
05/27/2025	4.0.9	RULE-7400	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-7400	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-7400	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-7400	UPDATE	Ta max	0.02
04/24/2025	4.0.7	RULE-7400	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7399	UPDATE	Active	True	False
10/07/2025	4.0.19	RULE-7399	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	RULE-7399	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7398	UPDATE	Active	True	False
10/07/2025	4.0.19	RULE-7398	UPDATE	Priority	Critical	N/A
10/07/2025	4.0.19	RULE-7398	UPDATE	Category	File integrity	N/A
10/07/2025	4.0.19	RULE-7398	UPDATE	For ta comprehensive	TA- Inferential	No
10/07/2025	4.0.19	RULE-7398	UPDATE	For ta inferential	Yes	No
10/07/2025	4.0.19	RULE-7398	UPDATE	Ta min	0
10/07/2025	4.0.19	RULE-7398	UPDATE	Ta max	0.02
10/07/2025	4.0.19	RULE-7398	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	RULE-7398	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7397	UPDATE	Active	True	False
10/07/2025	4.0.19	RULE-7397	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	RULE-7397	ADD	N/A		Created
05/27/2025	4.0.9	RULE-7396	UPDATE	Category	File integrity	N/A
05/27/2025	4.0.9	RULE-7396	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-7396	UPDATE	Ta max	0.02
04/24/2025	4.0.7	RULE-7396	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7395	UPDATE	Active	True	False
10/07/2025	4.0.19	RULE-7395	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	RULE-7395	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7394	UPDATE	Active	True	False
10/07/2025	4.0.19	RULE-7394	UPDATE	Priority	Critical	N/A
10/07/2025	4.0.19	RULE-7394	UPDATE	Category	File integrity	N/A
10/07/2025	4.0.19	RULE-7394	UPDATE	For ta comprehensive	TA- Inferential	No
10/07/2025	4.0.19	RULE-7394	UPDATE	For ta inferential	Yes	No
10/07/2025	4.0.19	RULE-7394	UPDATE	Ta min	0
10/07/2025	4.0.19	RULE-7394	UPDATE	Ta max	0.02
10/07/2025	4.0.19	RULE-7394	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	RULE-7394	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7393	UPDATE	Active	True	False
10/07/2025	4.0.19	RULE-7393	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	RULE-7393	ADD	N/A		Created
05/27/2025	4.0.9	RULE-7392	UPDATE	Category	File integrity	N/A
05/27/2025	4.0.9	RULE-7392	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-7392	UPDATE	Ta max	0.02
04/24/2025	4.0.7	RULE-7392	ADD	N/A		Created
05/27/2025	4.0.9	RULE-7391	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-7391	UPDATE	Priority	High	N/A
05/27/2025	4.0.9	RULE-7391	UPDATE	Category	Expenditures	N/A
05/27/2025	4.0.9	RULE-7391	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-7391	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-7391	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-7391	UPDATE	Ta max	0.1
04/24/2025	4.0.7	RULE-7391	ADD	N/A		Created
05/27/2025	4.0.9	RULE-7390	UPDATE	Category	Expenditures	N/A
05/27/2025	4.0.9	RULE-7390	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-7390	UPDATE	Ta max	0.1
04/24/2025	4.0.7	RULE-7390	ADD	N/A		Created
05/27/2025	4.0.9	RULE-7389	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-7389	UPDATE	Priority	High	N/A
05/27/2025	4.0.9	RULE-7389	UPDATE	Category	Expenditures	N/A
05/27/2025	4.0.9	RULE-7389	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-7389	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-7389	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-7389	UPDATE	Ta max	0.1
04/24/2025	4.0.7	RULE-7389	ADD	N/A		Created
05/27/2025	4.0.9	RULE-7388	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-7388	UPDATE	Priority	High	N/A
05/27/2025	4.0.9	RULE-7388	UPDATE	Category	Expenditures	N/A
05/27/2025	4.0.9	RULE-7388	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-7388	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-7388	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-7388	UPDATE	Ta max	0.1
04/24/2025	4.0.7	RULE-7388	ADD	N/A		Created
05/27/2025	4.0.9	RULE-7387	UPDATE	Category	Expenditures	N/A
05/27/2025	4.0.9	RULE-7387	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-7387	UPDATE	Ta max	0.1
04/24/2025	4.0.7	RULE-7387	ADD	N/A		Created
05/27/2025	4.0.9	RULE-7386	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-7386	UPDATE	Priority	High	N/A
05/27/2025	4.0.9	RULE-7386	UPDATE	Category	Expenditures	N/A
05/27/2025	4.0.9	RULE-7386	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-7386	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-7386	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-7386	UPDATE	Ta max	0.1
04/24/2025	4.0.7	RULE-7386	ADD	N/A		Created
05/27/2025	4.0.9	RULE-7385	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-7385	UPDATE	Priority	High	N/A
05/27/2025	4.0.9	RULE-7385	UPDATE	Category	Expenditures	N/A
05/27/2025	4.0.9	RULE-7385	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-7385	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-7385	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-7385	UPDATE	Ta max	0.1
04/24/2025	4.0.7	RULE-7385	ADD	N/A		Created
05/27/2025	4.0.9	RULE-7384	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-7384	UPDATE	Priority	High	N/A
05/27/2025	4.0.9	RULE-7384	UPDATE	Category	Expenditures	N/A
05/27/2025	4.0.9	RULE-7384	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-7384	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-7384	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-7384	UPDATE	Ta max	0.1
04/24/2025	4.0.7	RULE-7384	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7383	UPDATE	Active	True	False
10/07/2025	4.0.19	RULE-7383	UPDATE	Priority	Critical	N/A
10/07/2025	4.0.19	RULE-7383	UPDATE	Category	File integrity	N/A
10/07/2025	4.0.19	RULE-7383	UPDATE	For ta comprehensive	TA- Inferential	No
10/07/2025	4.0.19	RULE-7383	UPDATE	For ta inferential	Yes	No
10/07/2025	4.0.19	RULE-7383	UPDATE	Ta min	0
10/07/2025	4.0.19	RULE-7383	UPDATE	Ta max	0.1
10/07/2025	4.0.19	RULE-7383	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	RULE-7383	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7382	UPDATE	Active	True	False
10/07/2025	4.0.19	RULE-7382	UPDATE	Priority	High	N/A
10/07/2025	4.0.19	RULE-7382	UPDATE	Category	Utilization	N/A
10/07/2025	4.0.19	RULE-7382	UPDATE	For ta comprehensive	TA- Inferential	No
10/07/2025	4.0.19	RULE-7382	UPDATE	For ta inferential	Yes	No
10/07/2025	4.0.19	RULE-7382	UPDATE	Ta min	0
10/07/2025	4.0.19	RULE-7382	UPDATE	Ta max	0.02
10/07/2025	4.0.19	RULE-7382	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	RULE-7382	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7192	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	RULE-7192	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7191	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	RULE-7191	ADD	N/A		Created
10/07/2025	4.0.19	RULE-2382	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-2382	ADD	N/A		Created
10/07/2025	4.0.19	MIS-90-001-1	UPDATE	Grace period expiration date	None	2023-09-30
04/24/2025	4.0.7	MIS-90-001-1	ADD	N/A		Created
10/07/2025	4.0.19	MIS-88-001-1	UPDATE	Grace period expiration date	None	2023-09-30
04/24/2025	4.0.7	MIS-88-001-1	ADD	N/A		Created
10/07/2025	4.0.19	EL-6-036-36	UPDATE	Grace period expiration date	None	2023-09-30
04/24/2025	4.0.7	EL-6-036-36	ADD	N/A		Created
10/07/2025	4.0.19	EL-6-032-35	UPDATE	Grace period expiration date	None	2023-04-30
04/24/2025	4.0.7	EL-6-032-35	ADD	N/A		Created
10/07/2025	4.0.19	EL-1-025-31	UPDATE	Grace period expiration date	None	2023-04-30
04/24/2025	4.0.7	EL-1-025-31	ADD	N/A		Created
11/20/2025	4.0.22	EL-15-011-11	UPDATE	Annotation	Calculate the percent difference between the T-MSIS Pharm Plus or specials duals count and the MMA Pharm Plus or specials duals count	N/A
11/20/2025	4.0.22	EL-15-011-11	UPDATE	Specification	STEP 1: MMA Pharm Plus or special duals countRetrieve the Pharm Plus or special duals count from the MMA data. This is an external source. More information is available at: https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/DataStatisticalResources/StateMMAFileNote: The MMA count is not always available for the T-MSIS DQ analysis month at the time of the measure calculation. In such cases, the DQ team will wait until the MMA data are ready to do the calculation, so that the MMA count and T-MSIS count are for the same month.STEP 2: Pharm Plus or special duals countUse the measure statistic from EL-6-019-19STEP 3: Difference Subtract the count from STEP 1 from the count of dual eligible beneficiaries from STEP 2STEP 4: PercentageDivide the difference from STEP 3 by the count in STEP 1	N/A
04/24/2025	4.0.7	EL-15-011-11	ADD	N/A		Created
11/20/2025	4.0.22	EL-15-010-10	UPDATE	Annotation	Calculate the percent difference between the T-MSIS Other duals count and the MMA Other duals count	N/A
11/20/2025	4.0.22	EL-15-010-10	UPDATE	Specification	STEP 1: MMA Other duals countRetrieve the Other duals count from the MMA data. This is an external source. More information is available at: https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/DataStatisticalResources/StateMMAFileNote: The MMA count is not always available for the T-MSIS DQ analysis month at the time of the measure calculation. In such cases, the DQ team will wait until the MMA data are ready to do the calculation, so that the MMA count and T-MSIS count are for the same month.STEP 2: Other duals countUse the measure statistic from EL-6-018-18STEP 3: Difference Subtract the count from STEP 1 from the count of dual eligible beneficiaries from STEP 2STEP 4: PercentageDivide the difference from STEP 3 by the count in STEP 1	N/A
04/24/2025	4.0.7	EL-15-010-10	ADD	N/A		Created
11/20/2025	4.0.22	EL-15-009-9	UPDATE	Annotation	Calculate the percent difference between the T-MSIS QI duals count and the MMA QI duals count	N/A
11/20/2025	4.0.22	EL-15-009-9	UPDATE	Specification	STEP 1: MMA QI countRetrieve the QI count from the MMA data. This is an external source. More information is available at: https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/DataStatisticalResources/StateMMAFileNote: The MMA count is not always available for the T-MSIS DQ analysis month at the time of the measure calculation. In such cases, the DQ team will wait until the MMA data are ready to do the calculation, so that the MMA count and T-MSIS count are for the same month.STEP 2: QI duals countUse the measure statistic from EL-6-017-17STEP 3: Difference Subtract the count from STEP 1 from the count of dual eligible beneficiaries from STEP 2STEP 4: PercentageDivide the difference from STEP 3 by the count in STEP 1	N/A
04/24/2025	4.0.7	EL-15-009-9	ADD	N/A		Created
11/20/2025	4.0.22	EL-15-008-8	UPDATE	Annotation	Calculate the percent difference between the T-MSIS QDWI duals count and the MMA QDWI duals count	N/A
11/20/2025	4.0.22	EL-15-008-8	UPDATE	Specification	STEP 1: MMA QDWI countRetrieve the QDWI count from the MMA data. This is an external source. More information is available at: https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/DataStatisticalResources/StateMMAFileNote: The MMA count is not always available for the T-MSIS DQ analysis month at the time of the measure calculation. In such cases, the DQ team will wait until the MMA data are ready to do the calculation, so that the MMA count and T-MSIS count are for the same month.STEP 2: QDWI duals countUse the measure statistic from EL-6-016-16STEP 3: Difference Subtract the count from STEP 1 from the count of dual eligible beneficiaries from STEP 2STEP 4: PercentageDivide the difference from STEP 3 by the count in STEP 1	N/A
04/24/2025	4.0.7	EL-15-008-8	ADD	N/A		Created
11/20/2025	4.0.22	EL-15-007-7	UPDATE	Annotation	Calculate the percent difference between the T-MSIS SLMB-plus duals count and the MMA SLMB-plus duals count	N/A
11/20/2025	4.0.22	EL-15-007-7	UPDATE	Specification	STEP 1: MMA SLMB-plus countRetrieve the SLMB-plus count from the MMA data. This is an external source. More information is available at: https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/DataStatisticalResources/StateMMAFileNote: The MMA count is not always available for the T-MSIS DQ analysis month at the time of the measure calculation. In such cases, the DQ team will wait until the MMA data are ready to do the calculation, so that the MMA count and T-MSIS count are for the same month.STEP 2: SLMB-plus duals countUse the measure statistic from EL-6-015-15STEP 3: Difference Subtract the count from STEP 1 from the count of dual eligible beneficiaries from STEP 2STEP 4: PercentageDivide the difference from STEP 3 by the count in STEP 1	N/A
04/24/2025	4.0.7	EL-15-007-7	ADD	N/A		Created
11/20/2025	4.0.22	EL-15-006-6	UPDATE	Annotation	Calculate the percent difference between the T-MSIS SLMB-only duals count and the MMA SLMB-only duals count	N/A
11/20/2025	4.0.22	EL-15-006-6	UPDATE	Specification	STEP 1: MMA SLMB-only countRetrieve the SLMB-only count from the MMA data. This is an external source. More information is available at: https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/DataStatisticalResources/StateMMAFileNote: The MMA count is not always available for the T-MSIS DQ analysis month at the time of the measure calculation. In such cases, the DQ team will wait until the MMA data are ready to do the calculation, so that the MMA count and T-MSIS count are for the same month.STEP 2: SLMB-only duals countUse the measure statistic from EL-6-014-14STEP 3: Difference Subtract the count from STEP 1 from the count of dual eligible beneficiaries from STEP 2STEP 4: PercentageDivide the difference from STEP 3 by the count in STEP 1	N/A
04/24/2025	4.0.7	EL-15-006-6	ADD	N/A		Created
11/20/2025	4.0.22	EL-15-005-5	UPDATE	Annotation	Calculate the percent difference between the T-MSIS QMB-plus duals count and the MMA QMB-plus duals count	N/A
11/20/2025	4.0.22	EL-15-005-5	UPDATE	Specification	STEP 1: MMA QMB-plus countRetrieve the QMB-plus count from the MMA data. This is an external source. More information is available at: https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/DataStatisticalResources/StateMMAFileNote: The MMA count is not always available for the T-MSIS DQ analysis month at the time of the measure calculation. In such cases, the DQ team will wait until the MMA data are ready to do the calculation, so that the MMA count and T-MSIS count are for the same month.STEP 2: QMB-plus duals countUse the measure statistic from EL-6-013-13STEP 3: Difference Subtract the count from STEP 1 from the count of dual eligible beneficiaries from STEP 2STEP 4: PercentageDivide the difference from STEP 3 by the count in STEP 1	N/A
04/24/2025	4.0.7	EL-15-005-5	ADD	N/A		Created
11/20/2025	4.0.22	EL-15-004-4	UPDATE	Annotation	Calculate the percent difference between the T-MSIS QMB-only duals count and the MMA QMB-only duals count	N/A
11/20/2025	4.0.22	EL-15-004-4	UPDATE	Specification	STEP 1: MMA QMB-only count Retrieve the QMB-only count from the MMA data. This is an external source. More information is available at: https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/DataStatisticalResources/StateMMAFileNote: The MMA count is not always available for the T-MSIS DQ analysis month at the time of the measure calculation. In such cases, the DQ team will wait until the MMA data are ready to do the calculation, so that the MMA count and T-MSIS count are for the same month.STEP 2: QMB-only duals countUse the measure statistic from EL-6-012-12STEP 3: Difference Subtract the count from STEP 1 from the count of dual eligible beneficiaries from STEP 2STEP 4: PercentageDivide the difference from STEP 3 by the count in STEP 1	N/A
04/24/2025	4.0.7	EL-15-004-4	ADD	N/A		Created
10/07/2025	4.0.19	EL-15-003-3	UPDATE	Grace period expiration date	None	2025-02-28
04/24/2025	4.0.7	EL-15-003-3	ADD	N/A		Created
08/13/2025	4.0.16	MIS-86-020-20	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-86-002-2 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-86-002-2 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/24/2025	4.0.7	MIS-86-020-20	ADD	N/A		Created
04/24/2025	4.0.7	MIS-86-019-19	ADD	N/A		Created
08/13/2025	4.0.16	MIS-86-018-18	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-86-002-2 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-86-002-2 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/24/2025	4.0.7	MIS-86-018-18	ADD	N/A		Created
04/24/2025	4.0.7	MIS-86-017-17	ADD	N/A		Created
04/24/2025	4.0.7	MIS-86-016-16	ADD	N/A		Created
08/13/2025	4.0.16	MIS-86-015-15	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-86-002-2 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-86-002-2 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/24/2025	4.0.7	MIS-86-015-15	ADD	N/A		Created
08/13/2025	4.0.16	MIS-86-014-14	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-86-002-2 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-86-002-2 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/24/2025	4.0.7	MIS-86-014-14	ADD	N/A		Created
04/24/2025	4.0.7	MIS-86-013-13	ADD	N/A		Created
04/24/2025	4.0.7	MIS-86-012-12	ADD	N/A		Created
04/24/2025	4.0.7	MIS-86-011-11	ADD	N/A		Created
04/24/2025	4.0.7	MIS-86-010-10	ADD	N/A		Created
04/24/2025	4.0.7	MIS-86-009-9	ADD	N/A		Created
04/24/2025	4.0.7	MIS-86-008-8	ADD	N/A		Created
04/24/2025	4.0.7	MIS-86-007-7	ADD	N/A		Created
04/24/2025	4.0.7	MIS-86-006-6	ADD	N/A		Created
04/24/2025	4.0.7	MIS-86-005-5	ADD	N/A		Created
04/24/2025	4.0.7	MIS-86-004-4	ADD	N/A		Created
08/13/2025	4.0.16	MIS-86-003-3	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-86-002-2 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-86-002-2 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/24/2025	4.0.7	MIS-86-003-3	ADD	N/A		Created
08/13/2025	4.0.16	MIS-86-002-2	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-86-002-2 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-86-002-2 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/24/2025	4.0.7	MIS-86-002-2	ADD	N/A		Created
04/24/2025	4.0.7	MIS-86-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-85-032-32	ADD	N/A		Created
04/24/2025	4.0.7	MIS-85-031-31	ADD	N/A		Created
04/24/2025	4.0.7	MIS-85-030-30	ADD	N/A		Created
04/24/2025	4.0.7	MIS-85-029-29	ADD	N/A		Created
04/24/2025	4.0.7	MIS-85-028-28	ADD	N/A		Created
04/24/2025	4.0.7	MIS-85-027-27	ADD	N/A		Created
10/07/2025	4.0.19	MIS-85-026-26	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-85-026-26	ADD	N/A		Created
11/20/2025	4.0.22	MIS-85-025-25	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-85-025-25	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-85-014-14, MIS-85-025-25, and MIS-85-026-26 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
04/24/2025	4.0.7	MIS-85-025-25	ADD	N/A		Created
04/24/2025	4.0.7	MIS-85-024-24	ADD	N/A		Created
10/07/2025	4.0.19	MIS-85-023-23	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-85-023-23	ADD	N/A		Created
11/20/2025	4.0.22	MIS-85-022-22	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-85-022-22	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-85-014-14, MIS-85-025-25, and MIS-85-026-26 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
04/24/2025	4.0.7	MIS-85-022-22	ADD	N/A		Created
10/07/2025	4.0.19	MIS-85-021-21	UPDATE	Grace period expiration date	None	2025-06-20
04/24/2025	4.0.7	MIS-85-021-21	ADD	N/A		Created
04/24/2025	4.0.7	MIS-85-020-20	ADD	N/A		Created
11/20/2025	4.0.22	MIS-85-019-19	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-85-019-19	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-85-014-14, MIS-85-025-25, and MIS-85-026-26 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
04/24/2025	4.0.7	MIS-85-019-19	ADD	N/A		Created
04/24/2025	4.0.7	MIS-85-018-18	ADD	N/A		Created
04/24/2025	4.0.7	MIS-85-017-17	ADD	N/A		Created
10/07/2025	4.0.19	MIS-85-016-16	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-85-016-16	ADD	N/A		Created
04/24/2025	4.0.7	MIS-85-015-15	ADD	N/A		Created
10/07/2025	4.0.19	MIS-85-014-14	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-85-014-14	ADD	N/A		Created
04/24/2025	4.0.7	MIS-85-013-13	ADD	N/A		Created
04/24/2025	4.0.7	MIS-85-012-12	ADD	N/A		Created
10/07/2025	4.0.19	MIS-85-011-11	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-85-011-11	ADD	N/A		Created
11/20/2025	4.0.22	MIS-85-010-10	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-85-010-10	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-85-014-14, MIS-85-025-25, and MIS-85-026-26 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
04/24/2025	4.0.7	MIS-85-010-10	ADD	N/A		Created
11/20/2025	4.0.22	MIS-85-009-9	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-85-009-9	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-85-014-14, MIS-85-025-25, and MIS-85-026-26 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
04/24/2025	4.0.7	MIS-85-009-9	ADD	N/A		Created
04/24/2025	4.0.7	MIS-85-008-8	ADD	N/A		Created
11/20/2025	4.0.22	MIS-85-007-7	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-85-007-7	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-85-014-14, MIS-85-025-25, and MIS-85-026-26 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
04/24/2025	4.0.7	MIS-85-007-7	ADD	N/A		Created
11/20/2025	4.0.22	MIS-85-006-6	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-85-006-6	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-85-014-14, MIS-85-025-25, and MIS-85-026-26 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
04/24/2025	4.0.7	MIS-85-006-6	ADD	N/A		Created
10/07/2025	4.0.19	MIS-85-005-5	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-85-005-5	ADD	N/A		Created
10/07/2025	4.0.19	MIS-85-004-4	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-85-004-4	ADD	N/A		Created
04/24/2025	4.0.7	MIS-85-003-3	ADD	N/A		Created
04/24/2025	4.0.7	MIS-85-002-2	ADD	N/A		Created
04/24/2025	4.0.7	MIS-85-001-1	ADD	N/A		Created
08/13/2025	4.0.16	MIS-84-030-30	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-84-004-4 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-84-004-4 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/24/2025	4.0.7	MIS-84-030-30	ADD	N/A		Created
04/24/2025	4.0.7	MIS-84-029-29	ADD	N/A		Created
08/13/2025	4.0.16	MIS-84-028-28	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-84-004-4 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-84-004-4 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/24/2025	4.0.7	MIS-84-028-28	ADD	N/A		Created
04/24/2025	4.0.7	MIS-84-027-27	ADD	N/A		Created
08/13/2025	4.0.16	MIS-84-026-26	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-84-004-4 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-84-004-4 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/24/2025	4.0.7	MIS-84-026-26	ADD	N/A		Created
08/13/2025	4.0.16	MIS-84-025-25	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-84-004-4 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-84-004-4 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/24/2025	4.0.7	MIS-84-025-25	ADD	N/A		Created
04/24/2025	4.0.7	MIS-84-024-24	ADD	N/A		Created
04/24/2025	4.0.7	MIS-84-023-23	ADD	N/A		Created
04/24/2025	4.0.7	MIS-84-022-22	ADD	N/A		Created
04/24/2025	4.0.7	MIS-84-021-21	ADD	N/A		Created
04/24/2025	4.0.7	MIS-84-020-20	ADD	N/A		Created
08/13/2025	4.0.16	MIS-84-019-19	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-84-004-4 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-84-004-4 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/24/2025	4.0.7	MIS-84-019-19	ADD	N/A		Created
04/24/2025	4.0.7	MIS-84-018-18	ADD	N/A		Created
04/24/2025	4.0.7	MIS-84-017-17	ADD	N/A		Created
04/24/2025	4.0.7	MIS-84-016-16	ADD	N/A		Created
04/24/2025	4.0.7	MIS-84-015-15	ADD	N/A		Created
04/24/2025	4.0.7	MIS-84-014-14	ADD	N/A		Created
04/24/2025	4.0.7	MIS-84-013-13	ADD	N/A		Created
04/24/2025	4.0.7	MIS-84-012-12	ADD	N/A		Created
04/24/2025	4.0.7	MIS-84-011-11	ADD	N/A		Created
04/24/2025	4.0.7	MIS-84-010-10	ADD	N/A		Created
04/24/2025	4.0.7	MIS-84-009-9	ADD	N/A		Created
04/24/2025	4.0.7	MIS-84-008-8	ADD	N/A		Created
04/24/2025	4.0.7	MIS-84-007-7	ADD	N/A		Created
10/07/2025	4.0.19	MIS-84-006-6	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-84-006-6	ADD	N/A		Created
04/24/2025	4.0.7	MIS-84-005-5	ADD	N/A		Created
08/13/2025	4.0.16	MIS-84-004-4	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-84-004-4 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-84-004-4 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/24/2025	4.0.7	MIS-84-004-4	ADD	N/A		Created
04/24/2025	4.0.7	MIS-84-003-3	ADD	N/A		Created
10/07/2025	4.0.19	MIS-84-002-2	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-84-002-2	ADD	N/A		Created
04/24/2025	4.0.7	MIS-84-001-1	ADD	N/A		Created
11/20/2025	4.0.22	MIS-83-038-38	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-83-038-38	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-83-020-20, MIS-83-028-28, and MIS-83-029-29 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
04/24/2025	4.0.7	MIS-83-038-38	ADD	N/A		Created
04/24/2025	4.0.7	MIS-83-037-37	ADD	N/A		Created
04/24/2025	4.0.7	MIS-83-036-36	ADD	N/A		Created
04/24/2025	4.0.7	MIS-83-035-35	ADD	N/A		Created
04/24/2025	4.0.7	MIS-83-034-34	ADD	N/A		Created
04/24/2025	4.0.7	MIS-83-033-33	ADD	N/A		Created
11/20/2025	4.0.22	MIS-83-032-32	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-83-032-32	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-83-020-20, MIS-83-028-28, and MIS-83-029-29 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
04/24/2025	4.0.7	MIS-83-032-32	ADD	N/A		Created
11/20/2025	4.0.22	MIS-83-031-31	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-83-031-31	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-83-020-20, MIS-83-028-28, and MIS-83-029-29 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
04/24/2025	4.0.7	MIS-83-031-31	ADD	N/A		Created
11/20/2025	4.0.22	MIS-83-030-30	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-83-030-30	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-83-020-20, MIS-83-028-28, and MIS-83-029-29 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
04/24/2025	4.0.7	MIS-83-030-30	ADD	N/A		Created
11/20/2025	4.0.22	MIS-83-029-29	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-83-029-29	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-83-020-20, MIS-83-028-28, and MIS-83-029-29 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
04/24/2025	4.0.7	MIS-83-029-29	ADD	N/A		Created
10/07/2025	4.0.19	MIS-83-028-28	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-83-028-28	ADD	N/A		Created
04/24/2025	4.0.7	MIS-83-027-27	ADD	N/A		Created
04/24/2025	4.0.7	MIS-83-026-26	ADD	N/A		Created
04/24/2025	4.0.7	MIS-83-025-25	ADD	N/A		Created
11/20/2025	4.0.22	MIS-83-024-24	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-83-024-24	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-83-020-20, MIS-83-028-28, and MIS-83-029-29 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
04/24/2025	4.0.7	MIS-83-024-24	ADD	N/A		Created
04/24/2025	4.0.7	MIS-83-023-23	ADD	N/A		Created
10/07/2025	4.0.19	MIS-83-022-22	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-83-022-22	ADD	N/A		Created
04/24/2025	4.0.7	MIS-83-021-21	ADD	N/A		Created
10/07/2025	4.0.19	MIS-83-020-20	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-83-020-20	ADD	N/A		Created
04/24/2025	4.0.7	MIS-83-019-19	ADD	N/A		Created
04/24/2025	4.0.7	MIS-83-018-18	ADD	N/A		Created
04/24/2025	4.0.7	MIS-83-017-17	ADD	N/A		Created
10/07/2025	4.0.19	MIS-83-016-16	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-83-016-16	ADD	N/A		Created
04/24/2025	4.0.7	MIS-83-015-15	ADD	N/A		Created
04/24/2025	4.0.7	MIS-83-014-14	ADD	N/A		Created
04/24/2025	4.0.7	MIS-83-013-13	ADD	N/A		Created
04/24/2025	4.0.7	MIS-83-012-12	ADD	N/A		Created
04/24/2025	4.0.7	MIS-83-011-11	ADD	N/A		Created
04/24/2025	4.0.7	MIS-83-010-10	ADD	N/A		Created
11/20/2025	4.0.22	MIS-83-009-9	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-83-009-9	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-83-020-20, MIS-83-028-28, and MIS-83-029-29 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
04/24/2025	4.0.7	MIS-83-009-9	ADD	N/A		Created
11/20/2025	4.0.22	MIS-83-008-8	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-83-008-8	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-83-020-20, MIS-83-028-28, and MIS-83-029-29 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
04/24/2025	4.0.7	MIS-83-008-8	ADD	N/A		Created
10/07/2025	4.0.19	MIS-83-007-7	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-83-007-7	ADD	N/A		Created
11/20/2025	4.0.22	MIS-83-006-6	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-83-006-6	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-83-020-20, MIS-83-028-28, and MIS-83-029-29 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
04/24/2025	4.0.7	MIS-83-006-6	ADD	N/A		Created
10/07/2025	4.0.19	MIS-83-005-5	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-83-005-5	ADD	N/A		Created
04/24/2025	4.0.7	MIS-83-004-4	ADD	N/A		Created
04/24/2025	4.0.7	MIS-83-003-3	ADD	N/A		Created
04/24/2025	4.0.7	MIS-83-002-2	ADD	N/A		Created
10/07/2025	4.0.19	MIS-83-001-1	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-83-001-1	ADD	N/A		Created
08/13/2025	4.0.16	MIS-82-017-17	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-82-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-82-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/24/2025	4.0.7	MIS-82-017-17	ADD	N/A		Created
04/24/2025	4.0.7	MIS-82-016-16	ADD	N/A		Created
04/24/2025	4.0.7	MIS-82-015-15	ADD	N/A		Created
08/13/2025	4.0.16	MIS-82-014-14	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-82-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-82-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/24/2025	4.0.7	MIS-82-014-14	ADD	N/A		Created
08/13/2025	4.0.16	MIS-82-013-13	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-82-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-82-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/24/2025	4.0.7	MIS-82-013-13	ADD	N/A		Created
08/13/2025	4.0.16	MIS-82-012-12	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-82-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-82-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/24/2025	4.0.7	MIS-82-012-12	ADD	N/A		Created
08/13/2025	4.0.16	MIS-82-011-11	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-82-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-82-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/24/2025	4.0.7	MIS-82-011-11	ADD	N/A		Created
04/24/2025	4.0.7	MIS-82-010-10	ADD	N/A		Created
04/24/2025	4.0.7	MIS-82-009-9	ADD	N/A		Created
04/24/2025	4.0.7	MIS-82-008-8	ADD	N/A		Created
04/24/2025	4.0.7	MIS-82-007-7	ADD	N/A		Created
04/24/2025	4.0.7	MIS-82-006-6	ADD	N/A		Created
04/24/2025	4.0.7	MIS-82-005-5	ADD	N/A		Created
04/24/2025	4.0.7	MIS-82-004-4	ADD	N/A		Created
10/07/2025	4.0.19	MIS-82-003-3	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-82-003-3	ADD	N/A		Created
10/07/2025	4.0.19	MIS-82-002-2	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-82-002-2	ADD	N/A		Created
04/24/2025	4.0.7	MIS-82-001-1	ADD	N/A		Created
10/07/2025	4.0.19	MIS-81-047-47	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-81-047-47	ADD	N/A		Created
04/24/2025	4.0.7	MIS-81-046-46	ADD	N/A		Created
04/24/2025	4.0.7	MIS-81-045-45	ADD	N/A		Created
04/24/2025	4.0.7	MIS-81-044-44	ADD	N/A		Created
04/24/2025	4.0.7	MIS-81-043-43	ADD	N/A		Created
04/24/2025	4.0.7	MIS-81-042-42	ADD	N/A		Created
10/07/2025	4.0.19	MIS-81-041-41	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-81-041-41	ADD	N/A		Created
11/20/2025	4.0.22	MIS-81-040-40	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-81-040-40	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-81-026-26, MIS-81-040-40, and MIS-81-041-41 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures),	N/A
04/24/2025	4.0.7	MIS-81-040-40	ADD	N/A		Created
04/24/2025	4.0.7	MIS-81-039-39	ADD	N/A		Created
11/20/2025	4.0.22	MIS-81-038-38	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-81-038-38	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-81-026-26, MIS-81-040-40, and MIS-81-041-41 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures),	N/A
04/24/2025	4.0.7	MIS-81-038-38	ADD	N/A		Created
11/20/2025	4.0.22	MIS-81-037-37	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-81-037-37	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-81-026-26, MIS-81-040-40, and MIS-81-041-41 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures),	N/A
04/24/2025	4.0.7	MIS-81-037-37	ADD	N/A		Created
04/24/2025	4.0.7	MIS-81-036-36	ADD	N/A		Created
11/20/2025	4.0.22	MIS-81-035-35	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-81-035-35	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-81-026-26, MIS-81-040-40, and MIS-81-041-41 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures),	N/A
04/24/2025	4.0.7	MIS-81-035-35	ADD	N/A		Created
11/20/2025	4.0.22	MIS-81-034-34	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-81-034-34	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-81-026-26, MIS-81-040-40, and MIS-81-041-41 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures),	N/A
04/24/2025	4.0.7	MIS-81-034-34	ADD	N/A		Created
04/24/2025	4.0.7	MIS-81-033-33	ADD	N/A		Created
04/24/2025	4.0.7	MIS-81-032-32	ADD	N/A		Created
04/24/2025	4.0.7	MIS-81-031-31	ADD	N/A		Created
10/07/2025	4.0.19	MIS-81-030-30	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-81-030-30	ADD	N/A		Created
04/24/2025	4.0.7	MIS-81-029-29	ADD	N/A		Created
04/24/2025	4.0.7	MIS-81-028-28	ADD	N/A		Created
04/24/2025	4.0.7	MIS-81-027-27	ADD	N/A		Created
10/07/2025	4.0.19	MIS-81-026-26	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-81-026-26	ADD	N/A		Created
04/24/2025	4.0.7	MIS-81-025-25	ADD	N/A		Created
04/24/2025	4.0.7	MIS-81-024-24	ADD	N/A		Created
04/24/2025	4.0.7	MIS-81-023-23	ADD	N/A		Created
04/24/2025	4.0.7	MIS-81-022-22	ADD	N/A		Created
04/24/2025	4.0.7	MIS-81-021-21	ADD	N/A		Created
04/24/2025	4.0.7	MIS-81-020-20	ADD	N/A		Created
04/24/2025	4.0.7	MIS-81-019-19	ADD	N/A		Created
10/07/2025	4.0.19	MIS-81-018-18	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-81-018-18	ADD	N/A		Created
04/24/2025	4.0.7	MIS-81-017-17	ADD	N/A		Created
04/24/2025	4.0.7	MIS-81-016-16	ADD	N/A		Created
04/24/2025	4.0.7	MIS-81-015-15	ADD	N/A		Created
04/24/2025	4.0.7	MIS-81-014-14	ADD	N/A		Created
04/24/2025	4.0.7	MIS-81-013-13	ADD	N/A		Created
04/24/2025	4.0.7	MIS-81-012-12	ADD	N/A		Created
11/20/2025	4.0.22	MIS-81-011-11	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-81-011-11	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-81-026-26, MIS-81-040-40, and MIS-81-041-41 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures),	N/A
04/24/2025	4.0.7	MIS-81-011-11	ADD	N/A		Created
11/20/2025	4.0.22	MIS-81-010-10	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-81-010-10	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-81-026-26, MIS-81-040-40, and MIS-81-041-41 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures),	N/A
04/24/2025	4.0.7	MIS-81-010-10	ADD	N/A		Created
10/07/2025	4.0.19	MIS-81-009-9	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-81-009-9	ADD	N/A		Created
11/20/2025	4.0.22	MIS-81-008-8	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-81-008-8	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-81-026-26, MIS-81-040-40, and MIS-81-041-41 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures),	N/A
04/24/2025	4.0.7	MIS-81-008-8	ADD	N/A		Created
10/07/2025	4.0.19	MIS-81-007-7	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-81-007-7	ADD	N/A		Created
04/24/2025	4.0.7	MIS-81-006-6	ADD	N/A		Created
04/24/2025	4.0.7	MIS-81-005-5	ADD	N/A		Created
04/24/2025	4.0.7	MIS-81-004-4	ADD	N/A		Created
10/07/2025	4.0.19	MIS-81-003-3	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-81-003-3	ADD	N/A		Created
04/24/2025	4.0.7	MIS-81-002-2	ADD	N/A		Created
04/24/2025	4.0.7	MIS-81-001-1	ADD	N/A		Created
08/13/2025	4.0.16	MIS-80-017-17	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-80-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure).	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-80-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure).
04/24/2025	4.0.7	MIS-80-017-17	ADD	N/A		Created
04/24/2025	4.0.7	MIS-80-016-16	ADD	N/A		Created
04/24/2025	4.0.7	MIS-80-015-15	ADD	N/A		Created
08/13/2025	4.0.16	MIS-80-014-14	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-80-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure).	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-80-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure).
04/24/2025	4.0.7	MIS-80-014-14	ADD	N/A		Created
08/13/2025	4.0.16	MIS-80-013-13	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-80-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure).	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-80-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure).
04/24/2025	4.0.7	MIS-80-013-13	ADD	N/A		Created
08/13/2025	4.0.16	MIS-80-012-12	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-80-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure).	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-80-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure).
04/24/2025	4.0.7	MIS-80-012-12	ADD	N/A		Created
08/13/2025	4.0.16	MIS-80-011-11	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-80-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure).	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-80-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure).
04/24/2025	4.0.7	MIS-80-011-11	ADD	N/A		Created
04/24/2025	4.0.7	MIS-80-010-10	ADD	N/A		Created
04/24/2025	4.0.7	MIS-80-009-9	ADD	N/A		Created
04/24/2025	4.0.7	MIS-80-008-8	ADD	N/A		Created
04/24/2025	4.0.7	MIS-80-007-7	ADD	N/A		Created
04/24/2025	4.0.7	MIS-80-006-6	ADD	N/A		Created
04/24/2025	4.0.7	MIS-80-005-5	ADD	N/A		Created
04/24/2025	4.0.7	MIS-80-004-4	ADD	N/A		Created
10/07/2025	4.0.19	MIS-80-003-3	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-80-003-3	ADD	N/A		Created
10/07/2025	4.0.19	MIS-80-002-2	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-80-002-2	ADD	N/A		Created
04/24/2025	4.0.7	MIS-80-001-1	ADD	N/A		Created
11/20/2025	4.0.22	MIS-79-060-60	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-79-060-60	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
04/24/2025	4.0.7	MIS-79-060-60	ADD	N/A		Created
10/07/2025	4.0.19	MIS-79-059-59	UPDATE	Grace period expiration date	None	2023-10-31
04/24/2025	4.0.7	MIS-79-059-59	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-058-58	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-057-57	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-056-56	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-055-55	ADD	N/A		Created
10/07/2025	4.0.19	MIS-79-054-54	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-79-054-54	ADD	N/A		Created
11/20/2025	4.0.22	MIS-79-053-53	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-79-053-53	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
04/24/2025	4.0.7	MIS-79-053-53	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-052-52	ADD	N/A		Created
11/20/2025	4.0.22	MIS-79-051-51	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-79-051-51	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
04/24/2025	4.0.7	MIS-79-051-51	ADD	N/A		Created
11/20/2025	4.0.22	MIS-79-050-50	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-79-050-50	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
04/24/2025	4.0.7	MIS-79-050-50	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-049-49	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-048-48	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-047-47	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-046-46	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-045-45	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-044-44	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-043-43	ADD	N/A		Created
11/20/2025	4.0.22	MIS-79-042-42	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-79-042-42	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
04/24/2025	4.0.7	MIS-79-042-42	ADD	N/A		Created
11/20/2025	4.0.22	MIS-79-041-41	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-79-041-41	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
04/24/2025	4.0.7	MIS-79-041-41	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-040-40	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-039-39	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-038-38	ADD	N/A		Created
10/07/2025	4.0.19	MIS-79-037-37	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-79-037-37	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-036-36	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-035-35	ADD	N/A		Created
11/20/2025	4.0.22	MIS-79-034-34	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-79-034-34	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
04/24/2025	4.0.7	MIS-79-034-34	ADD	N/A		Created
10/07/2025	4.0.19	MIS-79-033-33	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-79-033-33	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-032-32	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-031-31	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-030-30	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-029-29	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-028-28	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-027-27	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-026-26	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-025-25	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-024-24	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-023-23	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-022-22	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-021-21	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-020-20	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-019-19	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-018-18	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-017-17	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-016-16	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-015-15	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-014-14	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-013-13	ADD	N/A		Created
11/20/2025	4.0.22	MIS-79-012-12	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-79-012-12	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
04/24/2025	4.0.7	MIS-79-012-12	ADD	N/A		Created
11/20/2025	4.0.22	MIS-79-011-11	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-79-011-11	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
04/24/2025	4.0.7	MIS-79-011-11	ADD	N/A		Created
10/07/2025	4.0.19	MIS-79-010-10	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-79-010-10	ADD	N/A		Created
11/20/2025	4.0.22	MIS-79-009-9	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-79-009-9	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
04/24/2025	4.0.7	MIS-79-009-9	ADD	N/A		Created
10/07/2025	4.0.19	MIS-79-008-8	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-79-008-8	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-007-7	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-006-6	ADD	N/A		Created
04/24/2025	4.0.7	MIS-79-005-5	ADD	N/A		Created
11/20/2025	4.0.22	MIS-79-004-4	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-79-004-4	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
04/24/2025	4.0.7	MIS-79-004-4	ADD	N/A		Created
11/20/2025	4.0.22	MIS-79-003-3	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-79-003-3	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
04/24/2025	4.0.7	MIS-79-003-3	ADD	N/A		Created
11/20/2025	4.0.22	MIS-79-002-2	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-79-002-2	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
04/24/2025	4.0.7	MIS-79-002-2	ADD	N/A		Created
10/07/2025	4.0.19	MIS-79-001-1	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-79-001-1	ADD	N/A		Created
08/13/2025	4.0.16	MIS-28-021-21	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2
04/24/2025	4.0.7	MIS-28-021-21	ADD	N/A		Created
04/24/2025	4.0.7	MIS-28-020-20	ADD	N/A		Created
08/13/2025	4.0.16	MIS-28-019-19	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2
04/24/2025	4.0.7	MIS-28-019-19	ADD	N/A		Created
04/24/2025	4.0.7	MIS-28-018-18	ADD	N/A		Created
04/24/2025	4.0.7	MIS-28-017-17	ADD	N/A		Created
08/13/2025	4.0.16	MIS-28-016-16	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2
04/24/2025	4.0.7	MIS-28-016-16	ADD	N/A		Created
08/13/2025	4.0.16	MIS-28-015-15	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2
04/24/2025	4.0.7	MIS-28-015-15	ADD	N/A		Created
04/24/2025	4.0.7	MIS-28-014-14	ADD	N/A		Created
04/24/2025	4.0.7	MIS-28-013-13	ADD	N/A		Created
04/24/2025	4.0.7	MIS-28-012-12	ADD	N/A		Created
04/24/2025	4.0.7	MIS-28-011-11	ADD	N/A		Created
04/24/2025	4.0.7	MIS-28-009-9	ADD	N/A		Created
04/24/2025	4.0.7	MIS-28-008-8	ADD	N/A		Created
04/24/2025	4.0.7	MIS-28-007-7	ADD	N/A		Created
04/24/2025	4.0.7	MIS-28-006-6	ADD	N/A		Created
04/24/2025	4.0.7	MIS-28-005-5	ADD	N/A		Created
08/13/2025	4.0.16	MIS-28-004-4	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2
04/24/2025	4.0.7	MIS-28-004-4	ADD	N/A		Created
04/24/2025	4.0.7	MIS-28-003-3	ADD	N/A		Created
04/24/2025	4.0.7	MIS-28-002-2	ADD	N/A		Created
04/24/2025	4.0.7	MIS-28-001-10	ADD	N/A		Created
04/24/2025	4.0.7	MIS-27-032-32	ADD	N/A		Created
04/24/2025	4.0.7	MIS-27-031-31	ADD	N/A		Created
04/24/2025	4.0.7	MIS-27-029-29	ADD	N/A		Created
04/24/2025	4.0.7	MIS-27-028-28	ADD	N/A		Created
04/24/2025	4.0.7	MIS-27-027-27	ADD	N/A		Created
10/07/2025	4.0.19	MIS-27-026-26	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-27-026-26	ADD	N/A		Created
11/20/2025	4.0.22	MIS-27-025-25	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-27-025-25	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MIS-27-025-25	ADD	N/A		Created
04/24/2025	4.0.7	MIS-27-024-24	ADD	N/A		Created
10/07/2025	4.0.19	MIS-27-023-23	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-27-023-23	ADD	N/A		Created
11/20/2025	4.0.22	MIS-27-022-22	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-27-022-22	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MIS-27-022-22	ADD	N/A		Created
10/07/2025	4.0.19	MIS-27-021-21	UPDATE	Grace period expiration date	None	2025-06-20
04/24/2025	4.0.7	MIS-27-021-21	ADD	N/A		Created
11/20/2025	4.0.22	MIS-27-019-19	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-27-019-19	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MIS-27-019-19	ADD	N/A		Created
04/24/2025	4.0.7	MIS-27-018-18	ADD	N/A		Created
04/24/2025	4.0.7	MIS-27-017-17	ADD	N/A		Created
10/07/2025	4.0.19	MIS-27-016-16	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-27-016-16	ADD	N/A		Created
04/24/2025	4.0.7	MIS-27-015-15	ADD	N/A		Created
10/07/2025	4.0.19	MIS-27-014-14	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-27-014-14	ADD	N/A		Created
04/24/2025	4.0.7	MIS-27-013-13	ADD	N/A		Created
04/24/2025	4.0.7	MIS-27-012-12	ADD	N/A		Created
10/07/2025	4.0.19	MIS-27-011-11	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-27-011-11	ADD	N/A		Created
11/20/2025	4.0.22	MIS-27-009-9	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-27-009-9	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MIS-27-009-9	ADD	N/A		Created
04/24/2025	4.0.7	MIS-27-008-8	ADD	N/A		Created
11/20/2025	4.0.22	MIS-27-007-7	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-27-007-7	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MIS-27-007-7	ADD	N/A		Created
11/20/2025	4.0.22	MIS-27-006-6	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-27-006-6	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MIS-27-006-6	ADD	N/A		Created
10/07/2025	4.0.19	MIS-27-005-5	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-27-005-5	ADD	N/A		Created
10/07/2025	4.0.19	MIS-27-004-4	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-27-004-4	ADD	N/A		Created
04/24/2025	4.0.7	MIS-27-003-30	ADD	N/A		Created
04/24/2025	4.0.7	MIS-27-003-3	ADD	N/A		Created
04/24/2025	4.0.7	MIS-27-002-20	ADD	N/A		Created
04/24/2025	4.0.7	MIS-27-002-2	ADD	N/A		Created
11/20/2025	4.0.22	MIS-27-001-10	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-27-001-10	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MIS-27-001-10	ADD	N/A		Created
04/24/2025	4.0.7	MIS-27-001-1	ADD	N/A		Created
08/13/2025	4.0.16	MIS-26-031-31	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2
04/24/2025	4.0.7	MIS-26-031-31	ADD	N/A		Created
08/13/2025	4.0.16	MIS-26-029-29	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2
04/24/2025	4.0.7	MIS-26-029-29	ADD	N/A		Created
04/24/2025	4.0.7	MIS-26-028-28	ADD	N/A		Created
08/13/2025	4.0.16	MIS-26-027-27	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2
04/24/2025	4.0.7	MIS-26-027-27	ADD	N/A		Created
08/13/2025	4.0.16	MIS-26-026-26	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2
04/24/2025	4.0.7	MIS-26-026-26	ADD	N/A		Created
04/24/2025	4.0.7	MIS-26-025-25	ADD	N/A		Created
04/24/2025	4.0.7	MIS-26-024-24	ADD	N/A		Created
04/24/2025	4.0.7	MIS-26-023-23	ADD	N/A		Created
04/24/2025	4.0.7	MIS-26-022-22	ADD	N/A		Created
04/24/2025	4.0.7	MIS-26-021-21	ADD	N/A		Created
04/24/2025	4.0.7	MIS-26-019-19	ADD	N/A		Created
04/24/2025	4.0.7	MIS-26-018-18	ADD	N/A		Created
04/24/2025	4.0.7	MIS-26-017-17	ADD	N/A		Created
04/24/2025	4.0.7	MIS-26-016-16	ADD	N/A		Created
04/24/2025	4.0.7	MIS-26-015-15	ADD	N/A		Created
04/24/2025	4.0.7	MIS-26-014-14	ADD	N/A		Created
04/24/2025	4.0.7	MIS-26-013-13	ADD	N/A		Created
04/24/2025	4.0.7	MIS-26-012-12	ADD	N/A		Created
04/24/2025	4.0.7	MIS-26-011-11	ADD	N/A		Created
04/24/2025	4.0.7	MIS-26-009-9	ADD	N/A		Created
04/24/2025	4.0.7	MIS-26-008-8	ADD	N/A		Created
10/07/2025	4.0.19	MIS-26-007-7	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-26-007-7	ADD	N/A		Created
04/24/2025	4.0.7	MIS-26-006-6	ADD	N/A		Created
04/24/2025	4.0.7	MIS-26-005-5	ADD	N/A		Created
04/24/2025	4.0.7	MIS-26-004-4	ADD	N/A		Created
04/24/2025	4.0.7	MIS-26-003-30	ADD	N/A		Created
10/07/2025	4.0.19	MIS-26-003-3	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-26-003-3	ADD	N/A		Created
08/13/2025	4.0.16	MIS-26-002-20	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2
04/24/2025	4.0.7	MIS-26-002-20	ADD	N/A		Created
04/24/2025	4.0.7	MIS-26-002-2	ADD	N/A		Created
04/24/2025	4.0.7	MIS-26-001-10	ADD	N/A		Created
11/20/2025	4.0.22	MIS-25-038-38	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-25-038-38	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MIS-25-038-38	ADD	N/A		Created
04/24/2025	4.0.7	MIS-25-037-37	ADD	N/A		Created
04/24/2025	4.0.7	MIS-25-036-36	ADD	N/A		Created
04/24/2025	4.0.7	MIS-25-035-35	ADD	N/A		Created
04/24/2025	4.0.7	MIS-25-034-34	ADD	N/A		Created
04/24/2025	4.0.7	MIS-25-033-33	ADD	N/A		Created
11/20/2025	4.0.22	MIS-25-032-32	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-25-032-32	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MIS-25-032-32	ADD	N/A		Created
11/20/2025	4.0.22	MIS-25-031-31	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-25-031-31	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MIS-25-031-31	ADD	N/A		Created
11/20/2025	4.0.22	MIS-25-029-29	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-25-029-29	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MIS-25-029-29	ADD	N/A		Created
10/07/2025	4.0.19	MIS-25-028-28	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-25-028-28	ADD	N/A		Created
04/24/2025	4.0.7	MIS-25-027-27	ADD	N/A		Created
04/24/2025	4.0.7	MIS-25-026-26	ADD	N/A		Created
04/24/2025	4.0.7	MIS-25-025-25	ADD	N/A		Created
11/20/2025	4.0.22	MIS-25-024-24	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-25-024-24	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MIS-25-024-24	ADD	N/A		Created
04/24/2025	4.0.7	MIS-25-023-23	ADD	N/A		Created
10/07/2025	4.0.19	MIS-25-022-22	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-25-022-22	ADD	N/A		Created
04/24/2025	4.0.7	MIS-25-021-21	ADD	N/A		Created
04/24/2025	4.0.7	MIS-25-019-19	ADD	N/A		Created
04/24/2025	4.0.7	MIS-25-018-18	ADD	N/A		Created
04/24/2025	4.0.7	MIS-25-017-17	ADD	N/A		Created
10/07/2025	4.0.19	MIS-25-016-16	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-25-016-16	ADD	N/A		Created
04/24/2025	4.0.7	MIS-25-015-15	ADD	N/A		Created
04/24/2025	4.0.7	MIS-25-014-14	ADD	N/A		Created
04/24/2025	4.0.7	MIS-25-013-13	ADD	N/A		Created
04/24/2025	4.0.7	MIS-25-012-12	ADD	N/A		Created
04/24/2025	4.0.7	MIS-25-011-11	ADD	N/A		Created
11/20/2025	4.0.22	MIS-25-009-9	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-25-009-9	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MIS-25-009-9	ADD	N/A		Created
11/20/2025	4.0.22	MIS-25-008-8	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-25-008-8	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MIS-25-008-8	ADD	N/A		Created
10/07/2025	4.0.19	MIS-25-007-7	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-25-007-7	ADD	N/A		Created
11/20/2025	4.0.22	MIS-25-006-6	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-25-006-6	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MIS-25-006-6	ADD	N/A		Created
10/07/2025	4.0.19	MIS-25-005-5	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-25-005-5	ADD	N/A		Created
04/24/2025	4.0.7	MIS-25-004-4	ADD	N/A		Created
11/20/2025	4.0.22	MIS-25-003-30	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-25-003-30	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MIS-25-003-30	ADD	N/A		Created
04/24/2025	4.0.7	MIS-25-003-3	ADD	N/A		Created
10/07/2025	4.0.19	MIS-25-002-20	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-25-002-20	ADD	N/A		Created
04/24/2025	4.0.7	MIS-25-002-2	ADD	N/A		Created
04/24/2025	4.0.7	MIS-25-001-10	ADD	N/A		Created
10/07/2025	4.0.19	MIS-25-001-1	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-25-001-1	ADD	N/A		Created
08/13/2025	4.0.16	MIS-24-018-18	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2
04/24/2025	4.0.7	MIS-24-018-18	ADD	N/A		Created
04/24/2025	4.0.7	MIS-24-017-17	ADD	N/A		Created
04/24/2025	4.0.7	MIS-24-016-16	ADD	N/A		Created
08/13/2025	4.0.16	MIS-24-015-15	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2
04/24/2025	4.0.7	MIS-24-015-15	ADD	N/A		Created
08/13/2025	4.0.16	MIS-24-014-14	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2
04/24/2025	4.0.7	MIS-24-014-14	ADD	N/A		Created
08/13/2025	4.0.16	MIS-24-013-13	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2
04/24/2025	4.0.7	MIS-24-013-13	ADD	N/A		Created
04/24/2025	4.0.7	MIS-24-012-12	ADD	N/A		Created
04/24/2025	4.0.7	MIS-24-011-11	ADD	N/A		Created
04/24/2025	4.0.7	MIS-24-009-9	ADD	N/A		Created
04/24/2025	4.0.7	MIS-24-008-8	ADD	N/A		Created
04/24/2025	4.0.7	MIS-24-007-7	ADD	N/A		Created
04/24/2025	4.0.7	MIS-24-006-6	ADD	N/A		Created
04/24/2025	4.0.7	MIS-24-005-5	ADD	N/A		Created
10/07/2025	4.0.19	MIS-24-004-4	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-24-004-4	ADD	N/A		Created
10/07/2025	4.0.19	MIS-24-003-3	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-24-003-3	ADD	N/A		Created
04/24/2025	4.0.7	MIS-24-002-2	ADD	N/A		Created
04/24/2025	4.0.7	MIS-24-001-10	ADD	N/A		Created
10/07/2025	4.0.19	MIS-23-047-47	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-23-047-47	ADD	N/A		Created
04/24/2025	4.0.7	MIS-23-046-46	ADD	N/A		Created
04/24/2025	4.0.7	MIS-23-045-45	ADD	N/A		Created
04/24/2025	4.0.7	MIS-23-044-44	ADD	N/A		Created
04/24/2025	4.0.7	MIS-23-043-43	ADD	N/A		Created
04/24/2025	4.0.7	MIS-23-042-42	ADD	N/A		Created
10/07/2025	4.0.19	MIS-23-041-41	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-23-041-41	ADD	N/A		Created
11/20/2025	4.0.22	MIS-23-040-40	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-23-040-40	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS or Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MIS-23-040-40	ADD	N/A		Created
04/24/2025	4.0.7	MIS-23-039-39	ADD	N/A		Created
11/20/2025	4.0.22	MIS-23-038-38	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-23-038-38	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS or Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MIS-23-038-38	ADD	N/A		Created
11/20/2025	4.0.22	MIS-23-037-37	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-23-037-37	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS or Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MIS-23-037-37	ADD	N/A		Created
04/24/2025	4.0.7	MIS-23-036-36	ADD	N/A		Created
11/20/2025	4.0.22	MIS-23-035-35	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-23-035-35	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS or Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MIS-23-035-35	ADD	N/A		Created
11/20/2025	4.0.22	MIS-23-034-34	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-23-034-34	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS or Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MIS-23-034-34	ADD	N/A		Created
04/24/2025	4.0.7	MIS-23-033-33	ADD	N/A		Created
04/24/2025	4.0.7	MIS-23-032-32	ADD	N/A		Created
04/24/2025	4.0.7	MIS-23-031-31	ADD	N/A		Created
10/07/2025	4.0.19	MIS-23-030-30	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-23-030-30	ADD	N/A		Created
04/24/2025	4.0.7	MIS-23-029-29	ADD	N/A		Created
04/24/2025	4.0.7	MIS-23-028-28	ADD	N/A		Created
04/24/2025	4.0.7	MIS-23-027-27	ADD	N/A		Created
10/07/2025	4.0.19	MIS-23-026-26	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-23-026-26	ADD	N/A		Created
04/24/2025	4.0.7	MIS-23-025-25	ADD	N/A		Created
04/24/2025	4.0.7	MIS-23-024-24	ADD	N/A		Created
04/24/2025	4.0.7	MIS-23-023-23	ADD	N/A		Created
04/24/2025	4.0.7	MIS-23-022-22	ADD	N/A		Created
04/24/2025	4.0.7	MIS-23-021-21	ADD	N/A		Created
04/24/2025	4.0.7	MIS-23-020-20	ADD	N/A		Created
04/24/2025	4.0.7	MIS-23-019-19	ADD	N/A		Created
10/07/2025	4.0.19	MIS-23-018-18	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-23-018-18	ADD	N/A		Created
04/24/2025	4.0.7	MIS-23-017-17	ADD	N/A		Created
04/24/2025	4.0.7	MIS-23-016-16	ADD	N/A		Created
04/24/2025	4.0.7	MIS-23-015-15	ADD	N/A		Created
04/24/2025	4.0.7	MIS-23-014-14	ADD	N/A		Created
04/24/2025	4.0.7	MIS-23-013-13	ADD	N/A		Created
04/24/2025	4.0.7	MIS-23-012-12	ADD	N/A		Created
11/20/2025	4.0.22	MIS-23-011-11	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-23-011-11	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS or Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MIS-23-011-11	ADD	N/A		Created
11/20/2025	4.0.22	MIS-23-010-10	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-23-010-10	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS or Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MIS-23-010-10	ADD	N/A		Created
10/07/2025	4.0.19	MIS-23-009-9	UPDATE	Grace period expiration date	None	2024-12-21
04/24/2025	4.0.7	MIS-23-009-9	ADD	N/A		Created
11/20/2025	4.0.22	MIS-23-008-8	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-23-008-8	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS or Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MIS-23-008-8	ADD	N/A		Created
10/07/2025	4.0.19	MIS-23-007-7	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-23-007-7	ADD	N/A		Created
04/24/2025	4.0.7	MIS-23-006-6	ADD	N/A		Created
04/24/2025	4.0.7	MIS-23-005-5	ADD	N/A		Created
04/24/2025	4.0.7	MIS-23-004-4	ADD	N/A		Created
10/07/2025	4.0.19	MIS-23-003-3	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-23-003-3	ADD	N/A		Created
04/24/2025	4.0.7	MIS-23-002-2	ADD	N/A		Created
04/24/2025	4.0.7	MIS-23-001-1	ADD	N/A		Created
08/13/2025	4.0.16	MIS-22-018-18	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2
04/24/2025	4.0.7	MIS-22-018-18	ADD	N/A		Created
04/24/2025	4.0.7	MIS-22-017-17	ADD	N/A		Created
04/24/2025	4.0.7	MIS-22-016-16	ADD	N/A		Created
08/13/2025	4.0.16	MIS-22-015-15	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2
04/24/2025	4.0.7	MIS-22-015-15	ADD	N/A		Created
08/13/2025	4.0.16	MIS-22-014-14	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2
04/24/2025	4.0.7	MIS-22-014-14	ADD	N/A		Created
08/13/2025	4.0.16	MIS-22-013-13	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2
04/24/2025	4.0.7	MIS-22-013-13	ADD	N/A		Created
04/24/2025	4.0.7	MIS-22-012-12	ADD	N/A		Created
04/24/2025	4.0.7	MIS-22-011-11	ADD	N/A		Created
04/24/2025	4.0.7	MIS-22-010-10	ADD	N/A		Created
04/24/2025	4.0.7	MIS-22-009-9	ADD	N/A		Created
04/24/2025	4.0.7	MIS-22-008-8	ADD	N/A		Created
04/24/2025	4.0.7	MIS-22-007-7	ADD	N/A		Created
04/24/2025	4.0.7	MIS-22-006-6	ADD	N/A		Created
04/24/2025	4.0.7	MIS-22-005-5	ADD	N/A		Created
10/07/2025	4.0.19	MIS-22-004-4	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-22-004-4	ADD	N/A		Created
10/07/2025	4.0.19	MIS-22-003-3	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-22-003-3	ADD	N/A		Created
04/24/2025	4.0.7	MIS-22-002-2	ADD	N/A		Created
11/20/2025	4.0.22	MIS-21-060-60	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-21-060-60	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MIS-21-060-60	ADD	N/A		Created
10/07/2025	4.0.19	MIS-21-059-59	UPDATE	Grace period expiration date	None	2023-10-31
04/24/2025	4.0.7	MIS-21-059-59	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-058-58	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-057-57	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-056-56	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-055-55	ADD	N/A		Created
10/07/2025	4.0.19	MIS-21-054-54	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-21-054-54	ADD	N/A		Created
11/20/2025	4.0.22	MIS-21-053-53	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-21-053-53	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MIS-21-053-53	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-052-52	ADD	N/A		Created
11/20/2025	4.0.22	MIS-21-051-51	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-21-051-51	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MIS-21-051-51	ADD	N/A		Created
11/20/2025	4.0.22	MIS-21-050-50	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-21-050-50	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MIS-21-050-50	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-049-49	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-048-48	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-047-47	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-046-46	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-045-45	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-044-44	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-043-43	ADD	N/A		Created
11/20/2025	4.0.22	MIS-21-042-42	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-21-042-42	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MIS-21-042-42	ADD	N/A		Created
11/20/2025	4.0.22	MIS-21-041-41	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-21-041-41	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MIS-21-041-41	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-040-40	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-039-39	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-038-38	ADD	N/A		Created
10/07/2025	4.0.19	MIS-21-037-37	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-21-037-37	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-036-36	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-035-35	ADD	N/A		Created
11/20/2025	4.0.22	MIS-21-034-34	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-21-034-34	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MIS-21-034-34	ADD	N/A		Created
10/07/2025	4.0.19	MIS-21-033-33	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-21-033-33	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-032-32	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-031-31	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-030-30	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-029-29	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-028-28	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-027-27	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-026-26	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-025-25	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-024-24	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-023-23	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-022-22	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-021-21	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-020-20	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-019-19	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-018-18	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-017-17	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-016-16	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-015-15	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-014-14	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-013-13	ADD	N/A		Created
11/20/2025	4.0.22	MIS-21-012-12	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-21-012-12	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MIS-21-012-12	ADD	N/A		Created
11/20/2025	4.0.22	MIS-21-011-11	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-21-011-11	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MIS-21-011-11	ADD	N/A		Created
10/07/2025	4.0.19	MIS-21-010-10	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-21-010-10	ADD	N/A		Created
11/20/2025	4.0.22	MIS-21-009-9	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-21-009-9	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MIS-21-009-9	ADD	N/A		Created
10/07/2025	4.0.19	MIS-21-008-8	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-21-008-8	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-007-7	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-006-6	ADD	N/A		Created
04/24/2025	4.0.7	MIS-21-005-5	ADD	N/A		Created
11/20/2025	4.0.22	MIS-21-004-4	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-21-004-4	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MIS-21-004-4	ADD	N/A		Created
11/20/2025	4.0.22	MIS-21-003-3	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-21-003-3	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MIS-21-003-3	ADD	N/A		Created
11/20/2025	4.0.22	MIS-21-002-2	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-21-002-2	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MIS-21-002-2	ADD	N/A		Created
10/07/2025	4.0.19	MIS-21-001-1	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-21-001-1	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7578	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-7578	ADD	N/A		Created
05/27/2025	4.0.9	RULE-7536	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-7536	UPDATE	Priority	High	N/A
05/27/2025	4.0.9	RULE-7536	UPDATE	Category	Expenditures	N/A
05/27/2025	4.0.9	RULE-7536	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-7536	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-7536	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-7536	UPDATE	Ta max	0.001
04/24/2025	4.0.7	RULE-7536	ADD	N/A		Created
05/27/2025	4.0.9	RULE-7535	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-7535	UPDATE	Priority	High	N/A
05/27/2025	4.0.9	RULE-7535	UPDATE	Category	Expenditures	N/A
05/27/2025	4.0.9	RULE-7535	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-7535	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-7535	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-7535	UPDATE	Ta max	0.001
04/24/2025	4.0.7	RULE-7535	ADD	N/A		Created
05/27/2025	4.0.9	RULE-7534	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-7534	UPDATE	Priority	High	N/A
05/27/2025	4.0.9	RULE-7534	UPDATE	Category	Expenditures	N/A
05/27/2025	4.0.9	RULE-7534	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-7534	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-7534	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-7534	UPDATE	Ta max	0.001
04/24/2025	4.0.7	RULE-7534	ADD	N/A		Created
05/27/2025	4.0.9	RULE-7533	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-7533	UPDATE	Priority	High	N/A
05/27/2025	4.0.9	RULE-7533	UPDATE	Category	Expenditures	N/A
05/27/2025	4.0.9	RULE-7533	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-7533	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-7533	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-7533	UPDATE	Ta max	0.001
04/24/2025	4.0.7	RULE-7533	ADD	N/A		Created
05/27/2025	4.0.9	RULE-7379	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-7379	UPDATE	Priority	High	N/A
05/27/2025	4.0.9	RULE-7379	UPDATE	Category	Expenditures	N/A
05/27/2025	4.0.9	RULE-7379	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-7379	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-7379	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-7379	UPDATE	Ta max	0.02
04/24/2025	4.0.7	RULE-7379	ADD	N/A		Created
05/27/2025	4.0.9	RULE-7378	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-7378	UPDATE	Priority	High	N/A
05/27/2025	4.0.9	RULE-7378	UPDATE	Category	Expenditures	N/A
05/27/2025	4.0.9	RULE-7378	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-7378	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-7378	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-7378	UPDATE	Ta max	0.02
04/24/2025	4.0.7	RULE-7378	ADD	N/A		Created
05/27/2025	4.0.9	RULE-7377	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-7377	UPDATE	Priority	High	N/A
05/27/2025	4.0.9	RULE-7377	UPDATE	Category	Expenditures	N/A
05/27/2025	4.0.9	RULE-7377	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-7377	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-7377	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-7377	UPDATE	Ta max	0.02
04/24/2025	4.0.7	RULE-7377	ADD	N/A		Created
05/27/2025	4.0.9	RULE-7376	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-7376	UPDATE	Priority	High	N/A
05/27/2025	4.0.9	RULE-7376	UPDATE	Category	Expenditures	N/A
05/27/2025	4.0.9	RULE-7376	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-7376	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-7376	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-7376	UPDATE	Ta max	0.02
04/24/2025	4.0.7	RULE-7376	ADD	N/A		Created
05/27/2025	4.0.9	RULE-7375	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-7375	UPDATE	Priority	High	N/A
05/27/2025	4.0.9	RULE-7375	UPDATE	Category	Expenditures	N/A
05/27/2025	4.0.9	RULE-7375	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-7375	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-7375	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-7375	UPDATE	Ta max	0.02
04/24/2025	4.0.7	RULE-7375	ADD	N/A		Created
05/27/2025	4.0.9	RULE-7374	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-7374	UPDATE	Priority	High	N/A
05/27/2025	4.0.9	RULE-7374	UPDATE	Category	Expenditures	N/A
05/27/2025	4.0.9	RULE-7374	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-7374	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-7374	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-7374	UPDATE	Ta max	0.02
04/24/2025	4.0.7	RULE-7374	ADD	N/A		Created
05/27/2025	4.0.9	RULE-7373	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-7373	UPDATE	Priority	High	N/A
05/27/2025	4.0.9	RULE-7373	UPDATE	Category	Expenditures	N/A
05/27/2025	4.0.9	RULE-7373	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-7373	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-7373	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-7373	UPDATE	Ta max	0.02
04/24/2025	4.0.7	RULE-7373	ADD	N/A		Created
05/27/2025	4.0.9	RULE-7372	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-7372	UPDATE	Priority	High	N/A
05/27/2025	4.0.9	RULE-7372	UPDATE	Category	Expenditures	N/A
05/27/2025	4.0.9	RULE-7372	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-7372	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-7372	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-7372	UPDATE	Ta max	0.02
04/24/2025	4.0.7	RULE-7372	ADD	N/A		Created
04/24/2025	4.0.7	PRV-6-004-4	ADD	N/A		Created
04/24/2025	4.0.7	PRV-6-003-3	ADD	N/A		Created
11/20/2025	4.0.22	PRV-6-002-2	UPDATE	Annotation	Calculate the percentage of submitting state provider IDs that have a facility group individual code indicating individual but whose provider classification code does not indicate individual	N/A
11/20/2025	4.0.22	PRV-6-002-2	UPDATE	Specification	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 2: Provider attributes are active on last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROVIDER-ATTRIBUTES-MAIN- PRV00002 by keeping records that satisfy the following criteria:1. PROV-ATTRIBUTES-EFF-DATE <= last day of the reporting month2. PROV-ATTRIBUTES-END-DATE >= last day of the reporting month or missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 3: Provider is an individualOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:1. FACILITY-GROUP-INDIVIDUAL-CODE = "03" STEP 4: Provider taxonomy is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 3, further refine the population using segment PROVIDER-TAXONOMY-CLASSIFICATION-PRV00006 by keeping records that satisfy the following criteria:1a. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= last day of the reporting month2a. PROV-TAXONOMY-CLASSIFICATION-END-DATE >= last day of the reporting month OR missingOR1b. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE is missing2b. PROV-TAXONOMY-CLASSIFICATION-END-DATE is missingSTEP 5: Provider Classification Lookup Designation is "Facility or Group" or missingOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 4, further refine the population by keeping records that meet the following criteria:1a. PROV-IDENTIFIER-TYPE and PROVIDER-CLASSIFICATION-CODE match values in Provider Classification lookup tableAND1b. Provider Classification Lookup Designation is never “Individual"OR2. PROV-IDENTIFIER-TYPE and PROVIDER-CLASSIFICATION-CODE are never equal to values in Provider Classification lookup tableOR3. PROV-IDENTIFIER-TYPE is always missingOR4. PROVIDER-CLASSIFICATION-CODE is always missingSTEP 6: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 5 by the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 3	N/A
04/24/2025	4.0.7	PRV-6-002-2	ADD	N/A		Created
11/20/2025	4.0.22	PRV-6-001-1	UPDATE	Annotation	Calculate the percentage of submitting state provider IDs that have a facility group individual code indicating facility or group but whose provider classification code does not indicate facility or group	N/A
11/20/2025	4.0.22	PRV-6-001-1	UPDATE	Specification	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 2: Provider attributes are active on last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROVIDER-ATTRIBUTES-MAIN- PRV00002 by keeping records that satisfy the following criteria:1. PROV-ATTRIBUTES-EFF-DATE <= last day of the reporting month2. PROV-ATTRIBUTES-END-DATE >= last day of the reporting month or missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 3: Provider is a facility or groupOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:1. FACILITY-GROUP-INDIVIDUAL-CODE = "01" or "02" STEP 4: Provider taxonomy is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 3, further refine the population using segment PROVIDER-TAXONOMY-CLASSIFICATION-PRV00006 by keeping records that satisfy the following criteria:1a. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= last day of the reporting month2a. PROV-TAXONOMY-CLASSIFICATION-END-DATE >= last day of the reporting month OR missingOR1b. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE is missing2b. PROV-TAXONOMY-CLASSIFICATION-END-DATE is missingSTEP 5: Provider Classification Lookup Designation is "Individual" or missingOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 4, further refine the population by keeping records that meet the following criteria:1a. PROV-IDENTIFIER-TYPE and PROVIDER-CLASSIFICATION-CODE match values in Provider Classification lookup tableAND1b. Provider Classification Lookup Designation is never “Non-Individual”OR2. PROV-IDENTIFIER-TYPE and PROVIDER-CLASSIFICATION-CODE are never equal to values in Provider Classification lookup tableOR3. PROV-IDENTIFIER-TYPE is always missingOR4. PROVIDER-CLASSIFICATION-CODE is always missingSTEP 6: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 5 by the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 3	N/A
04/24/2025	4.0.7	PRV-6-001-1	ADD	N/A		Created
08/13/2025	4.0.16	MCR-59-004-16	UPDATE	Specification	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Exclude childless headersOf the claim headers that meet the criteria from STEP 3, drop all headers that do not merge to at least one lineSTEP 5: Claims paid at the line levelOf claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 6: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 3, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 7: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 6 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 8: Calculate the percentage for the measureDivide the count of header claims from STEP 7 by the count of header claims from STEP 5.	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Exclude childless headersOf the claim headers that meet the criteria from STEP 3, drop all headers that do not merge to at least one lineSTEP 5: Claims paid at the line levelOf claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 6: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 3, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 7: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 6 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 8: Calculate the percentage for the measureDivide the count of claims from STEP 7 by the count of claims from STEP 5.
04/24/2025	4.0.7	MCR-59-004-16	ADD	N/A		Created
08/13/2025	4.0.16	MCR-59-003-15	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Exclude childless headersOf the claim headers that meet the criteria from STEP 3, drop all headers that do not merge to at least one lineSTEP 5: Claims paid at the line levelOf claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 6: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 5, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 7: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 6 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 8: Calculate the percentage for the measureDivide the count of header claims from STEP 7 by the count of header claims from STEP 5.	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Exclude childless headersOf the claim headers that meet the criteria from STEP 3, drop all headers that do not merge to at least one lineSTEP 5: Claims paid at the line levelOf claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 6: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 5, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 7: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 6 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 8: Calculate the percentage for the measureDivide the count of claims from STEP 7 by the count of claims from STEP 5.
04/24/2025	4.0.7	MCR-59-003-15	ADD	N/A		Created
08/13/2025	4.0.16	MCR-59-002-14	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Exclude childless headersOf the claim headers that meet the criteria from STEP 3, drop all headers that do not merge to at least one lineSTEP 5: Claims paid at the line levelOf claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 6: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 5, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 7: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 6 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 8: Calculate the percentage for the measureDivide the count of header claims from STEP 7 by the count of header claims from STEP 5.	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Exclude childless headersOf the claim headers that meet the criteria from STEP 3, drop all headers that do not merge to at least one lineSTEP 5: Claims paid at the line levelOf claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 6: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 5, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 7: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 6 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 8: Calculate the percentage for the measureDivide the count of claims from STEP 7 by the count of claims from STEP 5.
04/24/2025	4.0.7	MCR-59-002-14	ADD	N/A		Created
08/13/2025	4.0.16	MCR-59-001-13	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Exclude childless headersOf the claim headers that meet the criteria from STEP 3, drop all headers that do not merge to at least one lineSTEP 5: Claims paid at the line levelOf claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 6: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 3, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 7: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 6 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 8: Calculate the percentage for the measureDivide the count of header claims from STEP 7 by the count of header claims from STEP 5.	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Exclude childless headersOf the claim headers that meet the criteria from STEP 3, drop all headers that do not merge to at least one lineSTEP 5: Claims paid at the line levelOf claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 6: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 3, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 7: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 6 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 8: Calculate the percentage for the measureDivide the count of claims from STEP 7 by the count of claims from STEP 5.
04/24/2025	4.0.7	MCR-59-001-13	ADD	N/A		Created
10/07/2025	4.0.19	FFS-49-004-16	UPDATE	Grace period expiration date	None	2022-10-31
04/24/2025	4.0.7	FFS-49-004-16	ADD	N/A		Created
10/07/2025	4.0.19	FFS-49-003-15	UPDATE	Grace period expiration date	None	2022-10-31
04/24/2025	4.0.7	FFS-49-003-15	ADD	N/A		Created
10/07/2025	4.0.19	FFS-49-002-14	UPDATE	Grace period expiration date	None	2022-10-31
04/24/2025	4.0.7	FFS-49-002-14	ADD	N/A		Created
10/07/2025	4.0.19	FFS-49-001-13	UPDATE	Grace period expiration date	None	2022-10-31
04/24/2025	4.0.7	FFS-49-001-13	ADD	N/A		Created
10/07/2025	4.0.19	EL-19-001-1	UPDATE	Grace period expiration date	None	2023-09-30
04/24/2025	4.0.7	EL-19-001-1	ADD	N/A		Created
11/20/2025	4.0.22	EL-18-001-1	UPDATE	Annotation	Count the number of unique MSIS IDs for each valid value for race, invalid values, and the overall total	N/A
11/20/2025	4.0.22	EL-18-001-1	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION-ELG00016 by keeping active records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: FrequencyCount the number of unique MSIS IDs from STEP 2 for:1. Each valid value: RACE = (“001,” “002,” “003,” “004,” “005,” “006,” “007,” “008,” “009,” “010,” “011,” “012,” “013,” “014,” “015,” “016,” "017", and “018”) 2. Any valid value: RACE = (“001" or “002" or “003" or “004" or “005" or “006" or “007" or “008" or “009" or “010" or “011" or “012" or “013" or “014” or “015" or “016” "017" or “018”) 3. Invalid value: RACE not equal to (“001" or “002" or “003" or “004" or “005" or “006" or “007" or “008" or “009" or “010" or “011" or “012" or “013" or “014” or “015" or “016” or "017" or “018”) or missing4. Total: RACE = (any missing or non-missing value)	N/A
04/24/2025	4.0.7	EL-18-001-1	ADD	N/A		Created
10/07/2025	4.0.19	EL-1-024-30	UPDATE	Grace period expiration date	None	2022-10-31
04/24/2025	4.0.7	EL-1-024-30	ADD	N/A		Created
10/07/2025	4.0.19	EL-1-011_1-29	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	EL-1-011_1-29	ADD	N/A		Created
04/24/2025	4.0.7	ALL-36-001-1	ADD	N/A		Created
08/13/2025	4.0.16	ALL-35-004-4	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP FFS and Encounter: Original and Replacement Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Non-missing tooth numberOf the claims that meet criteria from STEP 2, keep those with non-missing TOOTH-NUM.STEP 4: Procedure code format does not indicate a CDT codeOf the claims that meet the criteria from STEP 3, keep those that do NOT meet following criteria:1. Length of PROCEDURE-CODE is 52. PROCEDURE-CODE begins with "D"3. PROCEDURE-CODE only contains digits 0-9 in positions 2-5STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 3	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP FFS and Encounter: Original and Replacement Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Non-missing tooth numberOf the claims that meet criteria from STEP 2, keep those with non-missing TOOTH-NUM.STEP 4: Procedure code format does not indicate a CDT codeOf the claims that meet the criteria from STEP 3, keep those that do NOT meet following criteria:1. Length of PROCEDURE-CODE is 52. PROCEDURE-CODE begins with "D"3. PROCEDURE-CODE only contains digits 0-9 in positions 2-5STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 3
04/24/2025	4.0.7	ALL-35-004-4	ADD	N/A		Created
08/13/2025	4.0.16	ALL-35-003-3	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS and Encounter: Original and Replacement Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Non-missing tooth numberOf the claims that meet criteria from STEP 2, keep those with non-missing TOOTH-NUM.STEP 4: Procedure code format does not indicate a CDT codeOf the claims that meet the criteria from STEP 3, keep those that do NOT meet following criteria:1. Length of PROCEDURE-CODE is 52. PROCEDURE-CODE begins with "D"3. PROCEDURE-CODE only contains digits 0-9 in positions 2-5STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 3	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS and Encounter: Original and Replacement Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Non-missing tooth numberOf the claims that meet criteria from STEP 2, keep those with non-missing TOOTH-NUM.STEP 4: Procedure code format does not indicate a CDT codeOf the claims that meet the criteria from STEP 3, keep those that do NOT meet following criteria:1. Length of PROCEDURE-CODE is 52. PROCEDURE-CODE begins with "D"3. PROCEDURE-CODE only contains digits 0-9 in positions 2-5STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 3
04/24/2025	4.0.7	ALL-35-003-3	ADD	N/A		Created
08/13/2025	4.0.16	ALL-35-002-2	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP FFS and Encounter: Original and Replacement Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Tooth-related procedure codesOf the claims that meet criteria from STEP 2, keep those with a PROCEDURE-CODE that matches one of the following criteria:1. PROCEDURE-CODE = “D1351” or “D2140” or “D2150” or “D2160” or “D2161” or “D2330” or “D2331” or “D2332” or “D2335” or “D2390” or “D2391” or “D2392” or “D2393” or “D2394” or “D3230” or “D3240” or “D3310” or “D3320” or “D3330”STEP 4: Missing tooth numberOf the claims that meet criteria from STEP 3, keep those with a missing TOOTH-NUMSTEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 3	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP FFS and Encounter: Original and Replacement Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Tooth-related procedure codesOf the claims that meet criteria from STEP 2, keep those with a PROCEDURE-CODE that matches one of the following criteria:1. PROCEDURE-CODE = “D1351” or “D2140” or “D2150” or “D2160” or “D2161” or “D2330” or “D2331” or “D2332” or “D2335” or “D2390” or “D2391” or “D2392” or “D2393” or “D2394” or “D3230” or “D3240” or “D3310” or “D3320” or “D3330”STEP 4: Missing tooth numberOf the claims that meet criteria from STEP 3, keep those with a missing TOOTH-NUMSTEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 3
04/24/2025	4.0.7	ALL-35-002-2	ADD	N/A		Created
08/13/2025	4.0.16	ALL-35-001-1	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS and Encounter: Original and Replacement Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Tooth-related procedure codesOf the claims that meet criteria from STEP 2, keep those with a PROCEDURE-CODE that matches one of the following criteria:1. PROCEDURE-CODE = “D1351” or “D2140” or “D2150” or “D2160” or “D2161” or “D2330” or “D2331” or “D2332” or “D2335” or “D2390” or “D2391” or “D2392” or “D2393” or “D2394” or “D3230” or “D3240” or “D3310” or “D3320” or “D3330”STEP 4: Missing tooth numberOf the claims that meet criteria from STEP 3, keep those with a missing TOOTH-NUMSTEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 3	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS and Encounter: Original and Replacement Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Tooth-related procedure codesOf the claims that meet criteria from STEP 2, keep those with a PROCEDURE-CODE that matches one of the following criteria:1. PROCEDURE-CODE = “D1351” or “D2140” or “D2150” or “D2160” or “D2161” or “D2330” or “D2331” or “D2332” or “D2335” or “D2390” or “D2391” or “D2392” or “D2393” or “D2394” or “D3230” or “D3240” or “D3310” or “D3320” or “D3330”STEP 4: Missing tooth numberOf the claims that meet criteria from STEP 3, keep those with a missing TOOTH-NUMSTEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 3
04/24/2025	4.0.7	ALL-35-001-1	ADD	N/A		Created
08/13/2025	4.0.16	ALL-34-002-2	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS and Encounter: Original and Replacement Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Non-missing procedure codeOf the claims that meet criteria from STEP 2, keep those with non-missing PROCEDURE-CODESTEP 4: Non-missing HCBS service code or HCBS taxonomyOf the claims that meet criteria from STEP 3, keep those with non-missing HCBS-SERVICE-CODE or non-missing HCBS-TAXONOMYSTEP 5: Procedure code format that indicates a CPT or CDT codeOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. Length of PROCEDURE-CODE is 52. PROCEDURE-CODE begins with "D" or any digit 0-93. PROCEDURE-CODE only contains digit 0-9 in positions 2-5STEP 6: Calculate percentageDivide the count of claim lines from STEP 5 by the count of claim lines from STEP 4	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS and Encounter: Original and Replacement Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Non-missing procedure codeOf the claims that meet criteria from STEP 2, keep those with non-missing PROCEDURE-CODESTEP 4: Non-missing HCBS service code or HCBS taxonomyOf the claims that meet criteria from STEP 3, keep those with non-missing HCBS-SERVICE-CODE or non-missing HCBS-TAXONOMYSTEP 5: Procedure code format that indicates a CPT or CDT codeOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. Length of PROCEDURE-CODE is 52. PROCEDURE-CODE begins with "D" or any digit 0-93. PROCEDURE-CODE only contains digit 0-9 in positions 2-5STEP 6: Calculate percentageDivide the count of claim lines from STEP 5 by the count of claim lines from STEP 4
04/24/2025	4.0.7	ALL-34-002-2	ADD	N/A		Created
08/13/2025	4.0.16	ALL-34-001-1	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS and Encounter: Original and Replacement Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Non-missing HCBS service codeOf the claims that meet criteria from STEP 2, keep those with non-missing HCBS-SERVICE-CODESTEP 4: Missing HCBS taxonomyOf the claims that meet criteria from STEP 3, keep those with missing HCBS-TAXONOMYSTEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 3	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS and Encounter: Original and Replacement Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Non-missing HCBS service codeOf the claims that meet criteria from STEP 2, keep those with non-missing HCBS-SERVICE-CODESTEP 4: Missing HCBS taxonomyOf the claims that meet criteria from STEP 3, keep those with missing HCBS-TAXONOMYSTEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 3
04/24/2025	4.0.7	ALL-34-001-1	ADD	N/A		Created
04/24/2025	4.0.7	RULE-7294	ADD	N/A		Created
05/27/2025	4.0.9	RULE-400	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-400	UPDATE	Priority	Medium	N/A
05/27/2025	4.0.9	RULE-400	UPDATE	Category	Utilization	N/A
05/27/2025	4.0.9	RULE-400	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-400	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-400	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-400	UPDATE	Ta max	0.01
04/24/2025	4.0.7	RULE-400	ADD	N/A		Created
05/27/2025	4.0.9	RULE-395	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-395	UPDATE	Priority	Medium	N/A
05/27/2025	4.0.9	RULE-395	UPDATE	Category	Utilization	N/A
05/27/2025	4.0.9	RULE-395	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-395	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-395	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-395	UPDATE	Ta max	0.01
04/24/2025	4.0.7	RULE-395	ADD	N/A		Created
05/27/2025	4.0.9	RULE-390	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-390	UPDATE	Priority	Medium	N/A
05/27/2025	4.0.9	RULE-390	UPDATE	Category	Utilization	N/A
05/27/2025	4.0.9	RULE-390	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-390	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-390	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-390	UPDATE	Ta max	0.01
04/24/2025	4.0.7	RULE-390	ADD	N/A		Created
05/27/2025	4.0.9	RULE-385	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-385	UPDATE	Priority	Medium	N/A
05/27/2025	4.0.9	RULE-385	UPDATE	Category	Utilization	N/A
05/27/2025	4.0.9	RULE-385	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-385	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-385	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-385	UPDATE	Ta max	0.01
04/24/2025	4.0.7	RULE-385	ADD	N/A		Created
05/27/2025	4.0.9	RULE-380	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-380	UPDATE	Priority	Medium	N/A
05/27/2025	4.0.9	RULE-380	UPDATE	Category	Utilization	N/A
05/27/2025	4.0.9	RULE-380	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-380	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-380	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-380	UPDATE	Ta max	0.01
04/24/2025	4.0.7	RULE-380	ADD	N/A		Created
05/27/2025	4.0.9	RULE-375	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-375	UPDATE	Priority	Medium	N/A
05/27/2025	4.0.9	RULE-375	UPDATE	Category	Utilization	N/A
05/27/2025	4.0.9	RULE-375	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-375	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-375	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-375	UPDATE	Ta max	0.01
04/24/2025	4.0.7	RULE-375	ADD	N/A		Created
05/27/2025	4.0.9	RULE-369	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-369	UPDATE	Priority	Medium	N/A
05/27/2025	4.0.9	RULE-369	UPDATE	Category	Utilization	N/A
05/27/2025	4.0.9	RULE-369	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-369	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-369	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-369	UPDATE	Ta max	0.01
04/24/2025	4.0.7	RULE-369	ADD	N/A		Created
05/27/2025	4.0.9	RULE-363	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-363	UPDATE	Priority	Medium	N/A
05/27/2025	4.0.9	RULE-363	UPDATE	Category	Utilization	N/A
05/27/2025	4.0.9	RULE-363	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-363	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-363	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-363	UPDATE	Ta max	0.01
04/24/2025	4.0.7	RULE-363	ADD	N/A		Created
05/27/2025	4.0.9	RULE-346	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-346	UPDATE	Priority	Medium	N/A
05/27/2025	4.0.9	RULE-346	UPDATE	Category	Utilization	N/A
05/27/2025	4.0.9	RULE-346	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-346	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-346	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-346	UPDATE	Ta max	0.01
04/24/2025	4.0.7	RULE-346	ADD	N/A		Created
04/24/2025	4.0.7	RULE-2614	ADD	N/A		Created
04/24/2025	4.0.7	RULE-1948	ADD	N/A		Created
10/07/2025	4.0.19	RULE-768	UPDATE	Grace period expiration date	None	2022-06-30
04/24/2025	4.0.7	RULE-768	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7434	UPDATE	Grace period expiration date	None	2022-06-30
04/24/2025	4.0.7	RULE-7434	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7433	UPDATE	Grace period expiration date	None	2022-06-30
04/24/2025	4.0.7	RULE-7433	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7432	UPDATE	Grace period expiration date	None	2022-06-30
04/24/2025	4.0.7	RULE-7432	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7431	UPDATE	Grace period expiration date	None	2022-06-30
04/24/2025	4.0.7	RULE-7431	ADD	N/A		Created
10/07/2025	4.0.19	RULE-1909	UPDATE	Grace period expiration date	None	2022-06-30
04/24/2025	4.0.7	RULE-1909	ADD	N/A		Created
10/07/2025	4.0.19	RULE-1610	UPDATE	Grace period expiration date	None	2022-06-30
04/24/2025	4.0.7	RULE-1610	ADD	N/A		Created
10/07/2025	4.0.19	RULE-1204	UPDATE	Grace period expiration date	None	2022-06-30
04/24/2025	4.0.7	RULE-1204	ADD	N/A		Created
10/07/2025	4.0.19	RULE-888	UPDATE	Grace period expiration date	None	2022-02-28
04/24/2025	4.0.7	RULE-888	ADD	N/A		Created
05/27/2025	4.0.9	RULE-884	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-884	UPDATE	Priority	Critical	N/A
05/27/2025	4.0.9	RULE-884	UPDATE	Claim type	Medicaid,FFS or Medicaid,Cap or Medicaid,Enc or Medicaid,Supp or CHIP,FFS or CHIP,Cap or CHIP,Enc or CHIP,Supp	N/A
05/27/2025	4.0.9	RULE-884	UPDATE	Category	File integrity	N/A
05/27/2025	4.0.9	RULE-884	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-884	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-884	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-884	UPDATE	Ta max	0.02
04/24/2025	4.0.7	RULE-884	ADD	N/A		Created
04/24/2025	4.0.7	RULE-810	ADD	N/A		Created
10/07/2025	4.0.19	RULE-774	UPDATE	Grace period expiration date	None	2022-02-28
04/24/2025	4.0.7	RULE-774	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7471	UPDATE	Grace period expiration date	None	2022-02-28
04/24/2025	4.0.7	RULE-7471	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7470	UPDATE	Grace period expiration date	None	2022-02-28
04/24/2025	4.0.7	RULE-7470	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7469	UPDATE	Grace period expiration date	None	2022-02-28
04/24/2025	4.0.7	RULE-7469	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7468	UPDATE	Grace period expiration date	None	2022-02-28
04/24/2025	4.0.7	RULE-7468	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7467	UPDATE	Grace period expiration date	None	2022-02-28
04/24/2025	4.0.7	RULE-7467	ADD	N/A		Created
04/24/2025	4.0.7	RULE-7466	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7465	UPDATE	Grace period expiration date	None	2022-02-28
04/24/2025	4.0.7	RULE-7465	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7464	UPDATE	Grace period expiration date	None	2022-02-28
04/24/2025	4.0.7	RULE-7464	ADD	N/A		Created
04/24/2025	4.0.7	RULE-689	ADD	N/A		Created
10/07/2025	4.0.19	RULE-340	UPDATE	Grace period expiration date	None	2022-02-28
04/24/2025	4.0.7	RULE-340	ADD	N/A		Created
05/27/2025	4.0.9	RULE-335	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-335	UPDATE	Priority	Critical	N/A
05/27/2025	4.0.9	RULE-335	UPDATE	Claim type	Medicaid,FFS or Medicaid,Cap or Medicaid,Enc or Medicaid,Supp or CHIP,FFS or CHIP,Cap or CHIP,Enc or CHIP,Supp	N/A
05/27/2025	4.0.9	RULE-335	UPDATE	Category	File integrity	N/A
05/27/2025	4.0.9	RULE-335	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-335	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-335	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-335	UPDATE	Ta max	0.02
04/24/2025	4.0.7	RULE-335	ADD	N/A		Created
04/24/2025	4.0.7	RULE-1964	ADD	N/A		Created
10/07/2025	4.0.19	RULE-1916	UPDATE	Grace period expiration date	None	2022-02-28
04/24/2025	4.0.7	RULE-1916	ADD	N/A		Created
04/24/2025	4.0.7	RULE-1845	ADD	N/A		Created
10/07/2025	4.0.19	RULE-1762	UPDATE	Grace period expiration date	None	2022-02-28
04/24/2025	4.0.7	RULE-1762	ADD	N/A		Created
05/27/2025	4.0.9	RULE-1758	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-1758	UPDATE	Priority	Critical	N/A
05/27/2025	4.0.9	RULE-1758	UPDATE	Claim type	Medicaid,FFS or Medicaid,Cap or Medicaid,Enc or Medicaid,Supp or CHIP,FFS or CHIP,Cap or CHIP,Enc or CHIP,Supp	N/A
05/27/2025	4.0.9	RULE-1758	UPDATE	Category	File integrity	N/A
05/27/2025	4.0.9	RULE-1758	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-1758	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-1758	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-1758	UPDATE	Ta max	0.02
04/24/2025	4.0.7	RULE-1758	ADD	N/A		Created
04/24/2025	4.0.7	RULE-1663	ADD	N/A		Created
10/07/2025	4.0.19	RULE-1616	UPDATE	Grace period expiration date	None	2022-02-28
04/24/2025	4.0.7	RULE-1616	ADD	N/A		Created
05/27/2025	4.0.9	RULE-1540	UPDATE	Category	Provider information	N/A
05/27/2025	4.0.9	RULE-1540	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-1540	UPDATE	Ta max	0.02
04/24/2025	4.0.7	RULE-1540	ADD	N/A		Created
04/24/2025	4.0.7	RULE-1246	ADD	N/A		Created
10/07/2025	4.0.19	RULE-1211	UPDATE	Grace period expiration date	None	2022-02-28
04/24/2025	4.0.7	RULE-1211	ADD	N/A		Created
04/24/2025	4.0.7	RULE-1126	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7447	UPDATE	Grace period expiration date	None	2023-07-31
04/24/2025	4.0.7	RULE-7447	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7190	UPDATE	Grace period expiration date	None	2021-11-30
04/24/2025	4.0.7	RULE-7190	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7189	UPDATE	Grace period expiration date	None	2021-11-30
04/24/2025	4.0.7	RULE-7189	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7188	UPDATE	Grace period expiration date	None	2021-11-30
04/24/2025	4.0.7	RULE-7188	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7187	UPDATE	Grace period expiration date	None	2021-11-30
04/24/2025	4.0.7	RULE-7187	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7186	UPDATE	Grace period expiration date	None	2021-11-30
04/24/2025	4.0.7	RULE-7186	ADD	N/A		Created
04/24/2025	4.0.7	RULE-7185	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7184	UPDATE	Grace period expiration date	None	2021-11-30
04/24/2025	4.0.7	RULE-7184	ADD	N/A		Created
10/07/2025	4.0.19	RULE-7183	UPDATE	Grace period expiration date	None	2021-11-30
04/24/2025	4.0.7	RULE-7183	ADD	N/A		Created
10/07/2025	4.0.19	RULE-3176	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-3176	ADD	N/A		Created
10/07/2025	4.0.19	RULE-3148	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-3148	ADD	N/A		Created
10/07/2025	4.0.19	RULE-3127	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-3127	ADD	N/A		Created
10/07/2025	4.0.19	RULE-3103	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-3103	ADD	N/A		Created
10/07/2025	4.0.19	RULE-3070	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-3070	ADD	N/A		Created
10/07/2025	4.0.19	RULE-3016	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-3016	ADD	N/A		Created
10/07/2025	4.0.19	RULE-2996	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-2996	ADD	N/A		Created
10/07/2025	4.0.19	RULE-2974	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-2974	ADD	N/A		Created
10/07/2025	4.0.19	RULE-2950	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-2950	ADD	N/A		Created
10/07/2025	4.0.19	RULE-2932	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-2932	ADD	N/A		Created
10/07/2025	4.0.19	RULE-2911	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-2911	ADD	N/A		Created
10/07/2025	4.0.19	RULE-2878	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-2878	ADD	N/A		Created
10/07/2025	4.0.19	RULE-2841	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-2841	ADD	N/A		Created
10/07/2025	4.0.19	RULE-2793	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-2793	ADD	N/A		Created
10/07/2025	4.0.19	RULE-2701	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-2701	ADD	N/A		Created
10/07/2025	4.0.19	RULE-2680	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-2680	ADD	N/A		Created
04/24/2025	4.0.7	RULE-2659	ADD	N/A		Created
10/07/2025	4.0.19	RULE-2636	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-2636	ADD	N/A		Created
10/07/2025	4.0.19	RULE-2598	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-2598	ADD	N/A		Created
10/07/2025	4.0.19	RULE-2578	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-2578	ADD	N/A		Created
10/07/2025	4.0.19	RULE-2519	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-2519	ADD	N/A		Created
10/07/2025	4.0.19	RULE-2498	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-2498	ADD	N/A		Created
10/07/2025	4.0.19	RULE-2478	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-2478	ADD	N/A		Created
10/07/2025	4.0.19	RULE-2458	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-2458	ADD	N/A		Created
10/07/2025	4.0.19	RULE-2438	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-2438	ADD	N/A		Created
10/07/2025	4.0.19	RULE-2413	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-2413	ADD	N/A		Created
10/07/2025	4.0.19	RULE-2392	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-2392	ADD	N/A		Created
10/07/2025	4.0.19	RULE-2361	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-2361	ADD	N/A		Created
10/07/2025	4.0.19	RULE-2338	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-2338	ADD	N/A		Created
10/07/2025	4.0.19	RULE-2313	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-2313	ADD	N/A		Created
10/07/2025	4.0.19	RULE-2289	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-2289	ADD	N/A		Created
10/07/2025	4.0.19	RULE-2263	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-2263	ADD	N/A		Created
10/07/2025	4.0.19	RULE-2241	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-2241	ADD	N/A		Created
10/07/2025	4.0.19	RULE-2217	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-2217	ADD	N/A		Created
10/07/2025	4.0.19	RULE-2188	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-2188	ADD	N/A		Created
10/07/2025	4.0.19	RULE-2165	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-2165	ADD	N/A		Created
10/07/2025	4.0.19	RULE-2105	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-2105	ADD	N/A		Created
10/07/2025	4.0.19	RULE-2071	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-2071	ADD	N/A		Created
10/07/2025	4.0.19	RULE-2028	UPDATE	Grace period expiration date	None	2024-03-31
04/24/2025	4.0.7	RULE-2028	ADD	N/A		Created
04/24/2025	4.0.7	ALL-33-001-1	ADD	N/A		Created
04/24/2025	4.0.7	ALL-32-001-1	ADD	N/A		Created
04/24/2025	4.0.7	ALL-31-001-1	ADD	N/A		Created
04/24/2025	4.0.7	ALL-30-001-1	ADD	N/A		Created
04/24/2025	4.0.7	ALL-29-001-1	ADD	N/A		Created
04/24/2025	4.0.7	ALL-28-001-1	ADD	N/A		Created
10/07/2025	4.0.19	ALL-27-002-2	UPDATE	Grace period expiration date	None	2024-09-29
04/24/2025	4.0.7	ALL-27-002-2	ADD	N/A		Created
10/07/2025	4.0.19	ALL-27-001-1	UPDATE	Grace period expiration date	None	2024-09-29
04/24/2025	4.0.7	ALL-27-001-1	ADD	N/A		Created
04/24/2025	4.0.7	ALL-26-004-4	ADD	N/A		Created
04/24/2025	4.0.7	ALL-26-003-3	ADD	N/A		Created
04/24/2025	4.0.7	ALL-26-002-2	ADD	N/A		Created
04/24/2025	4.0.7	ALL-26-001-1	ADD	N/A		Created
05/27/2025	4.0.9	RULE-896	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-896	UPDATE	Priority	Medium	N/A
05/27/2025	4.0.9	RULE-896	UPDATE	Category	Utilization	N/A
05/27/2025	4.0.9	RULE-896	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-896	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-896	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-896	UPDATE	Ta max	0.01
04/24/2025	4.0.7	RULE-896	ADD	N/A		Created
05/27/2025	4.0.9	RULE-405	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-405	UPDATE	Priority	Medium	N/A
05/27/2025	4.0.9	RULE-405	UPDATE	Category	Utilization	N/A
05/27/2025	4.0.9	RULE-405	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-405	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-405	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-405	UPDATE	Ta max	0.01
04/24/2025	4.0.7	RULE-405	ADD	N/A		Created
05/27/2025	4.0.9	RULE-357	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-357	UPDATE	Priority	Medium	N/A
05/27/2025	4.0.9	RULE-357	UPDATE	Category	Utilization	N/A
05/27/2025	4.0.9	RULE-357	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-357	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-357	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-357	UPDATE	Ta max	0.01
04/24/2025	4.0.7	RULE-357	ADD	N/A		Created
05/27/2025	4.0.9	RULE-351	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-351	UPDATE	Priority	Medium	N/A
05/27/2025	4.0.9	RULE-351	UPDATE	Category	Utilization	N/A
05/27/2025	4.0.9	RULE-351	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-351	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-351	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-351	UPDATE	Ta max	0.01
04/24/2025	4.0.7	RULE-351	ADD	N/A		Created
05/27/2025	4.0.9	RULE-347	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-347	UPDATE	Priority	Medium	N/A
05/27/2025	4.0.9	RULE-347	UPDATE	Category	Utilization	N/A
05/27/2025	4.0.9	RULE-347	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-347	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-347	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-347	UPDATE	Ta max	0.01
04/24/2025	4.0.7	RULE-347	ADD	N/A		Created
04/24/2025	4.0.7	RULE-2928	ADD	N/A		Created
04/24/2025	4.0.7	RULE-2813	ADD	N/A		Created
04/24/2025	4.0.7	RULE-2810	ADD	N/A		Created
04/24/2025	4.0.7	RULE-2809	ADD	N/A		Created
04/24/2025	4.0.7	RULE-2806	ADD	N/A		Created
10/07/2025	4.0.19	RULE-2135	UPDATE	Grace period expiration date	None	2022-07-31
04/24/2025	4.0.7	RULE-2135	ADD	N/A		Created
04/24/2025	4.0.7	RULE-1634	ADD	N/A		Created
04/24/2025	4.0.7	RULE-1371	ADD	N/A		Created
05/27/2025	4.0.9	RULE-1347	UPDATE	Category	Utilization	N/A
05/27/2025	4.0.9	RULE-1347	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-1347	UPDATE	Ta max	0.01
04/24/2025	4.0.7	RULE-1347	ADD	N/A		Created
05/27/2025	4.0.9	RULE-1343	UPDATE	Category	Utilization	N/A
05/27/2025	4.0.9	RULE-1343	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-1343	UPDATE	Ta max	0.01
04/24/2025	4.0.7	RULE-1343	ADD	N/A		Created
04/24/2025	4.0.7	RULE-1341	ADD	N/A		Created
05/27/2025	4.0.9	RULE-1337	UPDATE	Active	True	False
05/27/2025	4.0.9	RULE-1337	UPDATE	Priority	Critical	N/A
05/27/2025	4.0.9	RULE-1337	UPDATE	Claim type	Medicaid,FFS or Medicaid,Cap or Medicaid,Enc or Medicaid,Supp or CHIP,FFS or CHIP,Cap or CHIP,Enc or CHIP,Supp	N/A
05/27/2025	4.0.9	RULE-1337	UPDATE	Category	File integrity	N/A
05/27/2025	4.0.9	RULE-1337	UPDATE	For ta comprehensive	TA- Inferential	No
05/27/2025	4.0.9	RULE-1337	UPDATE	For ta inferential	Yes	No
05/27/2025	4.0.9	RULE-1337	UPDATE	Ta min	0
05/27/2025	4.0.9	RULE-1337	UPDATE	Ta max	0.02
04/24/2025	4.0.7	RULE-1337	ADD	N/A		Created
11/20/2025	4.0.22	PRV-2-010-10	UPDATE	Annotation	Calculate the percent of submitting state provider IDs that are individual providers but have more than one reported NPI	N/A
11/20/2025	4.0.22	PRV-2-010-10	UPDATE	Specification	STEP 1: Provider reported on the provider attributes main segment at any timeDefine the provider population from segment PROV-ATTRIBUTES-MAIN-PRV00002 by keeping active records that satisfy the following criteria:1. SUBMITTING-STATE-PROV-ID is not missingSTEP 2: Provider is an individual Of the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 1, further refine the population by keeping records that satisfy the following criteria:1. FACILITY-GROUP-INDIVIDUAL=CODE = "03" STEP 3: Provider identifier type is NPIOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 2, further refine the population using segment PROV-IDENTIFIERS-PRV00005 by keeping records that meet the following criteria:1. PROV-IDENTIFIER-TYPE = "2"2. PROV-IDENTIFIER is not missingSTEP 4: More than one NPI per submitting state provider IDOf the SUBMITTING-STATE-PROV-IDs identified in STEP 3, limit to unique SUBMITTING-STATE-PROV-IDs that meet the following criteria:1. Two or more unique PROV-IDENTIFIER values kept in STEP 3 for the SUBMITTING-STATE-PROV-ID STEP 5: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 4 by the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 2	N/A
04/24/2025	4.0.7	PRV-2-010-10	ADD	N/A		Created
04/24/2025	4.0.7	MIS-78-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-76-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-74-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-72-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-70-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-68-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-66-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-64-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-61-002-2	ADD	N/A		Created
04/24/2025	4.0.7	MIS-61-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-60-002-2	ADD	N/A		Created
04/24/2025	4.0.7	MIS-60-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-59-004-4	ADD	N/A		Created
04/24/2025	4.0.7	MIS-59-003-3	ADD	N/A		Created
04/24/2025	4.0.7	MIS-59-002-2	ADD	N/A		Created
04/24/2025	4.0.7	MIS-59-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-58-002-2	ADD	N/A		Created
04/24/2025	4.0.7	MIS-58-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-57-004-4	ADD	N/A		Created
04/24/2025	4.0.7	MIS-57-003-3	ADD	N/A		Created
04/24/2025	4.0.7	MIS-57-002-2	ADD	N/A		Created
04/24/2025	4.0.7	MIS-57-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-55-004-4	ADD	N/A		Created
04/24/2025	4.0.7	MIS-55-003-3	ADD	N/A		Created
04/24/2025	4.0.7	MIS-55-002-2	ADD	N/A		Created
04/24/2025	4.0.7	MIS-55-001-1	ADD	N/A		Created
04/24/2025	4.0.7	EXP-45-006-6	ADD	N/A		Created
04/24/2025	4.0.7	EXP-45-005-5	ADD	N/A		Created
08/13/2025	4.0.16	EXP-45-004-4	UPDATE	Annotation	Calculate the percentage of PCCM capitation payment Financial Transaction records with a non-missing plan ID that do not have a corresponding managed care participation PCCM plan	Calculate the percentage of unique MSIS IDs on Medicaid and S-CHIP Payment Financial Transaction Records found on any enrollment time span segment
08/13/2025	4.0.16	EXP-45-004-4	UPDATE	Specification	STEP 1: Active non-duplicate paid miscellaneous capitation payment financial transactions during report monthDefine the FTX universe for the FTX00095 table by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 2: Unique MSIS IDsFrom the records in STEP 1, create a list of unique MSIS-IDENTIFICATION-NUM values.STEP 3: Link FTX records to enrollment time span segmentOf the unique MSIS-IDENTIFICATION-NUM values from STEP 2, restrict to those where:1. MSIS-IDENTIFICATION-NUM is found on an ENROLLMENT-TIME-SPAN-ELG00021 segmentSTEP 4: Calculate percentage Divide the count of unique MSIS-IDENTIFICATION-NUM values from STEP 3 by the count from STEP 2	STEP 1: Active non-duplicate paid miscellaneous payment financial transactions during report monthDefine the FTX universe for the FTX00095 table by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 2: Unique MSIS IDsFrom the records in STEP 1, create a list of unique MSIS-IDENTIFICATION-NUM values.STEP 3: Link FTX records to enrollment time span segmentOf the unique MSIS-IDENTIFICATION-NUM values from STEP 2, restrict to those where:1. MSIS-IDENTIFICATION-NUM is found on an ENROLLMENT-TIME-SPAN-ELG00021 segmentSTEP 4: Calculate percentage Divide the count of unique MSIS-IDENTIFICATION-NUM values from STEP 3 by the count from STEP 2
04/24/2025	4.0.7	EXP-45-004-4	ADD	N/A		Created
04/24/2025	4.0.7	EXP-45-003-3	ADD	N/A		Created
04/24/2025	4.0.7	EXP-45-002-2	ADD	N/A		Created
04/24/2025	4.0.7	EXP-45-001-1	ADD	N/A		Created
04/24/2025	4.0.7	EXP-44-004-4	ADD	N/A		Created
04/24/2025	4.0.7	EXP-44-003-3	ADD	N/A		Created
04/24/2025	4.0.7	EXP-44-002-2	ADD	N/A		Created
04/24/2025	4.0.7	EXP-44-001-1	ADD	N/A		Created
04/24/2025	4.0.7	EXP-43-008-8	ADD	N/A		Created
04/24/2025	4.0.7	EXP-43-007-7	ADD	N/A		Created
04/24/2025	4.0.7	EXP-43-006-6	ADD	N/A		Created
04/24/2025	4.0.7	EXP-43-005-5	ADD	N/A		Created
04/24/2025	4.0.7	EXP-43-004-4	ADD	N/A		Created
04/24/2025	4.0.7	EXP-43-003-3	ADD	N/A		Created
04/24/2025	4.0.7	EXP-43-002-2	ADD	N/A		Created
04/24/2025	4.0.7	EXP-43-001-1	ADD	N/A		Created
04/24/2025	4.0.7	ALL-25-001-1	ADD	N/A		Created
04/24/2025	4.0.7	ALL-24-001-1	ADD	N/A		Created
04/24/2025	4.0.7	ALL-23-001-1	ADD	N/A		Created
04/24/2025	4.0.7	ALL-22-001-1	ADD	N/A		Created
11/20/2025	4.0.22	ALL-21-008-8	UPDATE	Annotation	Calculate the percentage of unique dispensing prescription drug provider numbers on Medicaid and S-CHIP FFS and Encounter: original and adjustment, paid RX claims that do not have an active record indicating they are a Medicaid-enrolled provider on a claim prescription fill date	N/A
11/20/2025	4.0.22	ALL-21-008-8	UPDATE	Specification	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS and Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" or "A" or "C"STEP 3: Unique dispensing provider numbers on the claimsFrom the claims that meet the criteria from STEP 2, create a list of unique DISPENSING-PRESCRIPTION-DRUG-PROV-NUM values where:1. DISPENSING-PRESCRIPTION-DRUG-PROV-NUM is not missingSTEP 4: Providers without enrollment on the prescription fill dateOf the unique provider identifiers from STEP 3, refine the list using PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping providers that do not meet all of the following criteria for all claims:1. DISPENSING-PRESCRIPTION-DRUG-PROV-NUM found in SUBMITTING-STATE-PROV-ID2. PROV-MEDICAID-ENROLLMENT-STATUS-CODE = ("1" or "01") or ("2" or "02") or ("3" or "03") or ("4" or "04") or ("5" or "05") or ("6" or "06")3. PRESCRIPTION-FILL-DATE from the claim is greater than or equal to PROV-MEDICAID-EFF-DATE4a. PRESCRIPTION-FILL-DATE from the claim is less than or equal to PROV-MEDICAID-END-DATEOR4b. PROV-MEDICAID-END-DATE is missingSTEP 5: Calculate percentageDivide the count of unique providers from STEP 4 by the count from STEP 3	N/A
04/24/2025	4.0.7	ALL-21-008-8	ADD	N/A		Created
08/13/2025	4.0.16	ALL-21-007-7	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS and Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" or "A" or "C"STEP 3: Unique servicing provider numbers on the claim linesFrom the claim lines that meet the criteria from STEP 2, create a list of unique SERVICING-PROV-NUM values where:1. SERVICING-PROV-NUM is not missingSTEP 4: Providers without enrollment on the date of serviceOf the unique provider identifiers from STEP 3, refine the list using PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping providers that do not meet all of the following criteria for all claims:1. SERVICING-PROV-NUM found in SUBMITTING-STATE-PROV-ID2. PROV-MEDICAID-ENROLLMENT-STATUS-CODE = ("1" or "01") or ("2" or "02") or ("3" or "03") or ("4" or "04") or ("5" or "05") or ("6" or "06")3. BEGINNING-DATE-OF-SERVICE from the claim line is greater than or equal to PROV-MEDICAID-EFF-DATE4a. BEGINNING-DATE-OF-SERVICE from the claim line is less than or equal to PROV-MEDICAID-END-DATEOR4b. PROV-MEDICAID-END-DATE is missingSTEP 5: Calculate percentageDivide the count of unique providers from STEP 4 by the count from STEP 3	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS and Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" or "A" or "C"STEP 3: Unique servicing provider numbers on the claim linesFrom the claim lines that meet the criteria from STEP 2, create a list of unique SERVICING-PROV-NUM values where:1. SERVICING-PROV-NUM is not missingSTEP 4: Providers without enrollment on the date of serviceOf the unique provider identifiers from STEP 3, refine the list using PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping providers that do not meet all of the following criteria for all claims:1. SERVICING-PROV-NUM found in SUBMITTING-STATE-PROV-ID2. PROV-MEDICAID-ENROLLMENT-STATUS-CODE = ("1" or "01") or ("2" or "02") or ("3" or "03") or ("4" or "04") or ("5" or "05") or ("6" or "06")3. BEGINNING-DATE-OF-SERVICE from the claim line is greater than or equal to PROV-MEDICAID-EFF-DATE4a. BEGINNING-DATE-OF-SERVICE from the claim line is less than or equal to PROV-MEDICAID-END-DATEOR4b. PROV-MEDICAID-END-DATE is missingSTEP 5: Calculate percentageDivide the count of unique providers from STEP 4 by the count from STEP 3
04/24/2025	4.0.7	ALL-21-007-7	ADD	N/A		Created
08/13/2025	4.0.16	ALL-21-006-6	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS and Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" or "A" or "C"STEP 3: Unique servicing provider numbers on the claim linesFrom the claim lines that meet the criteria from STEP 2, create a list of unique SERVICING-PROV-NUM values where:1. SERVICING-PROV-NUM is not missingSTEP 4: Providers without enrollment on the date of serviceOf the unique provider identifiers from STEP 3, refine the list using PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping providers that do not meet all of the following criteria for all claims:1. SERVICING-PROV-NUM found in SUBMITTING-STATE-PROV-ID2. PROV-MEDICAID-ENROLLMENT-STATUS-CODE = ("1" or "01") or ("2" or "02") or ("3" or "03") or ("4" or "04") or ("5" or "05") or ("6" or "06")3. BEGINNING-DATE-OF-SERVICE from the claim line is greater than or equal to PROV-MEDICAID-EFF-DATE4a. BEGINNING-DATE-OF-SERVICE from the claim line is less than or equal to PROV-MEDICAID-END-DATEOR4b. PROV-MEDICAID-END-DATE is missingSTEP 5: Calculate percentageDivide the count of unique providers from STEP 4 by the count from STEP 3	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS and Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" or "A" or "C"STEP 3: Unique servicing provider numbers on the claim linesFrom the claim lines that meet the criteria from STEP 2, create a list of unique SERVICING-PROV-NUM values where:1. SERVICING-PROV-NUM is not missingSTEP 4: Providers without enrollment on the date of serviceOf the unique provider identifiers from STEP 3, refine the list using PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping providers that do not meet all of the following criteria for all claims:1. SERVICING-PROV-NUM found in SUBMITTING-STATE-PROV-ID2. PROV-MEDICAID-ENROLLMENT-STATUS-CODE = ("1" or "01") or ("2" or "02") or ("3" or "03") or ("4" or "04") or ("5" or "05") or ("6" or "06")3. BEGINNING-DATE-OF-SERVICE from the claim line is greater than or equal to PROV-MEDICAID-EFF-DATE4a. BEGINNING-DATE-OF-SERVICE from the claim line is less than or equal to PROV-MEDICAID-END-DATEOR4b. PROV-MEDICAID-END-DATE is missingSTEP 5: Calculate percentageDivide the count of unique providers from STEP 4 by the count from STEP 3
04/24/2025	4.0.7	ALL-21-006-6	ADD	N/A		Created
08/13/2025	4.0.16	ALL-21-005-5	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS and Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" or "A" or "C"STEP 3: Unique servicing provider numbers on the claim linesFrom the claim lines that meet the criteria from STEP 2, create a list of unique SERVICING-PROV-NUM values where:1. SERVICING-PROV-NUM is not missingSTEP 4: Providers without enrollment on the date of serviceOf the unique provider identifiers from STEP 3, refine the list using PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping providers that do not meet all of the following criteria for all claims:1. SERVICING-PROV-NUM found in SUBMITTING-STATE-PROV-ID2. PROV-MEDICAID-ENROLLMENT-STATUS-CODE = ("1" or "01") or ("2" or "02") or ("3" or "03") or ("4" or "04") or ("5" or "05") or ("6" or "06")3. BEGINNING-DATE-OF-SERVICE from the claim line is greater than or equal to PROV-MEDICAID-EFF-DATE4a. BEGINNING-DATE-OF-SERVICE from the claim line is less than or equal to PROV-MEDICAID-END-DATEOR4b. PROV-MEDICAID-END-DATE is missingSTEP 5: Calculate percentageDivide the count of unique providers from STEP 4 by the count from STEP 3	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS and Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" or "A" or "C"STEP 3: Unique servicing provider numbers on the claim linesFrom the claim lines that meet the criteria from STEP 2, create a list of unique SERVICING-PROV-NUM values where:1. SERVICING-PROV-NUM is not missingSTEP 4: Providers without enrollment on the date of serviceOf the unique provider identifiers from STEP 3, refine the list using PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping providers that do not meet all of the following criteria for all claims:1. SERVICING-PROV-NUM found in SUBMITTING-STATE-PROV-ID2. PROV-MEDICAID-ENROLLMENT-STATUS-CODE = ("1" or "01") or ("2" or "02") or ("3" or "03") or ("4" or "04") or ("5" or "05") or ("6" or "06")3. BEGINNING-DATE-OF-SERVICE from the claim line is greater than or equal to PROV-MEDICAID-EFF-DATE4a. BEGINNING-DATE-OF-SERVICE from the claim line is less than or equal to PROV-MEDICAID-END-DATEOR4b. PROV-MEDICAID-END-DATE is missingSTEP 5: Calculate percentageDivide the count of unique providers from STEP 4 by the count from STEP 3
04/24/2025	4.0.7	ALL-21-005-5	ADD	N/A		Created
11/20/2025	4.0.22	ALL-21-004-4	UPDATE	Annotation	Calculate the percentage of unique billing provider numbers on Medicaid and S-CHIP FFS and Encounter: original and adjustment, paid RX claims that do not have an active record indicating they are a Medicaid-enrolled provider on a claim prescription fill date	N/A
11/20/2025	4.0.22	ALL-21-004-4	UPDATE	Specification	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS and Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" or "A" or "C"STEP 3: Unique billing provider numbers on the claimsFrom the claims that meet the criteria from STEP 2, create a list of unique BILLING-PROV-NUM values where:1. BILLING-PROV-NUM is not missingSTEP 4: Providers without enrollment on the prescription fill dateOf the unique provider identifiers from STEP 3, refine the list using PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping providers that do not meet all of the following criteria for all claims:1. BILLING-PROV-NUM found in SUBMITTING-STATE-PROV-ID2. PROV-MEDICAID-ENROLLMENT-STATUS-CODE = ("1" or "01") or ("2" or "02") or ("3" or "03") or ("4" or "04") or ("5" or "05") or ("6" or "06")3. PRESCRIPTION-FILL-DATE from the claim is greater than or equal to PROV-MEDICAID-EFF-DATE4a. PRESCRIPTION-FILL-DATE from the claim is less than or equal to PROV-MEDICAID-END-DATEOR4b. PROV-MEDICAID-END-DATE is missingSTEP 5: Calculate percentageDivide the count of unique providers from STEP 4 by the count from STEP 3	N/A
04/24/2025	4.0.7	ALL-21-004-4	ADD	N/A		Created
11/20/2025	4.0.22	ALL-21-003-3	UPDATE	Annotation	Calculate the percentage of unique billing provider numbers on Medicaid and S-CHIP FFS and Encounter: original and adjustment, paid OT claims that do not have an active record indicating they are a Medicaid-enrolled provider on a claim date of service	N/A
11/20/2025	4.0.22	ALL-21-003-3	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS and Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" or "A" or "C"STEP 3: Unique billing provider numbers on the claimsFrom the claims that meet the criteria from STEP 2, create a list of unique BILLING-PROV-NUM values where:1. BILLING-PROV-NUM is not missingSTEP 4: Providers without enrollment on the date of serviceOf the unique provider identifiers from STEP 3, refine the list using PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping providers that do not meet all of the following criteria for all claims:1. BILLING-PROV-NUM found in SUBMITTING-STATE-PROV-ID2. PROV-MEDICAID-ENROLLMENT-STATUS-CODE = ("1" or "01") or ("2" or "02") or ("3" or "03") or ("4" or "04") or ("5" or "05") or ("6" or "06")3. BEGINNING-DATE-OF-SERVICE from the claim is greater than or equal to PROV-MEDICAID-EFF-DATE4a. BEGINNING-DATE-OF-SERVICE from the claim is less than or equal to PROV-MEDICAID-END-DATEOR4b. PROV-MEDICAID-END-DATE is missingSTEP 5: Calculate percentageDivide the count of unique providers from STEP 4 by the count from STEP 3	N/A
04/24/2025	4.0.7	ALL-21-003-3	ADD	N/A		Created
11/20/2025	4.0.22	ALL-21-002-2	UPDATE	Annotation	Calculate the percentage of unique billing provider numbers on Medicaid and S-CHIP FFS and Encounter: original and adjustment, paid LT claims that do not have an active record indicating they are a Medicaid-enrolled provider on a claim date of service	N/A
11/20/2025	4.0.22	ALL-21-002-2	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS and Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" or "A" or "C"STEP 3: Unique billing provider numbers on the claimsFrom the claims that meet the criteria from STEP 2, create a list of unique BILLING-PROV-NUM values where:1. BILLING-PROV-NUM is not missingSTEP 4: Providers without enrollment on the date of serviceOf the unique provider identifiers from STEP 3, refine the list using PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping providers that do not meet all of the following criteria for all claims:1. BILLING-PROV-NUM found in SUBMITTING-STATE-PROV-ID2. PROV-MEDICAID-ENROLLMENT-STATUS-CODE = ("1" or "01") or ("2" or "02") or ("3" or "03") or ("4" or "04") or ("5" or "05") or ("6" or "06")3. BEGINNING-DATE-OF-SERVICE from the claim is greater than or equal to PROV-MEDICAID-EFF-DATE4a. BEGINNING-DATE-OF-SERVICE from the claim is less than or equal to PROV-MEDICAID-END-DATEOR4b. PROV-MEDICAID-END-DATE is missingSTEP 5: Calculate percentageDivide the count of unique providers from STEP 4 by the count from STEP 3	N/A
04/24/2025	4.0.7	ALL-21-002-2	ADD	N/A		Created
11/20/2025	4.0.22	ALL-21-001-1	UPDATE	Annotation	Calculate the percentage of unique billing provider numbers on Medicaid and S-CHIP FFS and Encounter: original and adjustment, paid IP claims that do not have an active record indicating they are a Medicaid-enrolled provider on a claim admission date	N/A
11/20/2025	4.0.22	ALL-21-001-1	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS and Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" or "A" or "C"STEP 3: Unique billing provider numbers on the claimsFrom the claims that meet the criteria from STEP 2, create a list of unique BILLING-PROV-NUM values where:1. BILLING-PROV-NUM is not missingSTEP 4: Providers without enrollment on the claim admission dateOf the unique provider identifiers from STEP 3, refine the list using PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping providers that do not meet all of the following criteria for all claims:1. BILLING-PROV-NUM found in SUBMITTING-STATE-PROV-ID2. PROV-MEDICAID-ENROLLMENT-STATUS-CODE = ("1" or "01") or ("2" or "02") or ("3" or "03") or ("4" or "04") or ("5" or "05") or ("6" or "06")3. ADMISSION-DATE from the claim is greater than or equal to PROV-MEDICAID-EFF-DATE4a. ADMISSION-DATE from the claim is less than or equal to PROV-MEDICAID-END-DATEOR4b. PROV-MEDICAID-END-DATE is missingSTEP 5: Calculate percentageDivide the count of unique providers from STEP 4 by the count from STEP 3	N/A
04/24/2025	4.0.7	ALL-21-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-8-012_1-35	ADD	N/A		Created
04/24/2025	4.0.7	MIS-7-001_1-33	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-027_4-41	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-027_3-40	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-027_2-39	ADD	N/A		Created
04/24/2025	4.0.7	MIS-5-001_1-21	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-034_2-49	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-034_1-48	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-002-2	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-002_1-47	ADD	N/A		Created
04/24/2025	4.0.7	MIS-3-009_1-19	ADD	N/A		Created
04/24/2025	4.0.7	MIS-3-001_1-18	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-047_2-63	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-047_1-62	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-004_2-61	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-004_1-60	ADD	N/A		Created
04/24/2025	4.0.7	MCR-64-004-4	ADD	N/A		Created
04/24/2025	4.0.7	MCR-64-003-3	ADD	N/A		Created
04/24/2025	4.0.7	MCR-64-002-2	ADD	N/A		Created
04/24/2025	4.0.7	MCR-64-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-63-004-4	ADD	N/A		Created
04/24/2025	4.0.7	MCR-63-003-3	ADD	N/A		Created
04/24/2025	4.0.7	MCR-63-002-2	ADD	N/A		Created
04/24/2025	4.0.7	MCR-63-001-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-54-004-4	ADD	N/A		Created
04/24/2025	4.0.7	FFS-54-003-3	ADD	N/A		Created
04/24/2025	4.0.7	FFS-54-002-2	ADD	N/A		Created
04/24/2025	4.0.7	FFS-54-001-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-53-004-4	ADD	N/A		Created
04/24/2025	4.0.7	FFS-53-003-3	ADD	N/A		Created
04/24/2025	4.0.7	FFS-53-002-2	ADD	N/A		Created
04/24/2025	4.0.7	FFS-53-001-1	ADD	N/A		Created
04/24/2025	4.0.7	EL-6-034-34	ADD	N/A		Created
04/24/2025	4.0.7	EL-6-033-33	ADD	N/A		Created
04/24/2025	4.0.7	EL-6-032-32	ADD	N/A		Created
11/20/2025	4.0.22	EL-6-031-31	UPDATE	Annotation	Calculate the percentage of Money Follows the Person participants without a restricted benefits code designating Money Follows the Person participation	N/A
11/20/2025	4.0.22	EL-6-031-31	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: MFP enrollment on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment MFP-INFORMATION-ELG00010 by keeping records that satisfy the following criteria:1. MFP-ENROLLMENT-EFF-DATE <= last day of the DQ report month2. MFP-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingSTEP 3: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 2, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 4: Money Follows the Person ParticipationOf the MSIS IDs that meet the criteria from STEP 3, further refine the population using by keeping MSIS IDs where:1. RESTRICTED-BENEFITS-CODE does not equal “D” OR2. RESTRICTED-BENEFITS-CODE is missingSTEP 5: Calculate percentageDivide the count from STEP 4 by the count from STEP 2	N/A
04/24/2025	4.0.7	EL-6-031-31	ADD	N/A		Created
11/20/2025	4.0.22	EL-6-030-30	UPDATE	Annotation	Calculate the percentage of eligibles with restricted benefits through S-CHIP dental coverage, but are not identified as S-CHIP in CHIP-CODE	N/A
11/20/2025	4.0.22	EL-6-030-30	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >=last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: S-CHIP dental coverageOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping MSIS IDs where:1. RESTRICTED-BENEFITS-CODE = "C"STEP 4: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 5: Not S-CHIPO the MSIS IDs that meet the criteria from STEP 4, restrict to those where: 1. CHIP-CODE not equal to "3" or is missingSTEP 6: Calculate percentageDivide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 3	N/A
04/24/2025	4.0.7	EL-6-030-30	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-092-92	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-092-92	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-092-92	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-032-32	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-032-32	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-032-32	ADD	N/A		Created
04/24/2025	4.0.7	EL-1-025-28	ADD	N/A		Created
04/24/2025	4.0.7	EL-1-024-24	ADD	N/A		Created
11/20/2025	4.0.22	EL-1-023-23	UPDATE	Annotation	Calculate the percentage of eligibles where the primary address county code, zip code, or state is not in-state	N/A
11/20/2025	4.0.22	EL-1-023-23	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligible contact on the last day of the DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBLE-CONTACT-INFORMATION-ELG00004 by keeping records that satisfy the following criteria:1a. ELIGIBLE-ADDR-EFF-DATE<= last day of the DQ report month2a. ELIGIBLE-ADDR-END-DATE >= last day of the DQ report month OR missingOR1b. ELIGIBLE-ADDR-EFF-DATE is missing2b. ELIGIBLE-ADDR-END-DATE is missingSTEP 3: Primary home addressOf the records that meet the criteria from STEP 2, restrict to segments where:1. ELIGIBLE-ADDR-TYPE = "01" STEP 4: Eligible county code, zip code, or state is not in-stateOf the segments that meet the criteria from STEP 3, further refine the population by keeping segments where:1 ELIGIBLE-STATE does not equal SUBMITTING-STATEOR2.ELIGIBLE-COUNTY-CODE is not in-stateOR3. ELIGIBLE-ZIP-CODE is not in-stateSTEP 5: Calculate percentageDivide the count of unique MSIS IDs from STEP 4 by the count of unique MSIS IDs from STEP 3	N/A
04/24/2025	4.0.7	EL-1-023-23	ADD	N/A		Created
11/20/2025	4.0.22	EL-1-022-22	UPDATE	Annotation	Calculate the percentage of eligibles that do not have an address that is labeled as the primary address	N/A
11/20/2025	4.0.22	EL-1-022-22	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligible contact on the last day of the DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBLE-CONTACT-INFORMATION-ELG00004 by keeping records that satisfy the following criteria:1a. ELIGIBLE-ADDR-EFF-DATE<= last day of the DQ report month2a. ELIGIBLE-ADDR-END-DATE >= last day of the DQ report month OR missingOR1b. ELIGIBLE-ADDR-EFF-DATE is missing2b. ELIGIBLE-ADDR-END-DATE is missingSTEP 3: No primary address typeOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping MSIS IDs where:1. ELIGIBLE-ADDR-TYPE is never "01"* STEP 4: Calculate percentageDivide the count of unique MSIS IDs from STEP 3 by the count of unique MSIS IDs from STEP 1*Note: This can include MSIS IDs from STEP 1 that did not join to an eligible contact information segment.	N/A
04/24/2025	4.0.7	EL-1-022-22	ADD	N/A		Created
04/24/2025	4.0.7	EL-1-015_2-26	ADD	N/A		Created
04/24/2025	4.0.7	EL-1-015_1-25	ADD	N/A		Created
11/20/2025	4.0.22	EL-1-012_1-27	UPDATE	Annotation	Calculate the percentage of eligibles with an American Indian / Alaskan Native indicator whose race is not American Indian/Alaskan Native	N/A
11/20/2025	4.0.22	EL-1-012_1-27	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION-ELG00016 by keeping records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: American Indian / Alaskan Native indicatorOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping MSIS IDs where:1. AMERICAN-INDIAN-ALASKAN-NATIVE-INDICATOR = "1" STEP 4: Race is American Indian or Alaskan NativeOf the MSIS IDs that meet the criteria from STEP 3, restrict to those where:1. RACE equals "003" on any record segmentSTEP 5: Race is not American Indian or Alaskan NativeSubtract the total number of MSIS IDs that meet the criteria from STEP 3 from the total number of MSIS IDs from STEP 4STEP 6: Calculate percentageDivide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 3	N/A
04/24/2025	4.0.7	EL-1-012_1-27	ADD	N/A		Created
04/24/2025	4.0.7	ALL-20-004-4	ADD	N/A		Created
04/24/2025	4.0.7	ALL-20-003-3	ADD	N/A		Created
04/24/2025	4.0.7	ALL-20-002-2	ADD	N/A		Created
04/24/2025	4.0.7	ALL-20-001-1	ADD	N/A		Created
08/13/2025	4.0.16	ALL-19-001-1	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claim lines that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" or "A" or "C"STEP 3: HCBS service under 1915(c) HCBS WaiverOf the claim lines that meet the criteria from STEP 2, restrict to: 1. HCBS-SERVICE-CODE = 4STEP 4: Missing WAIVER-IDOf the claim lines that meet the criteria from STEP 3, restrict to those that satisfy:1. WAIVER-ID is missing STEP 5: Calculate the percentage for the measureDivide the count of claim headers from STEP 4 by the count of claim headers from STEP 3	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claim lines that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" or "A" or "C"STEP 3: HCBS service under 1915(c) HCBS WaiverOf the claim lines that meet the criteria from STEP 2, restrict to: 1. HCBS-SERVICE-CODE = 4STEP 4: Missing WAIVER-IDOf the claim lines that meet the criteria from STEP 3, restrict to those that satisfy:1. WAIVER-ID is missing STEP 5: Calculate the percentage for the measureDivide the count of claim headers from STEP 4 by the count of claim headers from STEP 3
04/24/2025	4.0.7	ALL-19-001-1	ADD	N/A		Created
10/07/2025	4.0.19	MIS-1-021-21	UPDATE	Grace period expiration date	None	2022-06-30
04/24/2025	4.0.7	MIS-1-021-21	ADD	N/A		Created
10/07/2025	4.0.19	MIS-1-020-20	UPDATE	Grace period expiration date	None	2022-06-30
04/24/2025	4.0.7	MIS-1-020-20	ADD	N/A		Created
10/07/2025	4.0.19	EL-3-025-30	UPDATE	Grace period expiration date	None	2023-04-30
04/24/2025	4.0.7	EL-3-025-30	ADD	N/A		Created
11/20/2025	4.0.22	EL-3-024-29	UPDATE	Annotation	Count the number of mandatory eligibility groups for dual eligibles with at least one MSIS ID with a primarily eligibility group indicator associated with it	N/A
11/20/2025	4.0.22	EL-3-024-29	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Frequency of mandatory eligibility groupsOf the MSIS IDs that meet the criteria from STEP 2, count the number of unique MSIS IDs where ELIGIBILITY-GROUP is equal to each of the following values: 23, 24, 25, 26STEP 4: Count of categoriesOf the 4 mandatory eligibility group categories referenced in STEP 3, count the number of categories with at least one MSIS ID	N/A
04/24/2025	4.0.7	EL-3-024-29	ADD	N/A		Created
11/20/2025	4.0.22	EL-3-023-28	UPDATE	Annotation	Count the number of mandatory eligibility groups for traditional medical assistance with at least one MSIS ID with a primarily eligibility group indicator associated with it	N/A
11/20/2025	4.0.22	EL-3-023-28	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Frequency of mandatory eligibility groupsOf the MSIS IDs that meet the criteria from STEP 2, count the number of unique MSIS IDs where ELIGIBILITY-GROUP is equal to each of the following values: 02, 03STEP 4: Count of categoriesOf the 2 mandatory eligibility group categories referenced in STEP 3, count the number of categories with at least one MSIS ID	N/A
04/24/2025	4.0.7	EL-3-023-28	ADD	N/A		Created
11/20/2025	4.0.22	EL-3-022-27	UPDATE	Annotation	Count the number of mandatory eligibility groups for children, pregnant women, caretakers and foster children with at least one MSIS ID with a primary eligibility group indicator associated with it	N/A
11/20/2025	4.0.22	EL-3-022-27	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Frequency of mandatory eligibility groupsOf the MSIS IDs that meet the criteria from STEP 2, count the number of unique MSIS IDs where ELIGIBILITY-GROUP is equal to each of the following values: 01, 05, 06, 07, 08, 09STEP 4: Count of categoriesOf the 6 mandatory eligibility group categories referenced in STEP 3, count the number of categories with at least one MSIS ID	N/A
04/24/2025	4.0.7	EL-3-022-27	ADD	N/A		Created
04/24/2025	4.0.7	EL-3-021-26	ADD	N/A		Created
11/20/2025	4.0.22	EL-3-020-25	UPDATE	Annotation	Calculate the percentage of M-CHIP eligibles that are not enrolled in an M-CHIP eligibility group	N/A
11/20/2025	4.0.22	EL-3-020-25	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 2, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: CHIP code value indicates M-CHIP enrollmentOf the MSIS IDs that meet the criteria from STEP 2, further restrict to MSIS IDs where:1. CHIP-CODE = "2"STEP 4: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 5: Individuals not enrolled in an M-CHIP eligibility groupOf the MSIS IDs that meet the criteria from STEP 4, further restrict to MSIS IDs where:1a. ELIGBILITY-GROUP not equal to ("07" or "31" or "61")OR1b. ELIGIBILITY-GROUP is missing STEP 6: Calculate percentageDivide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 3	N/A
04/24/2025	4.0.7	EL-3-020-25	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-006-6	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-006-6	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1NOTE:The following value(s) should also be treated as missing for SEX (ELG00002):U	N/A
04/24/2025	4.0.7	MIS-1-006-6	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-001-1	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-1-001-1	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the MSIS-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-001-1	ADD	N/A		Created
11/20/2025	4.0.22	EL-6-029-29	UPDATE	Annotation	Calculate the percentage of rows in the ELG00012 segment with a 1915(b) or 1915(c) waiver type that have a waiver ID in an invalid format	N/A
11/20/2025	4.0.22	EL-6-029-29	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Waiver participation on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment WAIVER-PARTICIPATION-ELG00012 by keeping records that satisfy the following criteria:1a. WAIVER-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. WAIVER-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. WAIVER-ENROLLMENT-EFF-DATE is missing2b. WAIVER-ENROLLMENT-END-DATE is missingSTEP 3: 1915(b) or 1915(c) waiver typeOf the record segments that meet the criteria from STEP 2, keep those that satisfy the following criteria:1. WAIVER-TYPE = ("02" - "20") or "32" or "35"STEP 4: Invalid waiver ID valuesOf the record segments that meet the criteria from STEP 3, define invalid waiver ID values by counting the number of segments that meet the following criteria:1. WAIVER-ID does not begin with [A-Z/a-z]OR2. WAIVER-ID position 3 is not ”.” OR3. WAIVER-ID does not contain [0-9] in positions 4 to endOR4. WAIVER-ID is missingSTEP 5: Calculate percentage Divide the count of record segments from STEP 4 by the count of record segments from STEP 3	N/A
04/24/2025	4.0.7	EL-6-029-29	ADD	N/A		Created
08/13/2025	4.0.16	ALL-2-011-11	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Waiver participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment WAIVER-PARTICIPATION-ELG00012 by keeping records that satisfy the following criteria:1a. WAIVER-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. WAIVER-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. WAIVER-ENROLLMENT-EFF-DATE is missing2b. WAIVER-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in 1915(c) waiverOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where WAIVER-TYPE-CODE = ("06" - "20", "33")STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 5: Medicaid FFS and Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" 2. ADJUSTMENT-IND = "0"STEP 6: Link MSIS IDs from EL to OTRetain the MSIS IDs from STEP 3 that link to an OT claim from STEP 5STEP 7: Service under 1915(c) HCBS waiverRetain the MSIS IDs from STEP 6 where the HCBS-SERVICE-CODE = "4"STEP 8: MSIS IDs without service under 1915(c) HCBS waiverSubtract the number of unique MSIS IDs in STEP 7 from the number of unique MSIS IDs in STEP 3STEP 9: Calculate percentageDivide the count of unique MSIS IDs in STEP 8 by the count of unique MSIS IDs in STEP 3	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Waiver participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment WAIVER-PARTICIPATION-ELG00012 by keeping records that satisfy the following criteria:1a. WAIVER-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. WAIVER-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. WAIVER-ENROLLMENT-EFF-DATE is missing2b. WAIVER-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in 1915(c) waiverOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where WAIVER-TYPE-CODE = ("06" - "20", "33")STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 5: Medicaid FFS and Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" 2. ADJUSTMENT-IND = "0"STEP 6: Link MSIS IDs from EL to OTRetain the MSIS IDs from STEP 3 that link to an OT claim from STEP 5STEP 7: Service under 1915(c) HCBS waiverRetain the MSIS IDs from STEP 6 where the HCBS-SERVICE-CODE = "4"STEP 8: MSIS IDs without service under 1915(c) HCBS waiverSubtract the number of unique MSIS IDs in STEP 7 from the number of unique MSIS IDs in STEP 3STEP 9: Calculate percentageDivide the count of unique MSIS IDs in STEP 8 by the count of unique MSIS IDs in STEP 3
04/24/2025	4.0.7	ALL-2-011-11	ADD	N/A		Created
11/20/2025	4.0.22	ALL-2-010-10	UPDATE	Annotation	Calculate the percentage of eligibles enrolled in a 1915(c) waiver that do not have Medicaid FFS and Encounter, original paid OT claims with the corresponding program type	N/A
11/20/2025	4.0.22	ALL-2-010-10	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Waiver participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment WAIVER-PARTICIPATION-ELG00012 by keeping records that satisfy the following criteria:1a. WAIVER-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. WAIVER-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. WAIVER-ENROLLMENT-EFF-DATE is missing2b. WAIVER-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in 1915(c) waiverOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where WAIVER-TYPE-CODE = ("06" - "20", "33")STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid FFS and Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" 2. ADJUSTMENT-IND = "0"STEP 6: Link MSIS IDs from EL to OTRetain the MSIS IDs from STEP 3 that link to an OT claim from STEP 5 STEP 7: HCBS waiver services programRetain the MSIS IDs from STEP 6 where the PROGRAM-TYPE = "07"STEP 8: Count MSIS IDs without HCBS waiver services programSubtract the number of unique MSIS IDs in STEP 7 from the number of unique MSIS IDs in STEP 3STEP 9: Calculate percentageDivide the count of unique MSIS IDs in STEP 8 by the count of unique MSIS IDs in STEP 3	N/A
04/24/2025	4.0.7	ALL-2-010-10	ADD	N/A		Created
11/20/2025	4.0.22	ALL-2-009-9	UPDATE	Annotation	Calculate the percentage of eligibles enrolled in a 1915(c) waiver that do not have Medicaid FFS and Encounter, original paid OT claims with the corresponding waiver ID	N/A
11/20/2025	4.0.22	ALL-2-009-9	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Waiver participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment WAIVER-PARTICIPATION-ELG00012 by keeping records that satisfy the following criteria:1a. WAIVER-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. WAIVER-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. WAIVER-ENROLLMENT-EFF-DATE is missing2b. WAIVER-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in 1915(c) waiverOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where WAIVER-TYPE-CODE = ("06" - "20", "33")STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid FFS and Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" 2. ADJUSTMENT-IND = "0"STEP 6: Link MSIS IDs from EL to OTRetain the MSIS IDs from STEP 3 that link to an OT claim from STEP 5STEP 7: Waiver ID matchesRetain the MSIS IDs from STEP 6 where the WAIVER-ID on the claim equals the WAIVER-ID from the WAIVER-PARTICIPATION segmentSTEP 8: MSIS IDs without matching Waiver IDSubtract the number of MSIS IDs found in STEP 7 from the number of MSIS IDs found in STEP 3STEP 9: Calculate percentageDivide the count of unique MSIS IDs in STEP 8 by the count of unique MSIS IDs in STEP 3	N/A
04/24/2025	4.0.7	ALL-2-009-9	ADD	N/A		Created
11/20/2025	4.0.22	ALL-18-004-4	UPDATE	Annotation	Count the number of paid RX claim headers for TYPE-OF-CLAIM = U, V, W, X, Y that aren't MFP	N/A
11/20/2025	4.0.22	ALL-18-004-4	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Count "other" claims that aren't MFPOf the claims that meet the criteria from STEP 1, count the number of claims that satisfy the following criteria:1. TYPE-OF-CLAIM = "U" or "V" or "W" or "X" or "Y"2. PROGRAM-TYPE is not equal to "08" or is missing	N/A
04/24/2025	4.0.7	ALL-18-004-4	ADD	N/A		Created
11/20/2025	4.0.22	ALL-18-003-3	UPDATE	Annotation	Count the number of paid OT claim headers for TYPE-OF-CLAIM = U, V, W, X, Y that aren't MFP	N/A
11/20/2025	4.0.22	ALL-18-003-3	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Count other claims that aren't MFPOf the claims that meet the criteria from STEP 1, count the number of claims that satisfy the following criteria:1. TYPE-OF-CLAIM = "U" or "V" or "W" or "X" or "Y"2. PROGRAM-TYPE is not equal to "08" or is missing	N/A
04/24/2025	4.0.7	ALL-18-003-3	ADD	N/A		Created
11/20/2025	4.0.22	ALL-18-002-2	UPDATE	Annotation	Count the number of paid LT claim headers for TYPE-OF-CLAIM = U, V, W, X, Y that aren't MFP	N/A
11/20/2025	4.0.22	ALL-18-002-2	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Count "other" claims that aren't MFPOf the claims that meet the criteria from STEP 1, count the number of claims that satisfy the following criteria:1. TYPE-OF-CLAIM = "U" or "V" or "W" or "X" or "Y"2. PROGRAM-TYPE is not equal to "08" or is missing	N/A
04/24/2025	4.0.7	ALL-18-002-2	ADD	N/A		Created
11/20/2025	4.0.22	ALL-18-001-1	UPDATE	Annotation	Count the number of paid IP claim headers for TYPE-OF-CLAIM = U, V, W, X, Y that aren't MFP	N/A
11/20/2025	4.0.22	ALL-18-001-1	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Count "other" claims that aren't MFPOf the claims that meet the criteria from STEP 1, count the number of claims that satisfy the following criteria:1. TYPE-OF-CLAIM = "U" or "V" or "W" or "X" or "Y"2. PROGRAM-TYPE is not equal to "08" or is missing	N/A
04/24/2025	4.0.7	ALL-18-001-1	ADD	N/A		Created
08/13/2025	4.0.16	ALL-17-008-8	UPDATE	Specification	STEP 1: Active paid RX claims during DQ report monthDefine the RX claims universe at the line level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND, and keep all claims, including orphan lines1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines)1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Drop line duplicatesDuplicates are dropped at the line level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and LINE-ADJUSTMENT-IND.1e. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Orphan linesOf the claim lines that meet the criteria from STEP 1, keep claim lines that did not merge to any claim headerSTEP 3: Calculate percentageDivide the count of claim lines from STEP 2 by the count of claim lines from STEP 1	STEP 1: Active paid RX claims during DQ report monthDefine the RX claims universe at the line level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND, and keep all claims, including orphan lines1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines)1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Drop line duplicatesDuplicates are dropped at the line level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and LINE-ADJUSTMENT-IND.1e. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Orphan linesOf the claim lines that meet the criteria from STEP 1, keep claim lines that did not merge to any claim headerSTEP 3: Calculate percentageDivide the count of claim lines from STEP 2 by the count of claim lines from STEP 1
04/24/2025	4.0.7	ALL-17-008-8	ADD	N/A		Created
08/13/2025	4.0.16	ALL-17-007-7	UPDATE	Specification	STEP 1: Active paid OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND, and keep all claims, including orphan lines1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines)1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Drop line duplicatesDuplicates are dropped at the line level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and LINE-ADJUSTMENT-IND.1e. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Orphan linesOf the claim lines that meet the criteria from STEP 1, keep claim lines that did not merge to any claim headerSTEP 3: Calculate percentageDivide the count of claim lines from STEP 2 by the count of claim lines from STEP 1	STEP 1: Active paid OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND, and keep all claims, including orphan lines1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines)1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Drop line duplicatesDuplicates are dropped at the line level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and LINE-ADJUSTMENT-IND.1e. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Orphan linesOf the claim lines that meet the criteria from STEP 1, keep claim lines that did not merge to any claim headerSTEP 3: Calculate percentageDivide the count of claim lines from STEP 2 by the count of claim lines from STEP 1
04/24/2025	4.0.7	ALL-17-007-7	ADD	N/A		Created
08/13/2025	4.0.16	ALL-17-006-6	UPDATE	Specification	STEP 1: Active paid LT claims during DQ report monthDefine the LT claims universe at the line level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND, and keep all claims, including orphan lines1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines)1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Drop line duplicatesDuplicates are dropped at the line level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and LINE-ADJUSTMENT-IND.1e. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Orphan linesOf the claim lines that meet the criteria from STEP 1, keep claim lines that did not merge to any claim headerSTEP 3: Calculate percentageDivide the count of claim lines from STEP 2 by the count of claim lines from STEP 1	STEP 1: Active paid LT claims during DQ report monthDefine the LT claims universe at the line level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND, and keep all claims, including orphan lines1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines)1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Drop line duplicatesDuplicates are dropped at the line level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and LINE-ADJUSTMENT-IND.1e. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Orphan linesOf the claim lines that meet the criteria from STEP 1, keep claim lines that did not merge to any claim headerSTEP 3: Calculate percentageDivide the count of claim lines from STEP 2 by the count of claim lines from STEP 1
04/24/2025	4.0.7	ALL-17-006-6	ADD	N/A		Created
08/13/2025	4.0.16	ALL-17-005-5	UPDATE	Specification	STEP 1: Active paid IP claims during DQ report monthDefine the IP claims universe at the line level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND, and keep all claims, including orphan lines1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines)1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Drop line duplicatesDuplicates are dropped at the line level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and LINE-ADJUSTMENT-IND.1e. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Orphan linesOf the claim lines that meet the criteria from STEP 1, keep claim lines that did not merge to any claim headerSTEP 3: Calculate percentageDivide the count of claim lines from STEP 2 by the count of claim lines from STEP 1	STEP 1: Active paid IP claims during DQ report monthDefine the IP claims universe at the line level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND, and keep all claims, including orphan lines1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines)1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Drop line duplicatesDuplicates are dropped at the line level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and LINE-ADJUSTMENT-IND.1e. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Orphan linesOf the claim lines that meet the criteria from STEP 1, keep claim lines that did not merge to any claim headerSTEP 3: Calculate percentageDivide the count of claim lines from STEP 2 by the count of claim lines from STEP 1
04/24/2025	4.0.7	ALL-17-005-5	ADD	N/A		Created
08/13/2025	4.0.16	ALL-17-004-4	UPDATE	Specification	STEP 1: Active paid RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND, and keep all claims, even if there is no match1c. Keep headers and associated lines if header is not denied1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Drop Header DuplicatesDuplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.1e. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Childless headersOf the claim headers that meet the criteria from STEP 1, keep claim headers that did not merge to any claim lineSTEP 3: Calculate percentageDivide the count of claim headers from STEP 2 by the count of claim headers from STEP 1	STEP 1: Active paid RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND, and keep all claims, even if there is no match1c. Keep headers and associated lines if header is not denied1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Drop Header DuplicatesDuplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.1e. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Childless headersOf the claim headers that meet the criteria from STEP 1, keep claim headers that did not merge to any claim lineSTEP 3: Calculate percentageDivide the count of claim headers from STEP 2 by the count of claim headers from STEP 1
04/24/2025	4.0.7	ALL-17-004-4	ADD	N/A		Created
08/13/2025	4.0.16	ALL-17-003-3	UPDATE	Specification	STEP 1: Active paid OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND, and keep all claims, even if there is no match1c. Keep headers and associated lines if header is not denied1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Drop Header DuplicatesDuplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.1e. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Childless headersOf the claim headers that meet the criteria from STEP 1, keep claim headers that did not merge to any claim lineSTEP 3: Calculate percentageDivide the count of claim headers from STEP 2 by the count of claim headers from STEP 1	STEP 1: Active paid OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND, and keep all claims, even if there is no match1c. Keep headers and associated lines if header is not denied1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Drop Header DuplicatesDuplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.1e. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Childless headersOf the claim headers that meet the criteria from STEP 1, keep claim headers that did not merge to any claim lineSTEP 3: Calculate percentageDivide the count of claim headers from STEP 2 by the count of claim headers from STEP 1
04/24/2025	4.0.7	ALL-17-003-3	ADD	N/A		Created
08/13/2025	4.0.16	ALL-17-002-2	UPDATE	Specification	STEP 1: Active paid LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND, and keep all claims, even if there is no match1c. Keep headers and associated lines if header is not denied1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Drop Header DuplicatesDuplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.1e. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Childless headersOf the claim headers that meet the criteria from STEP 1, keep claim headers that did not merge to any claim lineSTEP 3: Calculate percentageDivide the count of claim headers from STEP 2 by the count of claim headers from STEP 1	STEP 1: Active paid LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND, and keep all claims, even if there is no match1c. Keep headers and associated lines if header is not denied1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Drop Header DuplicatesDuplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.1e. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Childless headersOf the claim headers that meet the criteria from STEP 1, keep claim headers that did not merge to any claim lineSTEP 3: Calculate percentageDivide the count of claim headers from STEP 2 by the count of claim headers from STEP 1
04/24/2025	4.0.7	ALL-17-002-2	ADD	N/A		Created
08/13/2025	4.0.16	ALL-17-001-1	UPDATE	Specification	STEP 1: Active paid IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND, and keep all claims, even if there is no match1c. Keep headers and associated lines if header is not denied1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Drop Header DuplicatesDuplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.1e. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Childless headersOf the claim headers that meet the criteria from STEP 1, keep claim headers that did not merge to any claim lineSTEP 3: Calculate percentageDivide the count of claim headers from STEP 2 by the count of claim headers from STEP 1	STEP 1: Active paid IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND, and keep all claims, even if there is no match1c. Keep headers and associated lines if header is not denied1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Drop Header DuplicatesDuplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.1e. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Childless headersOf the claim headers that meet the criteria from STEP 1, keep claim headers that did not merge to any claim lineSTEP 3: Calculate percentageDivide the count of claim headers from STEP 2 by the count of claim headers from STEP 1
04/24/2025	4.0.7	ALL-17-001-1	ADD	N/A		Created
08/13/2025	4.0.16	ALL-15-006-6	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS and Encounter: Original and Adjustment, Paid ClaimsOf the claim lines that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" or "A" or "C"STEP 3: Missing procedure code and revenue codeOf the claim lines that meet the criteria from STEP 2, restrict to claims that meet all of the following criteria: 1. PROCEDURE-CODE is missing2. REVENUE-CODE is missingSTEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS and Encounter: Original and Adjustment, Paid ClaimsOf the claim lines that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" or "A" or "C"STEP 3: Missing procedure code and revenue codeOf the claim lines that meet the criteria from STEP 2, restrict to claims that meet all of the following criteria: 1. PROCEDURE-CODE is missing2. REVENUE-CODE is missingSTEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2
04/24/2025	4.0.7	ALL-15-006-6	ADD	N/A		Created
08/13/2025	4.0.16	ALL-15-005-5	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS and Encounter: Original and Adjustment, Paid ClaimsOf the claim lines that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" or "A" or "C"STEP 3: Non-missing revenue codeOf the claim lines that meet the criteria from STEP 2, further restrict by the following criteria: 1. REVENUE-CODE is not missingSTEP 4: Type of bill is missingOf the claim lines that meet the criteria from STEP 3, restrict to claims that meet the following criteria: 1. TYPE-OF-BILL is missingSTEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 3	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS and Encounter: Original and Adjustment, Paid ClaimsOf the claim lines that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" or "A" or "C"STEP 3: Non-missing revenue codeOf the claim lines that meet the criteria from STEP 2, further restrict by the following criteria: 1. REVENUE-CODE is not missingSTEP 4: Type of bill is missingOf the claim lines that meet the criteria from STEP 3, restrict to claims that meet the following criteria: 1. TYPE-OF-BILL is missingSTEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 3
04/24/2025	4.0.7	ALL-15-005-5	ADD	N/A		Created
08/13/2025	4.0.16	ALL-15-004-4	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS and Encounter: Original and Adjustment, Paid ClaimsOf the claim lines that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" or "A" or "C"STEP 3: Non-missing type of billOf the claim lines that meet the criteria from STEP 2, further restrict by the following criteria: 1. TYPE-OF-BILL is not missingSTEP 4: Revenue code is missingOf the claim lines that meet the criteria from STEP 3, restrict to claims that meet the following criteria: 1. REVENUE-CODE is missingSTEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 3	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS and Encounter: Original and Adjustment, Paid ClaimsOf the claim lines that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" or "A" or "C"STEP 3: Non-missing type of billOf the claim lines that meet the criteria from STEP 2, further restrict by the following criteria: 1. TYPE-OF-BILL is not missingSTEP 4: Revenue code is missingOf the claim lines that meet the criteria from STEP 3, restrict to claims that meet the following criteria: 1. REVENUE-CODE is missingSTEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 3
04/24/2025	4.0.7	ALL-15-004-4	ADD	N/A		Created
08/13/2025	4.0.16	ALL-15-003-3	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS and Encounter: Original and Adjustment, Paid ClaimsOf the claim lines that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" or "A" or "C"STEP 3: Missing type of bill and place of serviceOf the claim lines that meet the criteria from STEP 2, restrict to claims that meet all of the following criteria: 1. TYPE-OF-BILL is missing2. PLACE-OF-SERVICE is missingSTEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS and Encounter: Original and Adjustment, Paid ClaimsOf the claim lines that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" or "A" or "C"STEP 3: Missing type of bill and place of serviceOf the claim lines that meet the criteria from STEP 2, restrict to claims that meet all of the following criteria: 1. TYPE-OF-BILL is missing2. PLACE-OF-SERVICE is missingSTEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2
04/24/2025	4.0.7	ALL-15-003-3	ADD	N/A		Created
04/24/2025	4.0.7	MCR-7-006-21	ADD	N/A		Created
04/24/2025	4.0.7	MCR-20-007-11	ADD	N/A		Created
04/24/2025	4.0.7	MCR-20-006-10	ADD	N/A		Created
04/24/2025	4.0.7	MCR-20-005-9	ADD	N/A		Created
11/20/2025	4.0.22	PRV-2-009-9	UPDATE	Annotation	Calculate the percent of submitting state provider IDs that have an NPI, but not a taxonomy code	N/A
11/20/2025	4.0.22	PRV-2-009-9	UPDATE	Specification	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missing STEP 2: Provider identifier is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROV-IDENTIFIER-PRV00005 by keeping records that satisfy the following criteria:1a. PROV-IDENTIFIER-EFF-DATE <= last day of the reporting month2a. PROV-IDENTIFIER-END-DATE >= last day of the reporting month OR missingOR1b. PROV-IDENTIFIER-EFF-DATE is missing2b. PROV-IDENTIFIER-END-DATE is missingSTEP 3: Provider classification type is "NPI"Of the providers that meet the criteria from STEP 2, keep records that satisfy the following criteria: 1. PROV-IDENTIFIER-TYPE = 2STEP 4: Provider taxonomy is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 3, further refine the population using segment PROVIDER-TAXONOMY-CLASSIFICATION-PRV00006 by keeping records that satisfy the following criteria:1a. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= last day of the reporting month2a. PROV-TAXONOMY-CLASSIFICATION-END-DATE >= last day of the reporting month OR missingOR1b. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE is missing2b. PROV-TAXONOMY-CLASSIFICATION-END-DATE is missingSTEP 5: Provider classification is taxonomyOf the providers that meet the criteria from STEP 4, keep records that satisfy the following criteria: 1. PROV-CLASSIFICATION-TYPE is = 1STEP 6: Calculate percent that have a taxonomyDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 5 by the count from STEP 3STEP 7: Calculate percent that do not have any taxonomy codesSubtract the percent from STEP 6 from 1	N/A
04/24/2025	4.0.7	PRV-2-009-9	ADD	N/A		Created
04/24/2025	4.0.7	MIS-8-015_1-34	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-021_1-37	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-008_1-38	ADD	N/A		Created
04/24/2025	4.0.7	MIS-54-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-52-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-50-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-48-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-46-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-44-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-42-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-025_1-45	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-008_1-46	ADD	N/A		Created
04/24/2025	4.0.7	MIS-40-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-032_1-58	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-009_1-59	ADD	N/A		Created
08/13/2025	4.0.16	MCR-62-007-7	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"STEP 3: Non-missing type of billOf the claims that meet the criteria from STEP 2, restrict to non-missing TYPE-OF-BILLSTEP 4: Count of claims with an invalid type of billOf the claims that meet the criteria from STEP 3, count claims where TYPE-OF-BILL does not begin with “03”or “07”or “08”or “012”or “013”or “014”or “022”or “023”or "024”STEP 5: Calculate percentDivide the count from STEP 4 by the count from STEP 3	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"STEP 3: Non-missing type of billOf the claims that meet the criteria from STEP 2, restrict to non-missing TYPE-OF-BILLSTEP 4: Count of claims with an invalid type of billOf the claims that meet the criteria from STEP 3, count claims where TYPE-OF-BILL does not begin with “03”or “07”or “08”or “012”or “013”or “014”or “022”or “023”or "024”STEP 5: Calculate percentDivide the count from STEP 4 by the count from STEP 3
04/24/2025	4.0.7	MCR-62-007-7	ADD	N/A		Created
11/20/2025	4.0.22	MCR-62-006-6	UPDATE	Annotation	Calculate the percent of Medicaid and S-CHIP: Encounter, original and adjustment, paid LT claims where type of bill does not begin with the value for "nursing facility" or "ICF"	N/A
11/20/2025	4.0.22	MCR-62-006-6	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"STEP 3: Non-missing type of billOf the claims that meet the criteria from STEP 2, restrict to non-missing TYPE-OF-BILLSTEP 4: Count of claims with an invalid type of billOf the claims that meet the criteria from STEP 3, count claims where TYPE-OF-BILL does not begin with "02" or "06"STEP 5: Calculate percentDivide the count from STEP 4 by the count from STEP 3	N/A
04/24/2025	4.0.7	MCR-62-006-6	ADD	N/A		Created
11/20/2025	4.0.22	MCR-62-005-5	UPDATE	Annotation	Calculate the percent of Medicaid and S-CHIP: Encounter, original and adjustment, paid IP claims where type of bill does not begin with the value for "inpatient hospital"	N/A
11/20/2025	4.0.22	MCR-62-005-5	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"STEP 3: Non-missing type of billOf the claims that meet the criteria from STEP 2, restrict to non-missing TYPE-OF-BILLSTEP 4: Count of claims with an invalid type of billOf the claims that meet the criteria from STEP 3, count claims where TYPE-OF-BILL does not begin with "011"STEP 5: Calculate percentDivide the count from STEP 4 by the count from STEP 3	N/A
04/24/2025	4.0.7	MCR-62-005-5	ADD	N/A		Created
08/13/2025	4.0.16	MCR-62-004-4	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"STEP 3: Non-missing revenue codeOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing REVENUE-CODESTEP 4: Accommodation revenue codesOf the claims that meet the criteria from STEP 3, select records where:1. REVENUE-CODE = "0100" through "0219"STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 3	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"STEP 3: Non-missing revenue codeOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing REVENUE-CODESTEP 4: Accommodation revenue codesOf the claims that meet the criteria from STEP 3, select records where:1. REVENUE-CODE = "0100" through "0219"STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 3
04/24/2025	4.0.7	MCR-62-004-4	ADD	N/A		Created
04/24/2025	4.0.7	MCR-62-003-3	ADD	N/A		Created
11/20/2025	4.0.22	MCR-62-002-2	UPDATE	Annotation	Calculate the percentage Medicaid and S-CHIP Encounter: original and adjustment, paid LT claims with billing provider taxonomy codes that do not begin with the characters "283Q" or "283X" or "282E" or "31" or "32" or "385H" or "281P"	N/A
11/20/2025	4.0.22	MCR-62-002-2	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"STEP 3: Non-missing billing provider taxonomyOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-TAXONOMYSTEP 4: Billing provider taxonomy does not begin with ("283Q" or "283X" or "282E" or "31" or "32" or "385H" or "281P")Of the claims that meet the criteria from STEP 3, keep claims where BILLING-PROV-TAXONOMY does not begin with ("283Q" or "283X" or "282E" or "31" or "32" or "385H" or "281P")STEP 5: Calculate percentDivide the count of claims from STEP 4 from STEP 3	N/A
04/24/2025	4.0.7	MCR-62-002-2	ADD	N/A		Created
11/20/2025	4.0.22	MCR-62-001-1	UPDATE	Annotation	Calculate the percentage Medicaid and S-CHIP Encounter: original and adjustment, paid IP claims with billing provider taxonomy codes that do not begin with the characters "27" or "28"	N/A
11/20/2025	4.0.22	MCR-62-001-1	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"STEP 3: Non-missing billing provider taxonomyOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-TAXONOMYSTEP 4: Billing provider taxonomy does not begin with 27 or 28Of the claims that meet the criteria from STEP 3, keep claims where BILLING-PROV-TAXONOMY does not begin with "27" or "28"STEP 5: Calculate percentDivide the count of claims from STEP 4 from STEP 3	N/A
04/24/2025	4.0.7	MCR-62-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-61-008-8	ADD	N/A		Created
04/24/2025	4.0.7	MCR-61-007-7	ADD	N/A		Created
04/24/2025	4.0.7	MCR-61-006-6	ADD	N/A		Created
04/24/2025	4.0.7	MCR-61-005-5	ADD	N/A		Created
04/24/2025	4.0.7	MCR-61-004-4	ADD	N/A		Created
04/24/2025	4.0.7	MCR-61-003-3	ADD	N/A		Created
04/24/2025	4.0.7	MCR-61-002-2	ADD	N/A		Created
04/24/2025	4.0.7	MCR-61-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-60-008-8	ADD	N/A		Created
04/24/2025	4.0.7	MCR-60-007-7	ADD	N/A		Created
04/24/2025	4.0.7	MCR-60-006-6	ADD	N/A		Created
04/24/2025	4.0.7	MCR-60-005-5	ADD	N/A		Created
04/24/2025	4.0.7	MCR-60-004-4	ADD	N/A		Created
04/24/2025	4.0.7	MCR-60-003-3	ADD	N/A		Created
04/24/2025	4.0.7	MCR-60-002-2	ADD	N/A		Created
04/24/2025	4.0.7	MCR-60-001-1	ADD	N/A		Created
08/13/2025	4.0.16	FFS-52-007-7	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" STEP 3: Non-missing type of billOf the claims that meet the criteria from STEP 2, restrict to non-missing TYPE-OF-BILLSTEP 4: Count of claims with an invalid type of billOf the claims that meet the criteria from STEP 3, count claims where TYPE-OF-BILL does not begin with “03”or “07”or “08”or “012”or “013”or “014”or “022”or “023”or “024”STEP 5: Calculate percentDivide the count from STEP 4 by the count from STEP 3	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" STEP 3: Non-missing type of billOf the claims that meet the criteria from STEP 2, restrict to non-missing TYPE-OF-BILLSTEP 4: Count of claims with an invalid type of billOf the claims that meet the criteria from STEP 3, count claims where TYPE-OF-BILL does not begin with “03”or “07”or “08”or “012”or “013”or “014”or “022”or “023”or “024”STEP 5: Calculate percentDivide the count from STEP 4 by the count from STEP 3
04/24/2025	4.0.7	FFS-52-007-7	ADD	N/A		Created
11/20/2025	4.0.22	FFS-52-006-6	UPDATE	Annotation	Calculate the percent of Medicaid and S-CHIP: FFS, original and adjustment, paid LT claims where type of bill does not begin with the value for "nursing facility" or "ICF"	N/A
11/20/2025	4.0.22	FFS-52-006-6	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" STEP 3: Non-missing type of billOf the claims that meet the criteria from STEP 2, restrict to non-missing TYPE-OF-BILLSTEP 4: Count of claims with an invalid type of billOf the claims that meet the criteria from STEP 3, count claims where TYPE-OF-BILL does not begin with "02" or "06"STEP 5: Calculate percentDivide the count from STEP 4 by the count from STEP 3	N/A
04/24/2025	4.0.7	FFS-52-006-6	ADD	N/A		Created
11/20/2025	4.0.22	FFS-52-005-5	UPDATE	Annotation	Calculate the percent of Medicaid and S-CHIP: FFS, original and adjustment, paid IP claims where type of bill does not begin with the value for "inpatient hospital"	N/A
11/20/2025	4.0.22	FFS-52-005-5	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" STEP 3: Non-missing type of billOf the claims that meet the criteria from STEP 2, restrict to non-missing TYPE-OF-BILLSTEP 4: Count of claims with an invalid type of billOf the claims that meet the criteria from STEP 3, count claims where TYPE-OF-BILL does not begin with "011"STEP 5: Calculate percentDivide the count from STEP 4 by the count from STEP 3	N/A
04/24/2025	4.0.7	FFS-52-005-5	ADD	N/A		Created
08/13/2025	4.0.16	FFS-52-004-4	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"STEP 3: Non-missing revenue codeOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing REVENUE-CODESTEP 4: Accommodation revenue codesOf the claims that meet the criteria from STEP 3, select records where:1. REVENUE-CODE = "0100" through "0219"STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 3	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"STEP 3: Non-missing revenue codeOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing REVENUE-CODESTEP 4: Accommodation revenue codesOf the claims that meet the criteria from STEP 3, select records where:1. REVENUE-CODE = "0100" through "0219"STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 3
04/24/2025	4.0.7	FFS-52-004-4	ADD	N/A		Created
04/24/2025	4.0.7	FFS-52-003-3	ADD	N/A		Created
11/20/2025	4.0.22	FFS-52-002-2	UPDATE	Annotation	Calculate the percentage Medicaid and S-CHIP FFS: original and adjustment, paid LT claims with billing provider taxonomy codes that do not begin with the characters "283Q" or "283X" or "282E" or "31" or "32" or "385H" or "281P"	N/A
11/20/2025	4.0.22	FFS-52-002-2	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"STEP 3: Non-missing billing provider taxonomyOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-TAXONOMYSTEP 4: Billing provider taxonomy does not begin with ("283Q" or "283X" or "282E" or "31" or "32" or "385H" or "281P")Of the claims that meet the criteria from STEP 3, keep claims where BILLING-PROV-TAXONOMY does not begin with ("283Q" or "283X" or "282E" or "31" or "32" or "385H" or "281P")STEP 5: Calculate percentDivide the count of claims from STEP 4 from STEP 3	N/A
04/24/2025	4.0.7	FFS-52-002-2	ADD	N/A		Created
11/20/2025	4.0.22	FFS-52-001-1	UPDATE	Annotation	Calculate the percentage Medicaid and S-CHIP FFS: original and adjustment, paid IP claims with billing provider taxonomy codes that do not begin with the characters "27" or "28"	N/A
11/20/2025	4.0.22	FFS-52-001-1	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"STEP 3: Non-missing billing provider taxonomyOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-TAXONOMYSTEP 4: Billing provider taxonomy does not begin with 27 or 28Of the claims that meet the criteria from STEP 3, keep claims where BILLING-PROV-TAXONOMY does not begin with "27" or "28"STEP 5: Calculate percentDivide the count of claims from STEP 4 from STEP 3	N/A
04/24/2025	4.0.7	FFS-52-001-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-51-008-8	ADD	N/A		Created
04/24/2025	4.0.7	FFS-51-007-7	ADD	N/A		Created
04/24/2025	4.0.7	FFS-51-006-6	ADD	N/A		Created
04/24/2025	4.0.7	FFS-51-005-5	ADD	N/A		Created
04/24/2025	4.0.7	FFS-51-004-4	ADD	N/A		Created
04/24/2025	4.0.7	FFS-51-003-3	ADD	N/A		Created
04/24/2025	4.0.7	FFS-51-002-2	ADD	N/A		Created
04/24/2025	4.0.7	FFS-51-001-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-50-008-8	ADD	N/A		Created
04/24/2025	4.0.7	FFS-50-007-7	ADD	N/A		Created
04/24/2025	4.0.7	FFS-50-006-6	ADD	N/A		Created
04/24/2025	4.0.7	FFS-50-005-5	ADD	N/A		Created
04/24/2025	4.0.7	FFS-50-004-4	ADD	N/A		Created
04/24/2025	4.0.7	FFS-50-003-3	ADD	N/A		Created
04/24/2025	4.0.7	FFS-50-002-2	ADD	N/A		Created
04/24/2025	4.0.7	FFS-50-001-1	ADD	N/A		Created
04/24/2025	4.0.7	EL-6-027-27	ADD	N/A		Created
04/24/2025	4.0.7	EL-6-026-26	ADD	N/A		Created
04/24/2025	4.0.7	EL-3-019-24	ADD	N/A		Created
04/24/2025	4.0.7	EL-3-018-23	ADD	N/A		Created
11/20/2025	4.0.22	EL-3-017-22	UPDATE	Annotation	Calculate the percentage of MSIS IDs with an ELIGIBILITY-GROUP value of "72" for states NOT expected to report this value according to public MBES enrollment data on Medicaid.gov	N/A
11/20/2025	4.0.22	EL-3-017-22	UPDATE	Specification	STEP 1: Measure applies to submitting state1a. If submitting state is NOT expected to report ELIGIBILITY-GROUP value "72" because there are NO enrollees in the “VIII group eligible” category in the MBES enrollment data, proceed to STEP 2ELSE1b. If submitting state is expected to report ELIGIBILITY-GROUP value "72" because there are enrollees in the “VIII group eligible” category in the public MBES enrollment data on Medicaid.gov, the final measure statistic will be displayed as "N/A"STEP 2: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 3: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 2, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 4: MSIS IDs with eligibility group 72Of the MSIS IDs that meet the criteria from STEP 3, count the number of unique MSIS IDs where ELIGIBILITY-GROUP = "72"STEP 5: Calculate percentageDivide the count from STEP 4 by the count from STEP 2	N/A
04/24/2025	4.0.7	EL-3-017-22	ADD	N/A		Created
04/24/2025	4.0.7	EL-3-016-21	ADD	N/A		Created
04/24/2025	4.0.7	EL-3-015-20	ADD	N/A		Created
11/20/2025	4.0.22	EL-3-014-19	UPDATE	Annotation	Calculate the percentage of MSIS IDs with an ELIGIBILITY-GROUP value of "72" for states expected to report this value according to public MBES enrollment data on Medicaid.gov	N/A
11/20/2025	4.0.22	EL-3-014-19	UPDATE	Specification	STEP 1: Measure applies to submitting state1a. If submitting state is expected to report ELIGIBILITY-GROUP value "72" because there are enrollees in the “VIII group eligible” category in the MBES enrollment data, proceed to STEP 2ELSE1b. If submitting state is NOT expected to report ELIGIBILITY-GROUP value "72" because there are NO enrollees in the “VIII group eligible” category in the public MBES enrollment data on Medicaid.gov, the final measure statistic will be displayed as "N/A"STEP 2: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 3: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 2, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 4: MSIS IDs with eligibility group 72Of the MSIS IDs that meet the criteria from STEP 3, count the number of unique MSIS IDs where ELIGIBILITY-GROUP = "72"STEP 5: Calculate percentageDivide the count from STEP 4 by the count from STEP 2	N/A
04/24/2025	4.0.7	EL-3-014-19	ADD	N/A		Created
08/13/2025	4.0.16	ALL-16-008-8	UPDATE	Specification	STEP 1: Active paid RX claims during DQ report monthDefine the RX claims universe at the line level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND, and keep all claims, including orphan lines1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines)1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Missing adjudication dateOf the claim lines that meet the criteria from STEP 2, select those where:1. ADJUDICATION-DATE is missingSTEP 3: Calculate percentageDivide the count of rows from STEP 2 by the count of rows from STEP 1	STEP 1: Active paid RX claims during DQ report monthDefine the RX claims universe at the line level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND, and keep all claims, including orphan lines1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines)1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Missing adjudication dateOf the claim lines that meet the criteria from STEP 2, select those where:1. ADJUDICATION-DATE is missingSTEP 3: Calculate percentageDivide the count of rows from STEP 2 by the count of rows from STEP 1
04/24/2025	4.0.7	ALL-16-008-8	ADD	N/A		Created
11/20/2025	4.0.22	ALL-16-007-7	UPDATE	Annotation	Calculate the percentage of paid RX claim header record segments containing a missing value for adjudication date	N/A
11/20/2025	4.0.22	ALL-16-007-7	UPDATE	Specification	STEP 1: Active RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Missing adjudication dateOf the claims that meet the criteria from STEP 1, select those where:1. ADJUDICATION-DATE is missingSTEP 3: Calculate percentageDivide the count of rows from STEP 2 by the count of rows from STEP 1	N/A
04/24/2025	4.0.7	ALL-16-007-7	ADD	N/A		Created
08/13/2025	4.0.16	ALL-16-006-6	UPDATE	Specification	STEP 1: Active paid OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND, and keep all claims, including orphan lines1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines)1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Missing adjudication dateOf the claim lines that meet the criteria from STEP 2, select those where:1. ADJUDICATION-DATE is missingSTEP 3: Calculate percentageDivide the count of rows from STEP 2 by the count of rows from STEP 1	STEP 1: Active paid OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND, and keep all claims, including orphan lines1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines)1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Missing adjudication dateOf the claim lines that meet the criteria from STEP 2, select those where:1. ADJUDICATION-DATE is missingSTEP 3: Calculate percentageDivide the count of rows from STEP 2 by the count of rows from STEP 1
04/24/2025	4.0.7	ALL-16-006-6	ADD	N/A		Created
11/20/2025	4.0.22	ALL-16-005-5	UPDATE	Annotation	Calculate the percentage of paid OT claim header record segments containing a missing value for adjudication date	N/A
11/20/2025	4.0.22	ALL-16-005-5	UPDATE	Specification	STEP 1: Active OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Missing adjudication dateOf the claims that meet the criteria from STEP 2, select those where:1. ADJUDICATION-DATE is missingSTEP 3: Calculate percentageDivide the count of rows from STEP 2 by the count of rows from STEP 1	N/A
04/24/2025	4.0.7	ALL-16-005-5	ADD	N/A		Created
08/13/2025	4.0.16	ALL-16-004-4	UPDATE	Specification	STEP 1: Active paid LT claims during DQ report monthDefine the LT claims universe at the line level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND, and keep all claims, including orphan lines1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines)1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Missing adjudication dateOf the claim lines that meet the criteria from STEP 2, select those where:1. ADJUDICATION-DATE is missingSTEP 3: Calculate percentageDivide the count of rows from STEP 2 by the count of rows from STEP 1	STEP 1: Active paid LT claims during DQ report monthDefine the LT claims universe at the line level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND, and keep all claims, including orphan lines1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines)1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Missing adjudication dateOf the claim lines that meet the criteria from STEP 2, select those where:1. ADJUDICATION-DATE is missingSTEP 3: Calculate percentageDivide the count of rows from STEP 2 by the count of rows from STEP 1
04/24/2025	4.0.7	ALL-16-004-4	ADD	N/A		Created
11/20/2025	4.0.22	ALL-16-003-3	UPDATE	Annotation	Calculate the percentage of paid LT claim header record segments containing a missing value for adjudication date	N/A
11/20/2025	4.0.22	ALL-16-003-3	UPDATE	Specification	STEP 1: Active LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Missing adjudication dateOf the claims that meet the criteria from STEP 2, select those where:1. ADJUDICATION-DATE is missingSTEP 3: Calculate percentageDivide the count of rows from STEP 2 by the count of rows from STEP 1	N/A
04/24/2025	4.0.7	ALL-16-003-3	ADD	N/A		Created
08/13/2025	4.0.16	ALL-16-002-2	UPDATE	Specification	STEP 1: Active paid IP claims during DQ report monthDefine the IP claims universe at the line level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND, and keep all claims, including orphan lines1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines)1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Missing adjudication dateOf the claim lines that meet the criteria from STEP 2, select those where:1. ADJUDICATION-DATE is missingSTEP 3: Calculate percentageDivide the count of rows from STEP 2 by the count of rows from STEP 1	STEP 1: Active paid IP claims during DQ report monthDefine the IP claims universe at the line level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND, and keep all claims, including orphan lines1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines)1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Missing adjudication dateOf the claim lines that meet the criteria from STEP 2, select those where:1. ADJUDICATION-DATE is missingSTEP 3: Calculate percentageDivide the count of rows from STEP 2 by the count of rows from STEP 1
04/24/2025	4.0.7	ALL-16-002-2	ADD	N/A		Created
11/20/2025	4.0.22	ALL-16-001-1	UPDATE	Annotation	Calculate the percentage of paid IP claim header record segments containing a missing value for adjudication date	N/A
11/20/2025	4.0.22	ALL-16-001-1	UPDATE	Specification	STEP 1: Active IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Missing adjudication dateOf the claims that meet the criteria from STEP 2, select those where:1. ADJUDICATION-DATE is missingSTEP 3: Calculate percentageDivide the count of rows from STEP 2 by the count of rows from STEP 1	N/A
04/24/2025	4.0.7	ALL-16-001-1	ADD	N/A		Created
08/13/2025	4.0.16	ALL-15-002-2	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS and Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" or "A" or "C"STEP 3: Non-missing type of bill and place of serviceOf the claims that meet the criteria from STEP 2, restrict to claims that meet all of the following criteria: 1. TYPE-OF-BILL is not missing2. PLACE-OF-SERVICE is not missingSTEP 4: Calculate percentageDivide the number of claims from STEP 3 by the number of claims from STEP 2	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS and Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" or "A" or "C"STEP 3: Non-missing type of bill and place of serviceOf the claims that meet the criteria from STEP 2, restrict to claims that meet all of the following criteria: 1. TYPE-OF-BILL is not missing2. PLACE-OF-SERVICE is not missingSTEP 4: Calculate percentageDivide the number of claims from STEP 3 by the number of claims from STEP 2
04/24/2025	4.0.7	ALL-15-002-2	ADD	N/A		Created
08/13/2025	4.0.16	ALL-15-001-1	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS and Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" or "A" or "C"STEP 3: Non-missing place of serviceOf the claims that meet the criteria from STEP 2, restrict to non-missing PLACE-OF-SERVICESTEP 4: Procedure code is missingOf the claims that meet the criteria from STEP 3, restrict to claims that meet the following criteria: 1. PROCEDURE-CODE is missingSTEP 5: Calculate percentageDivide the number of claims from STEP 4 by the number of claims from STEP 3	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS and Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" or "A" or "C"STEP 3: Non-missing place of serviceOf the claims that meet the criteria from STEP 2, restrict to non-missing PLACE-OF-SERVICESTEP 4: Procedure code is missingOf the claims that meet the criteria from STEP 3, restrict to claims that meet the following criteria: 1. PROCEDURE-CODE is missingSTEP 5: Calculate percentageDivide the number of claims from STEP 4 by the number of claims from STEP 3
04/24/2025	4.0.7	ALL-15-001-1	ADD	N/A		Created
11/20/2025	4.0.22	ALL-14-008-8	UPDATE	Annotation	Calculate the percentage of MSIS IDs on Medicaid FFS and Encounter: original and adjustment, crossover paid RX claims that: 1) can be found on an Eligible file enrollment time span segment, 2) can be found on an Eligible file eligibility determinant segment that spans the prescription fill date on the claims file, and 3) are enrolled as premium only dual	N/A
11/20/2025	4.0.22	ALL-14-008-8	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS and Encounter: Original and Adjustment, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" 2. CROSSOVER-IND = "1"STEP 3: Non-missing prescription fill dateOf the claims that meet the criteria from STEP 2, restrict to non-missing PRESCRIPTION-FILL-DATESTEP 4: Link claims to enrollment time spanKeep all claims from STEP 3 for which the MSIS ID on the claim is also found on an ENROLLEMENT-TIME-SPAN-ELG00021 segmentSTEP 5: Not enrolled as duals during admission dateLink MSIS-IDs from the claims in STEP 4 to the ELIGIBILITY-DETERMINANTS-ELG00005 file segment and keep segments that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12. DUAL-ELIGIBLE-CODE = (“03” or “05” or “06”)3. Claims PRESCRIPTION-FILL-DATE >= ELIGIBILITY-DETERMINANT-EFF-DATE 4. Claims PRESCRIPTION-FILL-DATE <= ELIGIBILITY-DETERMINANT-END-DATE OR ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 6: Unique MSIS IDs in claimsOf the claims that meet the criteria from STEP 5, limit to unique MSIS-IDsSTEP 7: Calculate percentageDivide the count of MSIS-IDs from STEP 6 by the count of MSIS-IDs in STEP 3	N/A
04/24/2025	4.0.7	ALL-14-008-8	ADD	N/A		Created
11/20/2025	4.0.22	ALL-14-007-7	UPDATE	Annotation	Calculate the percentage of MSIS IDs on Medicaid FFS and Encounter: original and adjustment, crossover paid OT claims that: 1) can be found on an Eligible file enrollment time span segment, 2) can be found on an Eligible file eligibility determinant segment that spans the service date on the claims file, and 3) are enrolled as premium only dual	N/A
11/20/2025	4.0.22	ALL-14-007-7	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS and Encounter: Original and Adjustment, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" 2. CROSSOVER-IND = "1"STEP 3: Non-missing service dateOf the claims that meet the criteria from STEP 2, restrict to non-missing BEGINNING-DATE-OF-SERVICESTEP 4: Link claims to enrollment time spanKeep all claims from STEP 3 for which the MSIS ID on the claim is also found on an ENROLLEMENT-TIME-SPAN-ELG00021 segmentSTEP 5: Not enrolled as duals during service dateLink MSIS-IDs from the claims in STEP 4 to the ELIGIBILITY-DETERMINANTS-ELG00005 file segment and keep segments that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12. DUAL-ELIGIBLE-CODE = (“03” or “05” or “06”)3. Claims BEGINNING-DATE-OF-SERVICE >= ELIGIBILITY-DETERMINANT-EFF-DATE 4. Claims BEGINNING-DATE-OF-SERVICE <= ELIGIBILITY-DETERMINANT-END-DATE OR ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 6: Unique MSIS IDs in claimsOf the claims that meet the criteria from STEP 5, limit to unique MSIS-IDsSTEP 7: Calculate percentageDivide the count of MSIS-IDs from STEP 6 by the count of MSIS-IDs in STEP 3	N/A
04/24/2025	4.0.7	ALL-14-007-7	ADD	N/A		Created
11/20/2025	4.0.22	ALL-14-006-6	UPDATE	Annotation	Calculate the percentage of MSIS IDs on Medicaid FFS and Encounter: original and adjustment, crossover paid LT claims that: 1) can be found on an Eligible file enrollment time span segment, 2) can be found on an Eligible file eligibility determinant segment that spans the service date on the claims file, and 3) are enrolled as premium only dual	N/A
11/20/2025	4.0.22	ALL-14-006-6	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS and Encounter: Original and Adjustment, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" 2. CROSSOVER-IND = "1"STEP 3: Non-missing service dateOf the claims that meet the criteria from STEP 2, restrict to non-missing BEGINNING-DATE-OF-SERVICESTEP 4: Link claims to enrollment time spanKeep all claims from STEP 3 for which the MSIS ID on the claim is also found on an ENROLLEMENT-TIME-SPAN-ELG00021 segmentSTEP 5: Not enrolled as duals during service dateLink MSIS-IDs from the claims in STEP 4 to the ELIGIBILITY-DETERMINANTS-ELG00005 file segment and keep segments that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12. DUAL-ELIGIBLE-CODE = (“03” or “05” or “06”)3. Claims BEGINNING-DATE-OF-SERVICE >= ELIGIBILITY-DETERMINANT-EFF-DATE 4. Claims BEGINNING-DATE-OF-SERVICE <= ELIGIBILITY-DETERMINANT-END-DATE OR ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 6: Unique MSIS IDs in claimsOf the claims that meet the criteria from STEP 5, limit to unique MSIS-IDsSTEP 7: Calculate percentageDivide the count of MSIS-IDs from STEP 6 by the count of MSIS-IDs in STEP 3	N/A
04/24/2025	4.0.7	ALL-14-006-6	ADD	N/A		Created
11/20/2025	4.0.22	ALL-14-005-5	UPDATE	Annotation	Calculate the percentage of MSIS IDs on Medicaid FFS and Encounter: original and adjustment, crossover paid IP claims that: 1) can be found on an Eligible file enrollment time span segment, 2) can be found on an Eligible file eligibility determinant segment that spans the admission date on the claims file, and 3) are enrolled as premium only dual	N/A
11/20/2025	4.0.22	ALL-14-005-5	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS and Encounter: Original and Adjustment, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" 2. CROSSOVER-IND = "1"STEP 3: Non-missing admission dateOf the claims that meet the criteria from STEP 2, restrict to non-missing ADMISSION-DATESTEP 4: Link claims to enrollment time spanKeep all claims from STEP 3 for which the MSIS ID on the claim is also found on an ENROLLEMENT-TIME-SPAN-ELG00021 segmentSTEP 5: Not enrolled as duals during admission dateLink MSIS-IDs from the claims in STEP 4 to the ELIGIBILITY-DETERMINANTS-ELG00005 file segment and keep segments that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12. DUAL-ELIGIBLE-CODE = (“03” or “05” or “06”)3. Claims ADMISSION-DATE >= ELIGIBILITY-DETERMINANT-EFF-DATE 4. Claims ADMISSION-DATE <= ELIGIBILITY-DETERMINANT-END-DATE OR ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 6: Unique MSIS IDs in claimsOf the claims that meet the criteria from STEP 5, limit to unique MSIS-IDsSTEP 7: Calculate percentageDivide the count of MSIS-IDs from STEP 6 by the count of MSIS-IDs in STEP 3	N/A
04/24/2025	4.0.7	ALL-14-005-5	ADD	N/A		Created
11/20/2025	4.0.22	ALL-14-004-4	UPDATE	Annotation	Calculate the percentage of MSIS IDs on Medicaid FFS and Encounter: original and adjustment, crossover paid RX claims that: 1) can be found on an Eligible file enrollment time span segment, 2) can be found on an Eligible file eligibility determinant segment that spans the prescription fill date on the claims file, and 3) are not enrolled as duals	N/A
11/20/2025	4.0.22	ALL-14-004-4	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS and Encounter: Original and Adjustment, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" 2. CROSSOVER-IND = "1"STEP 3: Non-missing prescription fill dateOf the claims that meet the criteria from STEP 2, restrict to non-missing PRESCRIPTION-FILL-DATESTEP 4: Link claims to enrollment time spanKeep all claims from STEP 3 for which the MSIS ID on the claim is also found on an ENROLLEMENT-TIME-SPAN-ELG00021 segmentSTEP 5: Not enrolled as duals during prescription fill dateLink MSIS-IDs from the claims in STEP 4 to the ELIGIBILITY-DETERMINANTS-ELG00005 file segment and keep segments that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12. DUAL-ELIGIBLE-CODE not equal to (“01” or “02” or “04” or “08”) or is missing3. Claims PRESCRIPTION-FILL-DATE >= ELIGIBILITY-DETERMINANT-EFF-DATE 4. Claims PRESCRIPTION-FILL-DATE <= ELIGIBILITY-DETERMINANT-END-DATE OR ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 6: Unique MSIS IDs in claimsOf the claims that meet the criteria from STEP 5, limit to unique MSIS-IDsSTEP 7: Calculate percentageDivide the count of MSIS-IDs from STEP 6 by the count of MSIS-IDs in STEP 3	N/A
04/24/2025	4.0.7	ALL-14-004-4	ADD	N/A		Created
11/20/2025	4.0.22	ALL-14-003-3	UPDATE	Annotation	Calculate the percentage of MSIS IDs on Medicaid FFS and Encounter: original and adjustment, crossover paid OT claims that: 1) can be found on an Eligible file enrollment time span segment, 2) can be found on an Eligible file eligibility determinant segment that spans the service date on the claims file, and 3) are not enrolled as duals	N/A
11/20/2025	4.0.22	ALL-14-003-3	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS and Encounter: Original and Adjustment, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" 2. CROSSOVER-IND = "1"STEP 3: Non-missing beginning service dateOf the claims that meet the criteria from STEP 2, restrict to non-missing BEGINNING-DATE-OF-SERVICESTEP 4: Link claims to enrollment time spanKeep all claims from STEP 3 for which the MSIS ID on the claim is also found on an ENROLLEMENT-TIME-SPAN-ELG00021 segmentSTEP 5: Eligible during service dateLink MSIS-IDs from the claims in STEP 4 to the ELIGIBILITY-DETERMINANTS-ELG00005 file segment and keep segments that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12. DUAL-ELIGIBLE-CODE not equal to (“01” or “02” or “04” or “08”) or is missing3. Claims BEGINNING-DATE-OF-SERVICE >= ELIGIBILITY-DETERMINANT-EFF-DATE 4. Claims BEGINNING-DATE-OF-SERVICE <= ELIGIBILITY-DETERMINANT-END-DATE OR ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 6: Unique MSIS IDs in claimsOf the claims that meet the criteria from STEP 5, limit to unique MSIS-IDsSTEP 7: Calculate percentageDivide the count of MSIS-IDs from STEP 6 by the count of MSIS-IDs in STEP 3	N/A
04/24/2025	4.0.7	ALL-14-003-3	ADD	N/A		Created
11/20/2025	4.0.22	ALL-14-002-2	UPDATE	Annotation	Calculate the percentage of MSIS IDs on Medicaid FFS and Encounter: original and adjustment, crossover paid LT claims that: 1) can be found on an Eligible file enrollment time span segment, 2) can be found on an Eligible file eligibility determinant segment that spans the service date on the claims file, and 3) are not enrolled as duals	N/A
11/20/2025	4.0.22	ALL-14-002-2	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS and Encounter: Original and Adjustment, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" 2. CROSSOVER-IND = "1"STEP 3: Non-missing beginning service dateOf the claims that meet the criteria from STEP 2, restrict to non-missing BEGINNING-DATE-OF-SERVICESTEP 4: Link claims to enrollment time spanKeep all claims from STEP 3 for which the MSIS ID on the claim is also found on an ENROLLEMENT-TIME-SPAN-ELG00021 segmentSTEP 5: Eligible during service dateLink MSIS-IDs from the claims in STEP 4 to the ELIGIBILITY-DETERMINANTS-ELG00005 file segment and keep segments that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12. DUAL-ELIGIBLE-CODE not equal to (“01” or “02” or “04” or “08”) or is missing3. Claims BEGINNING-DATE-OF-SERVICE >= ELIGIBILITY-DETERMINANT-EFF-DATE 4. Claims BEGINNING-DATE-OF-SERVICE <= ELIGIBILITY-DETERMINANT-END-DATE OR ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 6: Unique MSIS IDs in claimsOf the claims that meet the criteria from STEP 5, limit to unique MSIS-IDsSTEP 7: Calculate percentageDivide the count of MSIS-IDs from STEP 6 by the count of MSIS-IDs in STEP 3	N/A
04/24/2025	4.0.7	ALL-14-002-2	ADD	N/A		Created
11/20/2025	4.0.22	ALL-14-001-1	UPDATE	Annotation	Calculate the percentage of MSIS IDs on Medicaid FFS and Encounter: original and adjustment, crossover paid IP claims that: 1) can be found on an Eligible file enrollment time span segment, 2) can be found on an Eligible file eligibility determinant segment that spans the admission date on the claims file, and 3) are not enrolled as duals	N/A
11/20/2025	4.0.22	ALL-14-001-1	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS and Encounter: Original and Adjustment, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" 2. CROSSOVER-IND = "1"STEP 3: Non-missing admission dateOf the claims that meet the criteria from STEP 2, restrict to non-missing ADMISSION-DATESTEP 4: Link claims to enrollment time spanKeep all claims from STEP 3 for which the MSIS ID on the claim is also found on an ENROLLEMENT-TIME-SPAN-ELG00021 segmentSTEP 5: Not enrolled as duals during admission dateLink MSIS-IDs from the claims in STEP 4 to the ELIGIBILITY-DETERMINANTS-ELG00005 file segment and keep segments that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12. DUAL-ELIGIBLE-CODE not equal to (“01” or “02” or “04” or “08”) or is missing3. Claims ADMISSION-DATE >= ELIGIBILITY-DETERMINANT-EFF-DATE 4. Claims ADMISSION-DATE <= ELIGIBILITY-DETERMINANT-END-DATE OR ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 6: Unique MSIS IDs in claimsOf the claims that meet the criteria from STEP 5, limit to unique MSIS-IDsSTEP 7: Calculate percentageDivide the count of MSIS-IDs from STEP 6 by the count of MSIS-IDs in STEP 3	N/A
04/24/2025	4.0.7	ALL-14-001-1	ADD	N/A		Created
04/24/2025	4.0.7	ALL-13-004-6	ADD	N/A		Created
08/13/2025	4.0.16	ALL-13-003-5	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the header level by importing headers, lines, and DX segments that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.For DX segments:1. DX segments merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-TYPE-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 2: Medicaid FFS and Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3"2. ADJUSTMENT_IND = "0"STEP 3: Non-missing admission dateOf the claims that meet the criteria from STEP 2, restrict to non-missing ADMISSION-DATESTEP 4: Link claims to enrollment time spanKeep all claims from STEP 3 for which the MSIS ID on the claim is also found on an ENROLLMENT-TIME-SPAN-ELG00021 segmentSTEP 5: Alien during date of serviceLink MSIS-IDs from the claims in STEP 4 to the ELIGIBILITY-DETERMINANTS-ELG00005 file segment and keep segments that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12. RESTRICTED-BENEFIT-CODE = "2"3. Claims ADMISSION-DATE>= ELIGIBILITY-DETERMINANT-EFF-DATE4. Claims ADMISSION-DATE <= ELIGIBILITY-DETERMINANT-END-DATE OR ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 6: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 5, limit to unique MSIS-IDsSTEP 7: Non-emergency room and non-pregnancy related servicesOf the claims that meet the criteria from STEP 5, restrict to claims that do NOT have emergency room revenue codes or pregnancy-related diagnosis codes or procedure codes:NOT (1a. REVENUE-CODE equal to ("450", "451", "452", "453", "454", "455", "456", "457", "458", "459", "0450", "0451", "0452", "0453", "0454", "0455", "0456", "0457", "0458", "0459" ,“0981”,“0720”, “0721”, “0722”, “0723”, “0724”, “0729”)OR2a. PROCEDURE-CODE-1 through PROCEDURE-CODE-6 is found in the Pregnancy CodeSet tab for ICD-10-PCM code types)OR2a. has any DX segment where DIAGNOSIS-CODE is found in the Pregnancy CodeSet tab for ICD-10-CM code typesSTEP 8: Calculate percentageDivide the count of unique MSIS-IDs from STEP 7 by the count of MSIS-IDs from STEP 6.	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the header level by importing headers, lines, and DX segments that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.For DX segments:1. DX segments merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 2: Medicaid FFS and Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3"2. ADJUSTMENT_IND = "0"STEP 3: Non-missing admission dateOf the claims that meet the criteria from STEP 2, restrict to non-missing ADMISSION-DATESTEP 4: Link claims to enrollment time spanKeep all claims from STEP 3 for which the MSIS ID on the claim is also found on an ENROLLMENT-TIME-SPAN-ELG00021 segmentSTEP 5: Alien during date of serviceLink MSIS-IDs from the claims in STEP 4 to the ELIGIBILITY-DETERMINANTS-ELG00005 file segment and keep segments that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12. RESTRICTED-BENEFIT-CODE = "2"3. Claims ADMISSION-DATE>= ELIGIBILITY-DETERMINANT-EFF-DATE4. Claims ADMISSION-DATE <= ELIGIBILITY-DETERMINANT-END-DATE OR ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 6: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 5, limit to unique MSIS-IDsSTEP 7: Non-emergency room and non-pregnancy related servicesOf the claims that meet the criteria from STEP 5, restrict to claims that do NOT have emergency room revenue codes or pregnancy-related diagnosis codes or procedure codes:NOT (1a. REVENUE-CODE equal to ("450", "451", "452", "453", "454", "455", "456", "457", "458", "459", "0450", "0451", "0452", "0453", "0454", "0455", "0456", "0457", "0458", "0459" ,“0981”,“0720”, “0721”, “0722”, “0723”, “0724”, “0729”)OR2a. PROCEDURE-CODE-1 through PROCEDURE-CODE-6 is found in the Pregnancy CodeSet tab for ICD-10-PCM code typesOR2a. has any DX segment where DIAGNOSIS-CODE is found in the Pregnancy CodeSet tab for ICD-10-CM code typesSTEP 8: Calculate percentageDivide the count of unique MSIS-IDs from STEP 7 by the count of MSIS-IDs from STEP 6.
04/24/2025	4.0.7	ALL-13-003-5	ADD	N/A		Created
04/24/2025	4.0.7	MIS-7-002-32	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-027_1-36	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-024_1-35	ADD	N/A		Created
04/24/2025	4.0.7	MIS-5-002-20	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-032_1-44	ADD	N/A		Created
04/24/2025	4.0.7	MIS-30-003-3	ADD	N/A		Created
08/13/2025	4.0.16	MIS-30-002-2	UPDATE	Measure name	% missing: CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT (COT00003)	% missing: CATEGORY-FOR-FEDERAL-REIMBURSEMENT (COT00003)
08/13/2025	4.0.16	MIS-30-002-2	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Capitation Payment: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "2" or "B"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Capitation Payment: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "2" or "B"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2
04/24/2025	4.0.7	MIS-30-002-2	ADD	N/A		Created
04/24/2025	4.0.7	MIS-30-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-29-002-2	ADD	N/A		Created
04/24/2025	4.0.7	MIS-29-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-28-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-26-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-24-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-22-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-039_1-57	ADD	N/A		Created
11/20/2025	4.0.22	MIS-19-001-1	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-19-001-1	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: Calculate percentageDivide the count of claims from STEP 2 by the count of claims from STEP 1	N/A
04/24/2025	4.0.7	MIS-19-001-1	ADD	N/A		Created
11/20/2025	4.0.22	MIS-17-001-1	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-17-001-1	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: Calculate percentageDivide the count of claims from STEP 2 by the count of claims from STEP 1	N/A
04/24/2025	4.0.7	MIS-17-001-1	ADD	N/A		Created
11/20/2025	4.0.22	MIS-15-001-1	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-15-001-1	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: Calculate percentageDivide the count of claims from STEP 2 by the count of claims from STEP 1	N/A
04/24/2025	4.0.7	MIS-15-001-1	ADD	N/A		Created
11/20/2025	4.0.22	MIS-13-001-1	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-13-001-1	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: Calculate percentageDivide the count of claims from STEP 2 by the count of claims from STEP 1	N/A
04/24/2025	4.0.7	MIS-13-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-59-012-12	ADD	N/A		Created
08/13/2025	4.0.16	MCR-59-011-11	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Claim Line DetailOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 5: Non-missing Medicaid paid and allowed amountsOf the records from STEP 4, further refine the population with the following criteria: 1. MEDICAID-PAID-AMT is not missing2. ALLOWED-AMT is not missing3. ALLOWED-AMT is not equal to 0STEP 6: Medicaid paid is greater than allowedOf the records from STEP 5, further refine the population with the following criteria:1. MEDICAID-PAID-AMT > ALLOWED-AMTSTEP 7: PercentageDivide the count of claim lines from STEP 6 by the count of claim lines from STEP 5.	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Claim Line DetailOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 5: Non-missing Medicaid paid and allowed amountsOf the records from STEP 4, further refine the population with the following criteria: 1. MEDICAID-PAID-AMT is not missing2. ALLOWED-AMT is not missing3. ALLOWED-AMT is not equal to 0STEP 6: Medicaid paid is greater than allowedOf the records from STEP 5, further refine the population with the following criteria:1. MEDICAID-PAID-AMT > ALLOWED-AMTSTEP 7: PercentageDivide the count of claim lines from STEP 6 by the count of claim lines from STEP 5.
04/24/2025	4.0.7	MCR-59-011-11	ADD	N/A		Created
08/13/2025	4.0.16	MCR-59-010-10	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Claim Line DetailOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 5: Non-missing Medicaid paid and allowed amountsOf the records from STEP 4, further refine the population with the following criteria: 1. MEDICAID-PAID-AMT is not missing2. ALLOWED-AMT is not missing3. ALLOWED-AMT is not equal to 0STEP 6: Medicaid paid is greater than allowedOf the records from STEP 5, further refine the population with the following criteria:1. MEDICAID-PAID-AMT > ALLOWED-AMTSTEP 7: PercentageDivide the count of claim lines from STEP 6 by the count of claim lines from STEP 5.	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Claim Line DetailOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 5: Non-missing Medicaid paid and allowed amountsOf the records from STEP 4, further refine the population with the following criteria: 1. MEDICAID-PAID-AMT is not missing2. ALLOWED-AMT is not missing3. ALLOWED-AMT is not equal to 0STEP 6: Medicaid paid is greater than allowedOf the records from STEP 5, further refine the population with the following criteria:1. MEDICAID-PAID-AMT > ALLOWED-AMTSTEP 7: PercentageDivide the count of claim lines from STEP 6 by the count of claim lines from STEP 5.
04/24/2025	4.0.7	MCR-59-010-10	ADD	N/A		Created
08/13/2025	4.0.16	MCR-59-009-9	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Claim Line DetailOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 5: Non-missing Medicaid paid and allowed amountsOf the records from STEP 4, further refine the population with the following criteria: 1. MEDICAID-PAID-AMT is not missing2. ALLOWED-AMT is not missing3. ALLOWED-AMT is not equal to 0STEP 6: Medicaid paid is greater than allowedOf the records from STEP 5, further refine the population with the following criteria:1. MEDICAID-PAID-AMT > ALLOWED-AMTSTEP 7: PercentageDivide the count of claim lines from STEP 6 by the count of claim lines from STEP 5.	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Claim Line DetailOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 5: Non-missing Medicaid paid and allowed amountsOf the records from STEP 4, further refine the population with the following criteria: 1. MEDICAID-PAID-AMT is not missing2. ALLOWED-AMT is not missing3. ALLOWED-AMT is not equal to 0STEP 6: Medicaid paid is greater than allowedOf the records from STEP 5, further refine the population with the following criteria:1. MEDICAID-PAID-AMT > ALLOWED-AMTSTEP 7: PercentageDivide the count of claim lines from STEP 6 by the count of claim lines from STEP 5.
04/24/2025	4.0.7	MCR-59-009-9	ADD	N/A		Created
04/24/2025	4.0.7	MCR-59-008-8	ADD	N/A		Created
11/20/2025	4.0.22	MCR-59-007-7	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP Encounter: original, paid OT claims where the total Medicaid paid amount is greater than the total allowed amount	N/A
11/20/2025	4.0.22	MCR-59-007-7	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0"STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Non-missing total Medicaid paid and allowed amountsOf the records from STEP 3, further refine the population with the following criteria: 1. TOT-MEDICAID-PAID-AMT is not missing2. TOT-ALLOWED-AMT is not missing3. TOT-ALLOWED-AMT is not equal to 0STEP 5: Total Medicaid paid is greater than total allowed Of the records from STEP 4, further refine the population with the following criteria:1. TOT-MEDICAID-PAID-AMT > TOT-ALLOWED-AMTSTEP 6: PercentageDivide the count of claims from STEP 5 by the count of claims from STEP 4.	N/A
04/24/2025	4.0.7	MCR-59-007-7	ADD	N/A		Created
11/20/2025	4.0.22	MCR-59-006-6	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP Encounter: original, paid LT claims where the total Medicaid paid amount is greater than the total allowed amount	N/A
11/20/2025	4.0.22	MCR-59-006-6	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0"STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Non-missing total Medicaid paid and allowed amountsOf the records from STEP 3, further refine the population with the following criteria: 1. TOT-MEDICAID-PAID-AMT is not missing2. TOT-ALLOWED-AMT is not missing3. TOT-ALLOWED-AMT is not equal to 0STEP 5: Total Medicaid paid is greater than total allowed Of the records from STEP 4, further refine the population with the following criteria:1. TOT-MEDICAID-PAID-AMT > TOT-ALLOWED-AMTSTEP 6: PercentageDivide the count of claims from STEP 5 by the count of claims from STEP 4.	N/A
04/24/2025	4.0.7	MCR-59-006-6	ADD	N/A		Created
11/20/2025	4.0.22	MCR-59-005-5	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP Encounter: original, paid IP claims where the total Medicaid paid amount is greater than the total allowed amount	N/A
11/20/2025	4.0.22	MCR-59-005-5	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0"STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Non-missing total Medicaid paid and allowed amountsOf the records from STEP 3, further refine the population with the following criteria: 1. TOT-MEDICAID-PAID-AMT is not missing2. TOT-ALLOWED-AMT is not missing3. TOT-ALLOWED-AMT is not equal to 0STEP 5: Total Medicaid paid is greater than total allowed Of the records from STEP 4, further refine the population with the following criteria:1. TOT-MEDICAID-PAID-AMT > TOT-ALLOWED-AMTSTEP 6: PercentageDivide the count of claims from STEP 5 by the count of claims from STEP 4.	N/A
04/24/2025	4.0.7	MCR-59-005-5	ADD	N/A		Created
04/24/2025	4.0.7	MCR-59-004-4	ADD	N/A		Created
04/24/2025	4.0.7	MCR-59-003-3	ADD	N/A		Created
04/24/2025	4.0.7	MCR-59-002-2	ADD	N/A		Created
04/24/2025	4.0.7	MCR-59-001-1	ADD	N/A		Created
08/13/2025	4.0.16	FFS-49-012-12	UPDATE	Specification	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" STEP 3: Claim Line DetailOf the claims that meet the criteria from STEP2, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 4: Non-missing Medicaid paid and allowed amountsOf the records from STEP 3, further refine the population with the following criteria: 1. MEDICAID-PAID-AMT is not missing2. ALLOWED-AMT is not missing3. ALLOWED-AMT is not equal to 0STEP 5: Medicaid paid is greater than allowedOf the records from STEP 4, further refine the population with the following criteria:1. MEDICAID-PAID-AMT > ALLOWED-AMTSTEP 6: PercentageDivide the count of claim lines from STEP 5 by the count of claim lines from STEP 4	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" STEP 3: Claim Line DetailOf the claims that meet the criteria from STEP2, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 4: Non-missing Medicaid paid and allowed amountsOf the records from STEP 3, further refine the population with the following criteria: 1. MEDICAID-PAID-AMT is not missing2. ALLOWED-AMT is not missing3. ALLOWED-AMT is not equal to 0STEP 5: Medicaid paid is greater than allowedOf the records from STEP 4, further refine the population with the following criteria:1. MEDICAID-PAID-AMT > ALLOWED-AMTSTEP 6: PercentageDivide the count of claim lines from STEP 5 by the count of claim lines from STEP 4
04/24/2025	4.0.7	FFS-49-012-12	ADD	N/A		Created
08/13/2025	4.0.16	FFS-49-011-11	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" STEP 3: Claim Line DetailOf the claims that meet the criteria from STEP2, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 4: Non-missing Medicaid paid and allowed amountsOf the records from STEP 3, further refine the population with the following criteria: 1. MEDICAID-PAID-AMT is not missing2. ALLOWED-AMT is not missing3. ALLOWED-AMT is not equal to 0STEP 5: Medicaid paid is greater than allowedOf the records from STEP 4, further refine the population with the following criteria:1. MEDICAID-PAID-AMT > ALLOWED-AMTSTEP 6: PercentageDivide the count of claim lines from STEP 5 by the count of claim lines from STEP 4	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" STEP 3: Claim Line DetailOf the claims that meet the criteria from STEP2, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 4: Non-missing Medicaid paid and allowed amountsOf the records from STEP 3, further refine the population with the following criteria: 1. MEDICAID-PAID-AMT is not missing2. ALLOWED-AMT is not missing3. ALLOWED-AMT is not equal to 0STEP 5: Medicaid paid is greater than allowedOf the records from STEP 4, further refine the population with the following criteria:1. MEDICAID-PAID-AMT > ALLOWED-AMTSTEP 6: PercentageDivide the count of claim lines from STEP 5 by the count of claim lines from STEP 4
04/24/2025	4.0.7	FFS-49-011-11	ADD	N/A		Created
08/13/2025	4.0.16	FFS-49-010-10	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" STEP 3: Claim Line DetailOf the claims that meet the criteria from STEP2, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 4: Non-missing Medicaid paid and allowed amountsOf the records from STEP 3, further refine the population with the following criteria: 1. MEDICAID-PAID-AMT is not missing2. ALLOWED-AMT is not missing3. ALLOWED-AMT is not equal to 0STEP 5: Medicaid paid is greater than allowedOf the records from STEP 4, further refine the population with the following criteria:1. MEDICAID-PAID-AMT > ALLOWED-AMTSTEP 6: PercentageDivide the count of claim lines from STEP 5 by the count of claim lines from STEP 4	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" STEP 3: Claim Line DetailOf the claims that meet the criteria from STEP2, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 4: Non-missing Medicaid paid and allowed amountsOf the records from STEP 3, further refine the population with the following criteria: 1. MEDICAID-PAID-AMT is not missing2. ALLOWED-AMT is not missing3. ALLOWED-AMT is not equal to 0STEP 5: Medicaid paid is greater than allowedOf the records from STEP 4, further refine the population with the following criteria:1. MEDICAID-PAID-AMT > ALLOWED-AMTSTEP 6: PercentageDivide the count of claim lines from STEP 5 by the count of claim lines from STEP 4
04/24/2025	4.0.7	FFS-49-010-10	ADD	N/A		Created
08/13/2025	4.0.16	FFS-49-009-9	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" STEP 3: Claim Line DetailOf the claims that meet the criteria from STEP2, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 4: Non-missing Medicaid paid and allowed amountsOf the records from STEP 3, further refine the population with the following criteria: 1. MEDICAID-PAID-AMT is not missing2. ALLOWED-AMT is not missing3. ALLOWED-AMT is not equal to 0STEP 5: Medicaid paid is greater than allowedOf the records from STEP 4, further refine the population with the following criteria:1. MEDICAID-PAID-AMT > ALLOWED-AMTSTEP 6: PercentageDivide the count of claim lines from STEP 5 by the count of claim lines from STEP 4	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" STEP 3: Claim Line DetailOf the claims that meet the criteria from STEP2, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 4: Non-missing Medicaid paid and allowed amountsOf the records from STEP 3, further refine the population with the following criteria: 1. MEDICAID-PAID-AMT is not missing2. ALLOWED-AMT is not missing3. ALLOWED-AMT is not equal to 0STEP 5: Medicaid paid is greater than allowedOf the records from STEP 4, further refine the population with the following criteria:1. MEDICAID-PAID-AMT > ALLOWED-AMTSTEP 6: PercentageDivide the count of claim lines from STEP 5 by the count of claim lines from STEP 4
04/24/2025	4.0.7	FFS-49-009-9	ADD	N/A		Created
11/20/2025	4.0.22	FFS-49-008-8	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP FFS: original, paid RX claims where the total Medicaid paid amount is greater than the total allowed amount	N/A
11/20/2025	4.0.22	FFS-49-008-8	UPDATE	Specification	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0"STEP 3: Non-missing total Medicaid paid and allowed amountsOf the records from STEP 2, further refine the population with the following criteria: 1. TOT-MEDICAID-PAID-AMT is not missing2. TOT-ALLOWED-AMT is not missing3. TOT-ALLOWED-AMT is not equal to zeroSTEP 4: Total Medicaid paid is greater than total allowed Of the records from STEP 3, further refine the population with the following criteria:1. TOT-MEDICAID-PAID-AMT > TOT-ALLOWED-AMTSTEP 5: PercentageDivide the count of claims from STEP 4 by the count of claims from STEP 3	N/A
04/24/2025	4.0.7	FFS-49-008-8	ADD	N/A		Created
11/20/2025	4.0.22	FFS-49-007-7	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP FFS: original, paid OT claims where the total Medicaid paid amount is greater than the total allowed amount	N/A
11/20/2025	4.0.22	FFS-49-007-7	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0"STEP 3: Non-missing total Medicaid paid and allowed amountsOf the records from STEP 2, further refine the population with the following criteria: 1. TOT-MEDICAID-PAID-AMT is not missing2. TOT-ALLOWED-AMT is not missing3. TOT-ALLOWED-AMT is not equal to zeroSTEP 4: Total Medicaid paid is greater than total allowed Of the records from STEP 3, further refine the population with the following criteria:1. TOT-MEDICAID-PAID-AMT > TOT-ALLOWED-AMTSTEP 5: PercentageDivide the count of claims from STEP 4 by the count of claims from STEP 3	N/A
04/24/2025	4.0.7	FFS-49-007-7	ADD	N/A		Created
11/20/2025	4.0.22	FFS-49-006-6	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP FFS: original, paid LT claims where the total Medicaid paid amount is greater than the total allowed amount	N/A
11/20/2025	4.0.22	FFS-49-006-6	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0"STEP 3: Non-missing total Medicaid paid and allowed amountsOf the records from STEP 2, further refine the population with the following criteria: 1. TOT-MEDICAID-PAID-AMT is not missing2. TOT-ALLOWED-AMT is not missing3. TOT-ALLOWED-AMT is not equal to zeroSTEP 4: Total Medicaid paid is greater than total allowed Of the records from STEP 3, further refine the population with the following criteria:1. TOT-MEDICAID-PAID-AMT > TOT-ALLOWED-AMTSTEP 5: PercentageDivide the count of claims from STEP 4 by the count of claims from STEP 3	N/A
04/24/2025	4.0.7	FFS-49-006-6	ADD	N/A		Created
11/20/2025	4.0.22	FFS-49-005-5	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP FFS: original, paid IP claims where the total Medicaid paid amount is greater than the total allowed amount	N/A
11/20/2025	4.0.22	FFS-49-005-5	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0"STEP 3: Non-missing total Medicaid paid and allowed amountsOf the records from STEP 2, further refine the population with the following criteria: 1. TOT-MEDICAID-PAID-AMT is not missing2. TOT-ALLOWED-AMT is not missing3. TOT-ALLOWED-AMT is not equal to 0STEP 4: Total Medicaid paid is greater than total allowed Of the records from STEP 3, further refine the population with the following criteria:1. TOT-MEDICAID-PAID-AMT > TOT-ALLOWED-AMTSTEP 5: PercentageDivide the count of claims from STEP 4 by the count of claims from STEP 3	N/A
04/24/2025	4.0.7	FFS-49-005-5	ADD	N/A		Created
04/24/2025	4.0.7	FFS-49-004-4	ADD	N/A		Created
04/24/2025	4.0.7	FFS-49-003-3	ADD	N/A		Created
04/24/2025	4.0.7	FFS-49-002-2	ADD	N/A		Created
04/24/2025	4.0.7	FFS-49-001-1	ADD	N/A		Created
08/13/2025	4.0.16	EXP-24-009-9	UPDATE	Specification	STEP 1: Active non-duplicate paid capitation payment financial transactions during report monthDefine the FTX universe for the FTX0002, FTX0003, and FTX0005 tables respectively by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Capitation Payment: Original, Paid ClaimsOf the records that meet the criteria from STEP 1, further restrict them by the following criteria:1. MBESCBES-FORM-GROUP = "3"STEP 3: Payment or Recoupment Amount $0 or missingOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1a. PAYMENT-OR-RECOUPMENT-AMOUNT = "0" or is missingOR1b. PAYMENT-AMOUNT= "0" or is missingSTEP 4: Calculate the percentage for the measureDivide the count of records from STEP 3 by the count of records from STEP 2	STEP 1: Active non-duplicate paid capitation payment financial transactions during report monthDefine the FTX universe for the FTX0002, FTX0003, and FTX0005 tables respectively by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Capitation Payment: Original, Paid ClaimsOf the records that meet the criteria from STEP 1, further restrict them by the following criteria:1. MBESCBES-FORM-GROUP = "3"2. ADJUSTMENT-IND = "0"STEP 3: Payment or Recoupment Amount $0 or missingOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1a. PAYMENT-OR-RECOUPMENT-AMOUNT = "0" or is missingOR1b. PAYMENT-AMOUNT= "0" or is missingSTEP 4: Calculate the percentage for the measureDivide the count of records from STEP 3 by the count of records from STEP 2
04/24/2025	4.0.7	EXP-24-009-9	ADD	N/A		Created
08/13/2025	4.0.16	EXP-22-009-9	UPDATE	Specification	STEP 1: Active non-duplicate paid capitation payment financial transactions during report monthDefine the FTX universe for the FTX0002, FTX0003, and FTX0005 tables respectively by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Capitation Payment: Original, Paid ClaimsOf the records that meet the criteria from STEP 1, further restrict them by the following criteria:1. MBESCBES-FORM-GROUP = "1" or "2"STEP 3: Payment or Recoupment Amount $0 or missingOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1a. PAYMENT-OR-RECOUPMENT-AMOUNT = "0" or is missingOR1b. PAYMENT-AMOUNT= "0" or is missingSTEP 4: Calculate the percentage for the measureDivide the count of records from STEP 3 by the count of records from STEP 2	STEP 1: Active non-duplicate paid capitation payment financial transactions during report monthDefine the FTX universe for the FTX0002, FTX0003, and FTX0005 tables respectively by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Capitation Payment: Original, Paid ClaimsOf the records that meet the criteria from STEP 1, further restrict them by the following criteria:1. MBESCBES-FORM-GROUP = "1" or "2" 2. ADJUSTMENT-IND = "0"STEP 3: Payment or Recoupment Amount $0 or missingOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1a. PAYMENT-OR-RECOUPMENT-AMOUNT = "0" or is missingOR1b. PAYMENT-AMOUNT= "0" or is missingSTEP 4: Calculate the percentage for the measureDivide the count of records from STEP 3 by the count of records from STEP 2
04/24/2025	4.0.7	EXP-22-009-9	ADD	N/A		Created
11/20/2025	4.0.22	EL-6-028-28	UPDATE	Annotation	Calculate the percentage of rows in the ELG00012 segment with an 1115 waiver type that have a waiver ID in an invalid format	N/A
11/20/2025	4.0.22	EL-6-028-28	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Waiver participation on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment WAIVER-PARTICIPATION-ELG00012 by keeping records that satisfy the following criteria:1a. WAIVER-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. WAIVER-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. WAIVER-ENROLLMENT-EFF-DATE is missing2b. WAIVER-ENROLLMENT-END-DATE is missingSTEP 3: 1115 waiver typeOf the record segments that meet the criteria from STEP 2, keep those that satisfy the following criteria:1. WAIVER-TYPE = "01" or ("21" - "30")STEP 4: Invalid waiver ID valuesOf the record segments that meet the criteria from STEP 3, define invalid WAIVER-ID values by counting the number of segments that meet the following criteria:1. WAIVER-ID does not begin with (“11-W-“ OR “21-W-“)OR2. WAIVER-ID does not contain [0-9] in positions 6-10 and 12 to endOR3. WAIVER-ID position 11 is not "/"OR4. WAIVER-ID is missingSTEP 5: Calculate percentage Divide the count of record segments from STEP 4 by the count of record segments from STEP 3	N/A
04/24/2025	4.0.7	EL-6-028-28	ADD	N/A		Created
11/20/2025	4.0.22	EL-3-013-18	UPDATE	Annotation	Calculate the percentage of unique MSIS IDs classified as Medicaid with an eligibility group indicator associated with it	N/A
11/20/2025	4.0.22	EL-3-013-18	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: Medicaid enrolleesOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:1. CHIP-CODE="1"STEP 4: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 5: CHIP eligibility groupOf the MSIS IDs that meet the criteria from STEP 3, keep the MSIS IDs that satisfy the following criteria:1. ELIGIBILITY-GROUP = ("61", "62", "63, "64", "65", "66", "67", or "68")STEP 6: PercentageDivide the count of unique MSIS IDs from STEP 5 by the count in STEP 3	N/A
04/24/2025	4.0.7	EL-3-013-18	ADD	N/A		Created
04/24/2025	4.0.7	EL-3-012-17	ADD	N/A		Created
11/20/2025	4.0.22	EL-6-025-25	UPDATE	Annotation	Calculate the percentage of family planning restricted benefit eligibles that do not have a family planning eligibility group	N/A
11/20/2025	4.0.22	EL-6-025-25	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Family planning restricted benefit eligiblesOf the MSIS IDs which meet the criteria from STEP 3, restrict to those with family planning:1. RESTRICTED-BENEFITS-CODE = "6"STEP 4: Non-family planning eligibility groupOf the MSIS IDs that meet the criteria from STEP 3, further refine the population that satisfy the following criteria:1. ELIGIBILITY-GROUP not equal to ("35" or "70") or missingSTEP 5: Calculate percentageDivide the count of unique MSIS IDs from STEP 4 by the count of unique MSIS IDs from STEP 3	N/A
04/24/2025	4.0.7	EL-6-025-25	ADD	N/A		Created
04/24/2025	4.0.7	EL-6-022-22	ADD	N/A		Created
11/20/2025	4.0.22	EL-3-002_4-32	UPDATE	Annotation	Calculate the percentage of S-CHIP eligibles defined by CHIP-CODE that are designated as Medicaid according to ENROLLMENT-TYPE	N/A
11/20/2025	4.0.22	EL-3-002_4-32	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: S-CHIPOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:1. CHIP-CODE = "3"STEP 4: Medicaid enrollment typeOf the records that meet the criteria rom STEP 3, further refine the population by keeping records that satisfy the following criteria:1. ENROLLMENT-TYPE = "1"STEP 5: PercentageDivide the count of unique MSIS IDs from STEP 4 by the count of unique MSIS IDs from STEP 3	N/A
04/24/2025	4.0.7	EL-3-002_4-32	ADD	N/A		Created
11/20/2025	4.0.22	EL-3-002_3-16	UPDATE	Annotation	Calculate the percentage of M-CHIP eligibles defined by CHIP-CODE that are designated as S-CHIP according to ENROLLMENT-TYPE	N/A
11/20/2025	4.0.22	EL-3-002_3-16	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: M-CHIPOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:1. CHIP-CODE = "2"STEP 4: S-CHIP enrollment typeOf the records that meet the criteria rom STEP 3, further refine the population by keeping records that satisfy the following criteria:1. ENROLLMENT-TYPE = "2"STEP 5: PercentageDivide the count of unique MSIS IDs from STEP 4 by the count of unique MSIS IDs from STEP 3	N/A
04/24/2025	4.0.7	EL-3-002_3-16	ADD	N/A		Created
11/20/2025	4.0.22	EL-3-002_2-31	UPDATE	Annotation	Calculate the percentage of Medicaid eligibles defined by CHIP-CODE that are designated as S-CHIP according to ENROLLMENT-TYPE	N/A
11/20/2025	4.0.22	EL-3-002_2-31	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: Medicaid CHIP codeOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:1. CHIP-CODE = "1"STEP 4: S-CHIP enrollment typeOf the records that meet the criteria rom STEP 3, further refine the population by keeping records that satisfy the following criteria:1. ENROLLMENT-TYPE = "2"STEP 5: PercentageDivide the count of unique MSIS IDs from STEP 4 by the count of unique MSIS IDs from STEP 3	N/A
04/24/2025	4.0.7	EL-3-002_2-31	ADD	N/A		Created
11/20/2025	4.0.22	EL-3-001_2-14	UPDATE	Annotation	Calculate the percentage of unique MSIS IDs that are associated with more than one primary eligibility group record of all unique MSIS IDs	N/A
11/20/2025	4.0.22	EL-3-001_2-14	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Count duplicate MSIS IDsOf the MSIS IDs that meet the criteria from STEP 2, count the number of unique MSIS IDs that appear more than onceSTEP 4: PercentageDivide the count of unique MSIS IDs from STEP 3 by the count in STEP 1	N/A
04/24/2025	4.0.7	EL-3-001_2-14	ADD	N/A		Created
11/20/2025	4.0.22	EL-3-000-12	UPDATE	Annotation	Calculate the percentage of unique MSIS IDs with a primary eligibility group indicator and with an invalid or missing eligibility group code of all unique MSIS IDs with a primary eligibility group indicator	N/A
11/20/2025	4.0.22	EL-3-000-12	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Invalid eligibility groupOf the MSIS IDs that meet the criteria from STEP 2, count the number of unique MSIS IDs where ELIGIBILITY-GROUP is not equal to (01-09 or 11-56 or 59-76)STEP 4: PercentageDivide the count of unique MSIS IDs from STEP 3 by the count in STEP 1Note: This can include MSIS IDs from STEP 1 that did not join to an eligibility determinants segment.	N/A
04/24/2025	4.0.7	EL-3-000-12	ADD	N/A		Created
04/24/2025	4.0.7	EL-17-003-3	ADD	N/A		Created
04/24/2025	4.0.7	EL-17-002-2	ADD	N/A		Created
04/24/2025	4.0.7	EL-17-001-1	ADD	N/A		Created
04/24/2025	4.0.7	EL-16-009-9	ADD	N/A		Created
04/24/2025	4.0.7	EL-16-008-8	ADD	N/A		Created
04/24/2025	4.0.7	ALL-13-004-4	ADD	N/A		Created
04/24/2025	4.0.7	ALL-13-003-3	ADD	N/A		Created
11/20/2025	4.0.22	ALL-13-002-2	UPDATE	Annotation	Calculate the percentage of MSIS IDs on Medicaid FFS and Encounter: original, paid RX claims that: 1) can be found on an Eligible file enrollment time span segment, 2) can be found on an Eligible file eligibility determinant segment that spans the beginning date of service on the claims file, and 3) are limited to family planning benefits which also have a non-family planning program type	N/A
11/20/2025	4.0.22	ALL-13-002-2	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS and Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3"2. ADJUSTMENT_IND = "0"STEP 3: Non-missing prescription fill dateOf the claims that meet the criteria from STEP 2, restrict to non-missing PRESCRIPTION-FILL-DATESTEP 4: Link claims to enrollment time spanKeep all claims from STEP 3 for which the MSIS ID on the claim is also found on an ENROLLMENT-TIME-SPAN-ELG00021 segmentSTEP 5: Family planning during date of serviceLink MSIS-IDs from the claims in STEP 4 to the ELIGIBILITY-DETERMINANTS-ELG00005 file segment and keep segments that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12. RESTRICTED-BENEFIT-CODE = "6"3. Claims PRESCRIPTION-FILL-DATE >= ELIGIBILITY-DETERMINANT-EFF-DATE4. Claims PRESCRIPTION-FILL-DATE <= ELIGIBILITY-DETERMINANT-END-DATE OR ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 6: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 5, limit to unique MSIS-IDsSTEP 7: Non-family planning servicesOf the claims that meet the criteria from STEP 5, restrict to claims with:1a. PROGRAM-TYPE not equal to "2"OR1b. PROGRAM-TYPE is missingSTEP 8: Calculate percentageDivide the count of unique MSIS-IDs from STEP 7 by the count of MSIS-IDs from STEP 6	N/A
04/24/2025	4.0.7	ALL-13-002-2	ADD	N/A		Created
11/20/2025	4.0.22	ALL-13-001-1	UPDATE	Annotation	Calculate the percentage of MSIS IDs on Medicaid FFS and Encounter: original, paid OT claims that: 1) can be found on an Eligible file enrollment time span segment, 2) can be found on an Eligible file eligibility determinant segment that spans the beginning date of service on the claims file, and 3) are limited to family planning benefits which also have a non-family planning program type	N/A
11/20/2025	4.0.22	ALL-13-001-1	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS and Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3"2. ADJUSTMENT_IND = "0"STEP 3: Non-missing beginning date of serviceOf the claims that meet the criteria from STEP 2, restrict to non-missing BEGINNING-DATE-OF-SERVICESTEP 4: Link claims to enrollment time spanKeep all claims from STEP 3 for which the MSIS ID on the claim is also found on an ENROLLMENT-TIME-SPAN-ELG00021 segmentSTEP 5: Family planning during date of serviceLink MSIS-IDs from the claims in STEP 4 to the ELIGIBILITY-DETERMINANTS-ELG00005 file segment and keep segments that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12. RESTRICTED-BENEFIT-CODE = "6"3. Claims BEGINNING-DATE-OF-SERVICE >= ELIGIBILITY-DETERMINANT-EFF-DATE4. Claims BEGINNING-DATE-OF-SERVICE <= ELIGIBILITY-DETERMINANT-END-DATE OR ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 6: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 5, limit to unique MSIS-IDsSTEP 7: Non-family planning servicesOf the claims that meet the criteria from STEP 5, restrict to claims with:1a. PROGRAM-TYPE not equal to "2"OR1b. PROGRAM-TYPE is missingSTEP 8: Calculate percentageDivide the count of unique MSIS-IDs from STEP 7 by the count of MSIS-IDs from STEP 6	N/A
04/24/2025	4.0.7	ALL-13-001-1	ADD	N/A		Created
11/20/2025	4.0.22	ALL-12-001-1	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP FFS and Encounter: original and adjustment, paid OT claims that are classified as EPSDT, family planning, or FQHC according to program type	N/A
11/20/2025	4.0.22	ALL-12-001-1	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS and Encounter: Original, Non-Crossover Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" or "A" or "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: EPSDT, Family planning, FQHCOf the claims that meet the criteria from STEP 2, limit to those that satisfy the following criterion:1. PROGRAM-TYPE = "01" or "02" or "04"STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count in STEP 2	N/A
04/24/2025	4.0.7	ALL-12-001-1	ADD	N/A		Created
04/24/2025	4.0.7	TPL-8-005-5	ADD	N/A		Created
04/24/2025	4.0.7	TPL-8-004-4	ADD	N/A		Created
04/24/2025	4.0.7	TPL-8-003-3	ADD	N/A		Created
04/24/2025	4.0.7	TPL-8-002-2	ADD	N/A		Created
04/24/2025	4.0.7	TPL-8-001-1	ADD	N/A		Created
04/24/2025	4.0.7	PRV-5-009-9	ADD	N/A		Created
04/24/2025	4.0.7	PRV-5-008-8	ADD	N/A		Created
04/24/2025	4.0.7	PRV-5-007-7	ADD	N/A		Created
04/24/2025	4.0.7	PRV-5-006-6	ADD	N/A		Created
04/24/2025	4.0.7	PRV-5-005-5	ADD	N/A		Created
04/24/2025	4.0.7	PRV-5-004-4	ADD	N/A		Created
04/24/2025	4.0.7	PRV-5-003-3	ADD	N/A		Created
04/24/2025	4.0.7	PRV-5-002-2	ADD	N/A		Created
04/24/2025	4.0.7	PRV-5-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-58-008-8	ADD	N/A		Created
04/24/2025	4.0.7	MCR-58-007-7	ADD	N/A		Created
04/24/2025	4.0.7	MCR-58-006-6	ADD	N/A		Created
04/24/2025	4.0.7	MCR-58-005-5	ADD	N/A		Created
04/24/2025	4.0.7	MCR-58-004-4	ADD	N/A		Created
04/24/2025	4.0.7	MCR-58-003-3	ADD	N/A		Created
04/24/2025	4.0.7	MCR-58-002-2	ADD	N/A		Created
04/24/2025	4.0.7	MCR-58-001-1	ADD	N/A		Created
11/20/2025	4.0.22	MCR-57-001-1	UPDATE	Annotation	The percentage of claims that are S-CHIP Encounter: original and adjustment, and paid where patient status is not "Still a patient" and the discharge date is missing	N/A
11/20/2025	4.0.22	MCR-57-001-1	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"STEP 3: Patient status is not "Still a Patient"Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. PATIENT-STATUS is not equal to "30"2. PATIENT-STATUS is not missingSTEP 4: Missing discharge dateOf the claims from STEP 3, select records where:1. DISCHARGE-DATE is missingSTEP 5: Calculate percentageDivide the number of claims from STEP 4 by the number of claims from STEP 3	N/A
04/24/2025	4.0.7	MCR-57-001-1	ADD	N/A		Created
11/20/2025	4.0.22	MCR-56-001-1	UPDATE	Annotation	The percentage of claims that are Medicaid Encounter: original and adjustment, and paid where patient status is not "Still a patient" and the discharge date is missing	N/A
11/20/2025	4.0.22	MCR-56-001-1	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Patient status is not "Still a Patient"Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. PATIENT-STATUS is not equal to "30"2. PATIENT-STATUS is not missingSTEP 4: Missing discharge dateOf the claims from STEP 3, select records where:1. DISCHARGE-DATE is missingSTEP 5: Calculate percentageDivide the number of claims from STEP 4 by the number of claims from STEP 3	N/A
04/24/2025	4.0.7	MCR-56-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-3-018-21	ADD	N/A		Created
04/24/2025	4.0.7	MCR-3-017-20	ADD	N/A		Created
04/24/2025	4.0.7	MCR-3-014-19	ADD	N/A		Created
08/13/2025	4.0.16	MCR-1-017-21	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Ancillary revenue codesOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria: REVENUE-CODE IN “0220” through “0998”STEP 4: Unique header recordsCount the number of unique header records that meet the criteria from STEP 3STEP 5: Unique line recordsCount the number of unique line records that meet the criteria from STEP 3STEP 6: Calculate the average for measureDivide the count from STEP 5 by the count from STEP 4	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Ancillary revenue codesOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria: REVENUE-CODE IN “0220” through “0998”STEP 4: Unique header recordsCount the number of unique header records that meet the criteria from STEP 3STEP 5: Unique line recordsCount the number of unique line records that meet the criteria from STEP 3STEP 6: Calculate the average for measureDivide the count from STEP 5 by the count from STEP 4
04/24/2025	4.0.7	MCR-1-017-21	ADD	N/A		Created
08/13/2025	4.0.16	MCR-1-016-20	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Accommodation revenue codesOf the claims that meet the criteria from STEP 2, select records where: 1. REVENUE-CODE = "0100" through "0219"STEP 4: Unique header recordsCount the number of unique header records that meet the criteria from STEP 3STEP 5: Unique line recordsCount the number of unique line records that meet the criteria from STEP 3STEP 6: Calculate the average for measureDivide the count from STEP 5 by the count from STEP 4	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Accommodation revenue codesOf the claims that meet the criteria from STEP 2, select records where: 1. REVENUE-CODE = "0100" through "0219"STEP 4: Unique header recordsCount the number of unique header records that meet the criteria from STEP 3STEP 5: Unique line recordsCount the number of unique line records that meet the criteria from STEP 3STEP 6: Calculate the average for measureDivide the count from STEP 5 by the count from STEP 4
04/24/2025	4.0.7	MCR-1-016-20	ADD	N/A		Created
04/24/2025	4.0.7	MCR-1-013-19	ADD	N/A		Created
04/24/2025	4.0.7	FFS-48-001-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-47-001-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-46-001-1	ADD	N/A		Created
11/20/2025	4.0.22	FFS-45-001-1	UPDATE	Annotation	The percentage of Medicaid FFS: original and adjustment, crossover, paid OT claims where the sum of the Medicare deductible amount and Medicare coinsurance amount does not equal total Medicaid paid amount	N/A
11/20/2025	4.0.22	FFS-45-001-1	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Crossover Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. CROSSOVER-INDICATOR = "1"STEP 3: Total Medicare deductible and coinsurance amountOf the claims that meet the criteria from STEP 2, calculate the sum of TOT-MEDICARE-COINS-AMT* and TOT-MEDICARE-DEDUCTIBLE-AMTNote: Missing values are converted to 0 before calculating the sumSTEP 4: Claims where total Medicare deductibles and coinsurance amounts do not equal Medicaid paid amountsCount the number of claims where the sum from STEP 3 does NOT equal TOT-MEDICAID-PAID-AMTNote: Missing values are converted to 0 before comparisonSTEP 5: Calculate the percentage for the measureDivide the count from STEP 4 by the count from STEP 2	N/A
04/24/2025	4.0.7	FFS-45-001-1	ADD	N/A		Created
11/20/2025	4.0.22	FFS-44-001-1	UPDATE	Annotation	The percentage of Medicaid FFS: original and adjustment, crossover, paid LT claims where the sum of the Medicare deductible amount and Medicare coinsurance amount does not equal total Medicaid paid amount	N/A
11/20/2025	4.0.22	FFS-44-001-1	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Crossover Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. CROSSOVER-INDICATOR = "1"STEP 3: Total Medicare deductible and coinsurance amountOf the claims that meet the criteria from STEP 2, calculate the sum of TOT-MEDICARE-COINS-AMT* and TOT-MEDICARE-DEDUCTIBLE-AMTNote: Missing values are converted to 0 before calculating the sumSTEP 4: Claims where total Medicare deductibles and coinsurance amounts do not equal Medicaid paid amountsCount the number of claims where the sum from STEP 3 does NOT equal TOT-MEDICAID-PAID-AMTNote: Missing values are converted to 0 before comparisonSTEP 5: Calculate the percentage for the measureDivide the count from STEP 4 by the count from STEP 2	N/A
04/24/2025	4.0.7	FFS-44-001-1	ADD	N/A		Created
11/20/2025	4.0.22	FFS-43-001-1	UPDATE	Annotation	The percentage of Medicaid FFS: original and adjustment, crossover, paid IP claims where the sum of the Medicare deductible amount and Medicare coinsurance amount does not equal total Medicaid paid amount	N/A
11/20/2025	4.0.22	FFS-43-001-1	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Crossover Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. CROSSOVER-INDICATOR = "1"STEP 3: Total Medicare deductible and coinsurance amountOf the claims that meet the criteria from STEP 2, calculate the sum of TOT-MEDICARE-COINS-AMT* and TOT-MEDICARE-DEDUCTIBLE-AMTNote: Missing values are converted to 0 before calculating the sumSTEP 4: Claims where total Medicare deductibles and coinsurance amounts do not equal Medicaid paid amountsCount the number of claims where the sum from STEP 3 does NOT equal TOT-MEDICAID-PAID-AMTNote: Missing values are converted to 0 before comparisonSTEP 5: Calculate the percentage for the measureDivide the count from STEP 4 by the count from STEP 2	N/A
04/24/2025	4.0.7	FFS-43-001-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-3-018-21	ADD	N/A		Created
04/24/2025	4.0.7	FFS-3-017-20	ADD	N/A		Created
04/24/2025	4.0.7	FFS-3-014-19	ADD	N/A		Created
08/13/2025	4.0.16	FFS-1-018-33	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Ancillary revenue codesOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria: REVENUE-CODE IN “0220” through “0998”STEP 4: Unique header recordsCount the number of unique header records that meet the criteria from STEP 3STEP 5: Unique line recordsCount the number of unique line records that meet the criteria from STEP 3STEP 6: Calculate the average for measureDivide the count from STEP 5 by the count from STEP 4	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Ancillary revenue codesOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria: REVENUE-CODE IN “0220” through “0998”STEP 4: Unique header recordsCount the number of unique header records that meet the criteria from STEP 3STEP 5: Unique line recordsCount the number of unique line records that meet the criteria from STEP 3STEP 6: Calculate the average for measureDivide the count from STEP 5 by the count from STEP 4
04/24/2025	4.0.7	FFS-1-018-33	ADD	N/A		Created
08/13/2025	4.0.16	FFS-1-017-32	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Accommodation revenue codesOf the claims that meet the criteria from STEP 2, select records where: 1. REVENUE-CODE = "0100" through "0219"STEP 4: Unique header recordsCount the number of unique header records that meet the criteria from STEP 3STEP 5: Unique line recordsCount the number of unique line records that meet the criteria from STEP 3STEP 6: Calculate the average for measureDivide the count from STEP 5 by the count from STEP 4	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Accommodation revenue codesOf the claims that meet the criteria from STEP 2, select records where: 1. REVENUE-CODE = "0100" through "0219"STEP 4: Unique header recordsCount the number of unique header records that meet the criteria from STEP 3STEP 5: Unique line recordsCount the number of unique line records that meet the criteria from STEP 3STEP 6: Calculate the average for measureDivide the count from STEP 5 by the count from STEP 4
04/24/2025	4.0.7	FFS-1-017-32	ADD	N/A		Created
04/24/2025	4.0.7	FFS-1-014-31	ADD	N/A		Created
11/20/2025	4.0.22	EXP-42-001-1	UPDATE	Annotation	Calculate the percentage of S-CHIP Encounter: original, non-crossover, paid RX claims where total Medicaid paid amount is equal to $0 or missing	N/A
11/20/2025	4.0.22	EXP-42-001-1	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Total Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 3, restrict to claims that meet the following criteria:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 5: Calculate percentageDivide the number of claims from STEP 4 by the number of claims from STEP 3.	N/A
04/24/2025	4.0.7	EXP-42-001-1	ADD	N/A		Created
11/20/2025	4.0.22	EXP-41-001-1	UPDATE	Annotation	The percentage of Medicaid Encounter: original, non-crossover, paid RX claims that have total Medicaid paid amount equal to $0 or missing	N/A
11/20/2025	4.0.22	EXP-41-001-1	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Total Medicaid paid $0 or missingOf the claims from STEP 3, select records where:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3.	N/A
04/24/2025	4.0.7	EXP-41-001-1	ADD	N/A		Created
11/20/2025	4.0.22	EXP-40-001-1	UPDATE	Annotation	Calculate the percentage of S-CHIP Encounter: original, crossover, paid OT claims where total Medicaid paid amount is equal to $0 or missing	N/A
11/20/2025	4.0.22	EXP-40-001-1	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "1"STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Total Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 3, restrict to claims that meet the following criteria:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 5: Calculate percentageDivide the number of claims from STEP 4 by the number of claims from STEP 3.	N/A
04/24/2025	4.0.7	EXP-40-001-1	ADD	N/A		Created
04/24/2025	4.0.7	EXP-39-001-1	ADD	N/A		Created
11/20/2025	4.0.22	EXP-38-001-1	UPDATE	Annotation	The percentage of Medicaid Encounter: original, crossover, paid OT claims that have total Medicaid paid amount equal to $0 or missing	N/A
11/20/2025	4.0.22	EXP-38-001-1	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "1"STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Total Medicaid paid $0 or missingOf the claims from STEP 3, select records where:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3.	N/A
04/24/2025	4.0.7	EXP-38-001-1	ADD	N/A		Created
04/24/2025	4.0.7	EXP-37-001-1	ADD	N/A		Created
11/20/2025	4.0.22	EXP-36-001-1	UPDATE	Annotation	Calculate the percentage of S-CHIP Encounter: original, crossover, paid LT claims where total Medicaid paid amount is equal to $0 or missing	N/A
11/20/2025	4.0.22	EXP-36-001-1	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "1"STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Total Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 3, restrict to claims that meet the following criteria:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 5: Calculate percentageDivide the number of claims from STEP 4 by the number of claims from STEP 3.	N/A
04/24/2025	4.0.7	EXP-36-001-1	ADD	N/A		Created
11/20/2025	4.0.22	EXP-35-001-1	UPDATE	Annotation	Calculate the percentage of S-CHIP Encounter: original, non-crossover, paid LT claims where total Medicaid paid amount is equal to $0 or missing	N/A
11/20/2025	4.0.22	EXP-35-001-1	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Total Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 3, restrict to claims that meet the following criteria:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 5: Calculate percentageDivide the number of claims from STEP 4 by the number of claims from STEP 3.	N/A
04/24/2025	4.0.7	EXP-35-001-1	ADD	N/A		Created
11/20/2025	4.0.22	EXP-34-001-1	UPDATE	Annotation	The percentage of Medicaid Encounter: original, crossover, paid LT claims that have total Medicaid paid amount equal to $0 or missing	N/A
11/20/2025	4.0.22	EXP-34-001-1	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "1"STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Total Medicaid paid $0 or missingOf the claims from STEP 3, select records where:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3.	N/A
04/24/2025	4.0.7	EXP-34-001-1	ADD	N/A		Created
11/20/2025	4.0.22	EXP-33-001-1	UPDATE	Annotation	The percentage of Medicaid Encounter: original, non-crossover, paid LT claims that have total Medicaid paid amount equal to $0 or missing	N/A
11/20/2025	4.0.22	EXP-33-001-1	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Total Medicaid paid $0 or missingOf the claims from STEP 3, select records where:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3.	N/A
04/24/2025	4.0.7	EXP-33-001-1	ADD	N/A		Created
11/20/2025	4.0.22	EXP-32-001-1	UPDATE	Annotation	Calculate the percentage of S-CHIP Encounter: original, crossover, paid IP claims where total Medicaid paid amount is equal to $0 or missing	N/A
11/20/2025	4.0.22	EXP-32-001-1	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "1"STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Total Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 3, restrict to claims that meet the following criteria:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 5: Calculate percentageDivide the number of claims from STEP 4 by the number of claims from STEP 3.	N/A
04/24/2025	4.0.7	EXP-32-001-1	ADD	N/A		Created
11/20/2025	4.0.22	EXP-31-001-1	UPDATE	Annotation	Calculate the percentage of S-CHIP Encounter: original, non-crossover, paid IP claims where total Medicaid paid amount is equal to $0 or missing	N/A
11/20/2025	4.0.22	EXP-31-001-1	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Total Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 3, restrict to claims that meet the following criteria:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 5: Calculate percentageDivide the number of claims from STEP 4 by the number of claims from STEP 3.	N/A
04/24/2025	4.0.7	EXP-31-001-1	ADD	N/A		Created
11/20/2025	4.0.22	EXP-30-001-1	UPDATE	Annotation	The percentage of Medicaid Encounter: original, crossover, paid IP claims that have total Medicaid paid amount equal to $0 or missing	N/A
11/20/2025	4.0.22	EXP-30-001-1	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "1"STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Total Medicaid paid $0 or missingOf the claims from STEP 3, select records where:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	N/A
04/24/2025	4.0.7	EXP-30-001-1	ADD	N/A		Created
11/20/2025	4.0.22	EXP-29-001-1	UPDATE	Annotation	The percentage of Medicaid Encounter: original, non-crossover, paid IP claims that have total Medicaid paid amount equal to $0 or missing	N/A
11/20/2025	4.0.22	EXP-29-001-1	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Total Medicaid paid $0 or missingOf the claims from STEP 3, select records where:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	N/A
04/24/2025	4.0.7	EXP-29-001-1	ADD	N/A		Created
04/24/2025	4.0.7	EXP-28-002-2	ADD	N/A		Created
11/20/2025	4.0.22	EXP-28-001-1	UPDATE	Annotation	Calculate the percentage of S-CHIP FFS: original, crossover, paid OT claims where total Medicaid paid amount is equal to $0 or missing	N/A
11/20/2025	4.0.22	EXP-28-001-1	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "1"STEP 3: Total Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 2, restrict to claims that meet the following criteria:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 4: Calculate percentageDivide the number of claims from STEP 3 by the number of claims from STEP 2.	N/A
04/24/2025	4.0.7	EXP-28-001-1	ADD	N/A		Created
04/24/2025	4.0.7	EXP-27-002-2	ADD	N/A		Created
11/20/2025	4.0.22	EXP-27-001-1	UPDATE	Annotation	The percentage of Medicaid FFS: original, crossover, paid OT claims that have total Medicaid paid amount equal to $0 or missing	N/A
11/20/2025	4.0.22	EXP-27-001-1	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "1"STEP 3: Total Medicaid paid $0 or missingOf the claims from STEP 2, select records where:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	EXP-27-001-1	ADD	N/A		Created
04/24/2025	4.0.7	EL-6-024-24	ADD	N/A		Created
11/20/2025	4.0.22	EL-6-023-23	UPDATE	Annotation	Count the total number of MSIS IDs that receive full benefits determined by restricted benefits code	N/A
11/20/2025	4.0.22	EL-6-023-23	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Full-benefit enrolleesOf the MSIS ID's that meet the criteria from step 2, count the unique number of MSIS IDs where:1. RESTRICTED-BENEFITS-CODE = ("1", "4", "5" "7", "A", "B", "D") or is missing**Note: This can include MSIS IDs from STEP 1 that did not join to an eligibility determinants segment.	N/A
04/24/2025	4.0.7	EL-6-023-23	ADD	N/A		Created
10/07/2025	4.0.19	EL-15-002-2	UPDATE	Grace period expiration date	None	2023-05-31
04/24/2025	4.0.7	EL-15-002-2	ADD	N/A		Created
10/07/2025	4.0.19	EL-15-001-1	UPDATE	Grace period expiration date	None	2024-11-29
04/24/2025	4.0.7	EL-15-001-1	ADD	N/A		Created
04/24/2025	4.0.7	EL-16-007-7	ADD	N/A		Created
04/24/2025	4.0.7	EL-16-006-6	ADD	N/A		Created
04/24/2025	4.0.7	EL-16-005-5	ADD	N/A		Created
04/24/2025	4.0.7	EL-16-004-4	ADD	N/A		Created
04/24/2025	4.0.7	EL-16-003-3	ADD	N/A		Created
04/24/2025	4.0.7	EL-16-002-2	ADD	N/A		Created
04/24/2025	4.0.7	EL-16-001-1	ADD	N/A		Created
04/24/2025	4.0.7	EL-14-019-19	ADD	N/A		Created
04/24/2025	4.0.7	EL-14-018-18	ADD	N/A		Created
04/24/2025	4.0.7	EL-14-017-17	ADD	N/A		Created
04/24/2025	4.0.7	EL-14-016-16	ADD	N/A		Created
04/24/2025	4.0.7	EL-14-015-15	ADD	N/A		Created
04/24/2025	4.0.7	EL-14-014-14	ADD	N/A		Created
04/24/2025	4.0.7	EL-14-013-13	ADD	N/A		Created
04/24/2025	4.0.7	EL-14-012-12	ADD	N/A		Created
04/24/2025	4.0.7	EL-14-011-11	ADD	N/A		Created
04/24/2025	4.0.7	EL-14-010-10	ADD	N/A		Created
04/24/2025	4.0.7	EL-14-009-9	ADD	N/A		Created
04/24/2025	4.0.7	EL-14-008-8	ADD	N/A		Created
04/24/2025	4.0.7	EL-13-001-1	ADD	N/A		Created
04/24/2025	4.0.7	ALL-9-001-1	ADD	N/A		Created
08/13/2025	4.0.16	ALL-8-001-1	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS and Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3"2. ADJUSTMENT-IND = "0"STEP 3: Crossover claimsOf the claims that meet the criteria from STEP 2, select records where 1. CROSSOVER-INDICATOR = "1"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS and Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3"2. ADJUSTMENT-IND = "0"STEP 3: Crossover claimsOf the claims that meet the criteria from STEP 2, select records where 1. CROSSOVER-INDICATOR = "1"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2
04/24/2025	4.0.7	ALL-8-001-1	ADD	N/A		Created
11/20/2025	4.0.22	ALL-7-001-1	UPDATE	Annotation	The percentage of Medicaid FFS: original, paid LT claims that are crossovers	N/A
11/20/2025	4.0.22	ALL-7-001-1	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS and Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3"2. ADJUSTMENT-IND = "0"STEP 3: Crossover claimsOf the claims that meet the criteria from STEP 2, select records where 1. CROSSOVER-INDICATOR = "1"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	ALL-7-001-1	ADD	N/A		Created
11/20/2025	4.0.22	ALL-6-001-1	UPDATE	Annotation	The percentage of Medicaid FFS: original, paid IP claims that are crossovers	N/A
11/20/2025	4.0.22	ALL-6-001-1	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS and Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3"2. ADJUSTMENT-IND = "0"STEP 3: Crossover claimsOf the claims that meet the criteria from STEP 2, select records where 1. CROSSOVER-INDICATOR = "1"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	ALL-6-001-1	ADD	N/A		Created
04/24/2025	4.0.7	ALL-11-001-1	ADD	N/A		Created
04/24/2025	4.0.7	ALL-10-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-9-022-22	ADD	N/A		Created
04/24/2025	4.0.7	MIS-9-021-21	ADD	N/A		Created
04/24/2025	4.0.7	MIS-9-020-20	ADD	N/A		Created
04/24/2025	4.0.7	MIS-9-019-19	ADD	N/A		Created
04/24/2025	4.0.7	MIS-9-018-18	ADD	N/A		Created
04/24/2025	4.0.7	MIS-9-017-17	ADD	N/A		Created
04/24/2025	4.0.7	MIS-9-016-16	ADD	N/A		Created
04/24/2025	4.0.7	MIS-9-015-15	ADD	N/A		Created
04/24/2025	4.0.7	MIS-9-014-14	ADD	N/A		Created
04/24/2025	4.0.7	MIS-9-013-13	ADD	N/A		Created
04/24/2025	4.0.7	MIS-9-012-12	ADD	N/A		Created
04/24/2025	4.0.7	MIS-9-011-11	ADD	N/A		Created
04/24/2025	4.0.7	MIS-9-009-9	ADD	N/A		Created
04/24/2025	4.0.7	MIS-9-008-8	ADD	N/A		Created
04/24/2025	4.0.7	MIS-9-007-7	ADD	N/A		Created
04/24/2025	4.0.7	MIS-9-006-6	ADD	N/A		Created
04/24/2025	4.0.7	MIS-9-005-5	ADD	N/A		Created
04/24/2025	4.0.7	MIS-9-004-4	ADD	N/A		Created
04/24/2025	4.0.7	MIS-9-003-3	ADD	N/A		Created
04/24/2025	4.0.7	MIS-9-002-2	ADD	N/A		Created
04/24/2025	4.0.7	MIS-9-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-8-033-33	ADD	N/A		Created
04/24/2025	4.0.7	MIS-8-032-32	ADD	N/A		Created
04/24/2025	4.0.7	MIS-8-031-31	ADD	N/A		Created
04/24/2025	4.0.7	MIS-8-030-30	ADD	N/A		Created
04/24/2025	4.0.7	MIS-8-029-29	ADD	N/A		Created
04/24/2025	4.0.7	MIS-8-028-28	ADD	N/A		Created
04/24/2025	4.0.7	MIS-8-027-27	ADD	N/A		Created
04/24/2025	4.0.7	MIS-8-026-26	ADD	N/A		Created
04/24/2025	4.0.7	MIS-8-025-25	ADD	N/A		Created
04/24/2025	4.0.7	MIS-8-024-24	ADD	N/A		Created
04/24/2025	4.0.7	MIS-8-023-23	ADD	N/A		Created
04/24/2025	4.0.7	MIS-8-022-22	ADD	N/A		Created
04/24/2025	4.0.7	MIS-8-021-21	ADD	N/A		Created
04/24/2025	4.0.7	MIS-8-020-20	ADD	N/A		Created
04/24/2025	4.0.7	MIS-8-019-19	ADD	N/A		Created
04/24/2025	4.0.7	MIS-8-018-18	ADD	N/A		Created
04/24/2025	4.0.7	MIS-8-017-17	ADD	N/A		Created
04/24/2025	4.0.7	MIS-8-016-16	ADD	N/A		Created
04/24/2025	4.0.7	MIS-8-015-15	ADD	N/A		Created
04/24/2025	4.0.7	MIS-8-014-14	ADD	N/A		Created
04/24/2025	4.0.7	MIS-8-013-13	ADD	N/A		Created
04/24/2025	4.0.7	MIS-8-012-12	ADD	N/A		Created
04/24/2025	4.0.7	MIS-8-011-11	ADD	N/A		Created
04/24/2025	4.0.7	MIS-8-010-10	ADD	N/A		Created
04/24/2025	4.0.7	MIS-8-009-9	ADD	N/A		Created
04/24/2025	4.0.7	MIS-8-008-8	ADD	N/A		Created
04/24/2025	4.0.7	MIS-8-007-7	ADD	N/A		Created
04/24/2025	4.0.7	MIS-8-006-6	ADD	N/A		Created
04/24/2025	4.0.7	MIS-8-005-5	ADD	N/A		Created
04/24/2025	4.0.7	MIS-8-004-4	ADD	N/A		Created
04/24/2025	4.0.7	MIS-8-003-3	ADD	N/A		Created
04/24/2025	4.0.7	MIS-8-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-7-030-31	ADD	N/A		Created
04/24/2025	4.0.7	MIS-7-030-30	ADD	N/A		Created
04/24/2025	4.0.7	MIS-7-029-29	ADD	N/A		Created
04/24/2025	4.0.7	MIS-7-028-28	ADD	N/A		Created
04/24/2025	4.0.7	MIS-7-027-27	ADD	N/A		Created
04/24/2025	4.0.7	MIS-7-026-26	ADD	N/A		Created
04/24/2025	4.0.7	MIS-7-025-25	ADD	N/A		Created
04/24/2025	4.0.7	MIS-7-024-24	ADD	N/A		Created
04/24/2025	4.0.7	MIS-7-023-23	ADD	N/A		Created
04/24/2025	4.0.7	MIS-7-022-22	ADD	N/A		Created
04/24/2025	4.0.7	MIS-7-021-21	ADD	N/A		Created
04/24/2025	4.0.7	MIS-7-020-20	ADD	N/A		Created
04/24/2025	4.0.7	MIS-7-019-19	ADD	N/A		Created
04/24/2025	4.0.7	MIS-7-018-18	ADD	N/A		Created
04/24/2025	4.0.7	MIS-7-017-17	ADD	N/A		Created
04/24/2025	4.0.7	MIS-7-016-16	ADD	N/A		Created
04/24/2025	4.0.7	MIS-7-015-15	ADD	N/A		Created
04/24/2025	4.0.7	MIS-7-014-14	ADD	N/A		Created
04/24/2025	4.0.7	MIS-7-013-13	ADD	N/A		Created
04/24/2025	4.0.7	MIS-7-011-11	ADD	N/A		Created
04/24/2025	4.0.7	MIS-7-010-10	ADD	N/A		Created
04/24/2025	4.0.7	MIS-7-009-9	ADD	N/A		Created
04/24/2025	4.0.7	MIS-7-008-8	ADD	N/A		Created
04/24/2025	4.0.7	MIS-7-007-7	ADD	N/A		Created
04/24/2025	4.0.7	MIS-7-006-6	ADD	N/A		Created
04/24/2025	4.0.7	MIS-7-005-5	ADD	N/A		Created
04/24/2025	4.0.7	MIS-7-004-4	ADD	N/A		Created
04/24/2025	4.0.7	MIS-7-003-3	ADD	N/A		Created
04/24/2025	4.0.7	MIS-7-002-2	ADD	N/A		Created
04/24/2025	4.0.7	MIS-7-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-034-34	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-033-33	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-032-32	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-031-31	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-030-30	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-029-29	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-028-28	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-027-27	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-026-26	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-025-25	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-024-24	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-023-23	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-022-22	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-021-21	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-020-20	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-019-19	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-018-18	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-017-17	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-016-16	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-015-15	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-014-14	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-013-13	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-012-12	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-011-11	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-010-10	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-009-9	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-008-8	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-007-7	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-006-6	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-005-5	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-004-4	ADD	N/A		Created
10/07/2025	4.0.19	MIS-6-003-3	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-6-003-3	ADD	N/A		Created
04/24/2025	4.0.7	MIS-6-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-5-019-19	ADD	N/A		Created
04/24/2025	4.0.7	MIS-5-018-18	ADD	N/A		Created
04/24/2025	4.0.7	MIS-5-017-17	ADD	N/A		Created
04/24/2025	4.0.7	MIS-5-016-16	ADD	N/A		Created
04/24/2025	4.0.7	MIS-5-015-15	ADD	N/A		Created
04/24/2025	4.0.7	MIS-5-014-14	ADD	N/A		Created
04/24/2025	4.0.7	MIS-5-013-13	ADD	N/A		Created
04/24/2025	4.0.7	MIS-5-012-12	ADD	N/A		Created
04/24/2025	4.0.7	MIS-5-011-11	ADD	N/A		Created
04/24/2025	4.0.7	MIS-5-010-10	ADD	N/A		Created
04/24/2025	4.0.7	MIS-5-009-9	ADD	N/A		Created
04/24/2025	4.0.7	MIS-5-008-8	ADD	N/A		Created
04/24/2025	4.0.7	MIS-5-006-6	ADD	N/A		Created
04/24/2025	4.0.7	MIS-5-005-5	ADD	N/A		Created
04/24/2025	4.0.7	MIS-5-004-4	ADD	N/A		Created
08/13/2025	4.0.16	MIS-5-003-3	UPDATE	Measure name	% missing: CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT (CLT00003)	% missing: CATEGORY-FOR-FEDERAL-REIMBURSEMENT (CLT00003)
04/24/2025	4.0.7	MIS-5-003-3	ADD	N/A		Created
04/24/2025	4.0.7	MIS-5-002-2	ADD	N/A		Created
04/24/2025	4.0.7	MIS-5-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-043-43	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-042-42	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-041-41	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-040-40	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-039-39	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-038-38	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-037-37	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-036-36	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-035-35	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-034-34	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-033-33	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-032-32	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-031-31	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-030-30	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-029-29	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-028-28	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-027-27	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-026-26	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-025-25	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-024-24	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-023-23	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-022-22	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-021-21	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-020-20	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-019-19	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-018-18	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-017-17	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-016-16	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-015-15	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-014-14	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-013-13	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-012-12	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-011-11	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-010-10	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-009-9	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-008-8	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-007-7	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-006-6	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-005-5	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-004-4	ADD	N/A		Created
10/07/2025	4.0.19	MIS-4-003-3	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-4-003-3	ADD	N/A		Created
04/24/2025	4.0.7	MIS-4-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-3-017-17	ADD	N/A		Created
04/24/2025	4.0.7	MIS-3-016-16	ADD	N/A		Created
04/24/2025	4.0.7	MIS-3-015-15	ADD	N/A		Created
04/24/2025	4.0.7	MIS-3-014-14	ADD	N/A		Created
04/24/2025	4.0.7	MIS-3-013-13	ADD	N/A		Created
04/24/2025	4.0.7	MIS-3-012-12	ADD	N/A		Created
04/24/2025	4.0.7	MIS-3-011-11	ADD	N/A		Created
04/24/2025	4.0.7	MIS-3-010-10	ADD	N/A		Created
04/24/2025	4.0.7	MIS-3-009-9	ADD	N/A		Created
04/24/2025	4.0.7	MIS-3-008-8	ADD	N/A		Created
04/24/2025	4.0.7	MIS-3-007-7	ADD	N/A		Created
04/24/2025	4.0.7	MIS-3-005-5	ADD	N/A		Created
04/24/2025	4.0.7	MIS-3-004-4	ADD	N/A		Created
04/24/2025	4.0.7	MIS-3-003-3	ADD	N/A		Created
04/24/2025	4.0.7	MIS-3-002-2	ADD	N/A		Created
04/24/2025	4.0.7	MIS-3-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-056-56	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-055-55	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-054-54	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-053-53	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-052-52	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-051-51	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-050-50	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-049-49	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-048-48	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-047-47	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-046-46	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-045-45	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-044-44	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-043-43	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-042-42	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-041-41	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-040-40	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-039-39	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-038-38	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-037-37	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-036-36	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-035-35	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-034-34	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-033-33	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-032-32	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-031-31	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-030-30	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-029-29	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-028-28	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-027-27	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-026-26	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-025-25	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-024-24	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-023-23	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-022-22	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-021-21	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-020-20	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-019-19	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-018-18	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-017-17	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-016-16	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-015-15	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-014-14	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-013-13	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-012-12	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-011-11	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-010-10	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-009-9	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-008-8	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-007-7	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-006-6	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-005-5	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-004-4	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-003-3	ADD	N/A		Created
04/24/2025	4.0.7	MIS-2-001-1	ADD	N/A		Created
11/20/2025	4.0.22	MIS-12-003-3	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-12-003-3	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (TPL0000X)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-12-003-3	ADD	N/A		Created
11/20/2025	4.0.22	MIS-12-002-2	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-12-002-2	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (TPL0000X)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-12-002-2	ADD	N/A		Created
11/20/2025	4.0.22	MIS-11-057-57	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-11-057-57	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-11-057-57	ADD	N/A		Created
11/20/2025	4.0.22	MIS-11-056-56	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-11-056-56	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-11-056-56	ADD	N/A		Created
11/20/2025	4.0.22	MIS-11-055-55	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-11-055-55	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-11-055-55	ADD	N/A		Created
11/20/2025	4.0.22	MIS-11-053-53	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-11-053-53	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-11-053-53	ADD	N/A		Created
11/20/2025	4.0.22	MIS-11-052-52	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-11-052-52	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-11-052-52	ADD	N/A		Created
11/20/2025	4.0.22	MIS-11-051-51	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-11-051-51	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-11-051-51	ADD	N/A		Created
11/20/2025	4.0.22	MIS-11-050-50	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-11-050-50	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-11-050-50	ADD	N/A		Created
11/20/2025	4.0.22	MIS-11-048-48	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-11-048-48	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-11-048-48	ADD	N/A		Created
11/20/2025	4.0.22	MIS-11-046-46	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-11-046-46	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-11-046-46	ADD	N/A		Created
11/20/2025	4.0.22	MIS-11-045-45	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-11-045-45	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-11-045-45	ADD	N/A		Created
11/20/2025	4.0.22	MIS-11-044-44	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-11-044-44	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-11-044-44	ADD	N/A		Created
10/07/2025	4.0.19	MIS-11-043-43	UPDATE	Grace period expiration date	None	2022-11-30
04/24/2025	4.0.7	MIS-11-043-43	ADD	N/A		Created
11/20/2025	4.0.22	MIS-11-041-41	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-11-041-41	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-11-041-41	ADD	N/A		Created
10/07/2025	4.0.19	MIS-11-040-40	UPDATE	Grace period expiration date	None	2022-11-30
04/24/2025	4.0.7	MIS-11-040-40	ADD	N/A		Created
04/24/2025	4.0.7	MIS-11-039-39	ADD	N/A		Created
04/24/2025	4.0.7	MIS-11-038-38	ADD	N/A		Created
11/20/2025	4.0.22	MIS-11-036-36	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-11-036-36	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1NOTE:[Note: “000” is not considered missing]	N/A
04/24/2025	4.0.7	MIS-11-036-36	ADD	N/A		Created
04/24/2025	4.0.7	MIS-11-035-35	ADD	N/A		Created
04/24/2025	4.0.7	MIS-11-034-34	ADD	N/A		Created
11/20/2025	4.0.22	MIS-11-033-33	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-11-033-33	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-11-033-33	ADD	N/A		Created
04/24/2025	4.0.7	MIS-11-032-32	ADD	N/A		Created
04/24/2025	4.0.7	MIS-11-031-31	ADD	N/A		Created
11/20/2025	4.0.22	MIS-11-029-29	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-11-029-29	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1NOTE:[Note: “000” is not considered missing]	N/A
04/24/2025	4.0.7	MIS-11-029-29	ADD	N/A		Created
11/20/2025	4.0.22	MIS-11-028-28	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-11-028-28	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-11-028-28	ADD	N/A		Created
11/20/2025	4.0.22	MIS-11-027-27	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-11-027-27	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-11-027-27	ADD	N/A		Created
11/20/2025	4.0.22	MIS-11-026-26	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-11-026-26	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-11-026-26	ADD	N/A		Created
11/20/2025	4.0.22	MIS-11-025-25	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-11-025-25	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-11-025-25	ADD	N/A		Created
11/20/2025	4.0.22	MIS-11-024-24	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-11-024-24	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-11-024-24	ADD	N/A		Created
11/20/2025	4.0.22	MIS-11-021-21	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-11-021-21	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1NOTE:[Note: “000” is not considered missing]	N/A
04/24/2025	4.0.7	MIS-11-021-21	ADD	N/A		Created
11/20/2025	4.0.22	MIS-11-020-20	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-11-020-20	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-11-020-20	ADD	N/A		Created
10/07/2025	4.0.19	MIS-11-019-19	UPDATE	Grace period expiration date	None	2022-11-30
04/24/2025	4.0.7	MIS-11-019-19	ADD	N/A		Created
11/20/2025	4.0.22	MIS-11-018-18	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-11-018-18	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-11-018-18	ADD	N/A		Created
11/20/2025	4.0.22	MIS-11-017-17	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-11-017-17	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-11-017-17	ADD	N/A		Created
11/20/2025	4.0.22	MIS-11-016-16	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-11-016-16	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-11-016-16	ADD	N/A		Created
11/20/2025	4.0.22	MIS-11-015-15	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-11-015-15	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-11-015-15	ADD	N/A		Created
11/20/2025	4.0.22	MIS-11-014-14	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-11-014-14	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-11-014-14	ADD	N/A		Created
11/20/2025	4.0.22	MIS-11-013-13	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-11-013-13	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-11-013-13	ADD	N/A		Created
11/20/2025	4.0.22	MIS-11-012-12	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-11-012-12	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-11-012-12	ADD	N/A		Created
04/24/2025	4.0.7	MIS-11-010-10	ADD	N/A		Created
11/20/2025	4.0.22	MIS-11-009-9	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-11-009-9	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-11-009-9	ADD	N/A		Created
11/20/2025	4.0.22	MIS-11-008-8	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-11-008-8	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-11-008-8	ADD	N/A		Created
11/20/2025	4.0.22	MIS-11-007-7	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-11-007-7	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-11-007-7	ADD	N/A		Created
11/20/2025	4.0.22	MIS-11-006-6	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-11-006-6	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-11-006-6	ADD	N/A		Created
11/20/2025	4.0.22	MIS-11-005-5	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-11-005-5	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-11-005-5	ADD	N/A		Created
10/07/2025	4.0.19	MIS-11-004-4	UPDATE	Grace period expiration date	None	2022-11-30
04/24/2025	4.0.7	MIS-11-004-4	ADD	N/A		Created
04/24/2025	4.0.7	MIS-11-003-3	ADD	N/A		Created
11/20/2025	4.0.22	MIS-11-002-2	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-11-002-2	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-11-002-2	ADD	N/A		Created
11/20/2025	4.0.22	MIS-11-001-1	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-11-001-1	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-11-001-1	ADD	N/A		Created
04/24/2025	4.0.7	EL-14-007-7	ADD	N/A		Created
10/07/2025	4.0.19	MIS-1-091-91	UPDATE	Grace period expiration date	None	2022-11-30
04/24/2025	4.0.7	MIS-1-091-91	ADD	N/A		Created
10/07/2025	4.0.19	MIS-1-090-90	UPDATE	Grace period expiration date	None	2022-11-30
04/24/2025	4.0.7	MIS-1-090-90	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-088-88	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-1-088-88	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the MSIS-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-088-88	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-087-87	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-087-87	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-087-87	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-085-85	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-1-085-85	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the MSIS-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-085-85	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-084-84	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-084-84	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-084-84	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-082-82	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-1-082-82	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the MSIS-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-082-82	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-081-81	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-081-81	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-081-81	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-080-80	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-080-80	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-080-80	ADD	N/A		Created
10/07/2025	4.0.19	MIS-1-079-79	UPDATE	Grace period expiration date	None	2022-07-31
04/24/2025	4.0.7	MIS-1-079-79	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-078-78	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-078-78	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1NOTE:The following value(s) should also be treated as missing for RACE (ELG000016):017	N/A
04/24/2025	4.0.7	MIS-1-078-78	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-076-76	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-076-76	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-076-76	ADD	N/A		Created
10/07/2025	4.0.19	MIS-1-074-74	UPDATE	Grace period expiration date	None	2022-07-31
04/24/2025	4.0.7	MIS-1-074-74	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-073-73	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-073-73	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1NOTE:The following value(s) should also be treated as missing for ETHNICITY-CODE (ELG000015):6The following value(s) should not be treated as missing for ETHNICITY-CODE (ELG000015):0	N/A
04/24/2025	4.0.7	MIS-1-073-73	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-071-71	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-071-71	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-071-71	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-070-70	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-1-070-70	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the MSIS-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-070-70	ADD	N/A		Created
04/24/2025	4.0.7	MIS-1-069-69	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-067-67	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-067-67	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-067-67	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-066-66	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-066-66	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-066-66	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-065-65	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-1-065-65	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the MSIS-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-065-65	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-064-64	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-064-64	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-064-64	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-063-63	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-063-63	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-063-63	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-062-62	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-1-062-62	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the MSIS-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-062-62	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-060-60	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-060-60	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-060-60	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-059-59	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-1-059-59	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the MSIS-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-059-59	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-056-56	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-1-056-56	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the MSIS-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-056-56	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-055-55	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-1-055-55	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the MSIS-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-055-55	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-053-53	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-053-53	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-053-53	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-052-52	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-1-052-52	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the MSIS-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-052-52	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-051-51	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-051-51	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-051-51	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-049-49	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-049-49	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-049-49	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-048-48	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-1-048-48	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the MSIS-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-048-48	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-047-47	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-047-47	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-047-47	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-045-45	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-1-045-45	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the MSIS-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-045-45	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-044-44	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-044-44	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-044-44	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-043-43	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-043-43	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-043-43	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-042-42	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-042-42	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-042-42	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-040-40	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-1-040-40	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the MSIS-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-040-40	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-039-39	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-1-039-39	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the MSIS-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-039-39	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-038-38	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-038-38	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-038-38	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-037-37	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-037-37	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-037-37	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-036-36	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-036-36	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-036-36	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-035-35	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-035-35	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-035-35	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-034-34	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-034-34	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-034-34	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-033-33	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-033-33	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-033-33	ADD	N/A		Created
04/24/2025	4.0.7	EL-14-006-6	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-031-31	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-031-31	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-031-31	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-029-29	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-029-29	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-029-29	ADD	N/A		Created
04/24/2025	4.0.7	MIS-1-028-28	ADD	N/A		Created
04/24/2025	4.0.7	MIS-1-027-27	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-026-26	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-026-26	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-026-26	ADD	N/A		Created
10/07/2025	4.0.19	MIS-1-025-25	UPDATE	Grace period expiration date	None	2022-11-30
04/24/2025	4.0.7	MIS-1-025-25	ADD	N/A		Created
10/07/2025	4.0.19	MIS-1-024-24	UPDATE	Grace period expiration date	None	2022-11-30
04/24/2025	4.0.7	MIS-1-024-24	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-023-23	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-023-23	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-023-23	ADD	N/A		Created
04/24/2025	4.0.7	EL-14-005-5	ADD	N/A		Created
04/24/2025	4.0.7	EL-14-004-4	ADD	N/A		Created
10/07/2025	4.0.19	MIS-1-019-19	UPDATE	Grace period expiration date	None	2022-07-31
04/24/2025	4.0.7	MIS-1-019-19	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-018-18	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-018-18	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-018-18	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-017-17	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-017-17	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-017-17	ADD	N/A		Created
10/07/2025	4.0.19	MIS-1-016-16	UPDATE	Grace period expiration date	None	2022-07-31
04/24/2025	4.0.7	MIS-1-016-16	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-015-15	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-015-15	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-015-15	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-014-14	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-1-014-14	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the MSIS-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-014-14	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-012-12	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-012-12	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-012-12	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-011-11	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-011-11	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-011-11	ADD	N/A		Created
04/24/2025	4.0.7	MIS-1-010-10	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-009-9	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-009-9	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-009-9	ADD	N/A		Created
04/24/2025	4.0.7	MIS-1-008-8	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-007-7	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-1-007-7	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-007-7	ADD	N/A		Created
04/24/2025	4.0.7	EL-14-003-3	ADD	N/A		Created
10/07/2025	4.0.19	MIS-1-005-5	UPDATE	Grace period expiration date	None	2022-11-30
04/24/2025	4.0.7	MIS-1-005-5	ADD	N/A		Created
10/07/2025	4.0.19	MIS-1-004-4	UPDATE	Grace period expiration date	None	2022-11-30
04/24/2025	4.0.7	MIS-1-004-4	ADD	N/A		Created
11/20/2025	4.0.22	MIS-10-022-22	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-10-022-22	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (MCR0000X) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the STATE-PLAN-ID-NUMs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular STATE-PLAN-ID-NUMSTEP 4: Calculate percentageDivide the count of unique STATE-PLAN-ID-NUMs from STEP 3 by the count of unique STATE-PLAN-ID-NUMs from STEP 1	N/A
04/24/2025	4.0.7	MIS-10-022-22	ADD	N/A		Created
11/20/2025	4.0.22	MIS-1-002-2	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-1-002-2	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the MSIS-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
04/24/2025	4.0.7	MIS-1-002-2	ADD	N/A		Created
11/20/2025	4.0.22	MIS-10-021-21	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-10-021-21	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (MCR0000X) STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the STATE-PLAN-ID-NUMs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular STATE-PLAN-ID-NUMSTEP 4: Calculate percentageDivide the count of unique STATE-PLAN-ID-NUMs from STEP 3 by the count of unique STATE-PLAN-ID-NUMs from STEP 1	N/A
04/24/2025	4.0.7	MIS-10-021-21	ADD	N/A		Created
11/20/2025	4.0.22	MIS-10-019-19	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-10-019-19	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (MCR0000X) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the STATE-PLAN-ID-NUMs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular STATE-PLAN-ID-NUMSTEP 4: Calculate percentageDivide the count of unique STATE-PLAN-ID-NUMs from STEP 3 by the count of unique STATE-PLAN-ID-NUMs from STEP 1	N/A
04/24/2025	4.0.7	MIS-10-019-19	ADD	N/A		Created
11/20/2025	4.0.22	MIS-10-018-18	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-10-018-18	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (MCR0000X) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the STATE-PLAN-ID-NUMs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular STATE-PLAN-ID-NUMSTEP 4: Calculate percentageDivide the count of unique STATE-PLAN-ID-NUMs from STEP 3 by the count of unique STATE-PLAN-ID-NUMs from STEP 1	N/A
04/24/2025	4.0.7	MIS-10-018-18	ADD	N/A		Created
11/20/2025	4.0.22	MIS-10-017-17	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-10-017-17	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (MCR0000X) STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the STATE-PLAN-ID-NUMs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular STATE-PLAN-ID-NUMSTEP 4: Calculate percentageDivide the count of unique STATE-PLAN-ID-NUMs from STEP 3 by the count of unique STATE-PLAN-ID-NUMs from STEP 1	N/A
04/24/2025	4.0.7	MIS-10-017-17	ADD	N/A		Created
11/20/2025	4.0.22	MIS-10-015-15	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-10-015-15	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (MCR0000X) STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the STATE-PLAN-ID-NUMs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular STATE-PLAN-ID-NUMSTEP 4: Calculate percentageDivide the count of unique STATE-PLAN-ID-NUMs from STEP 3 by the count of unique STATE-PLAN-ID-NUMs from STEP 1	N/A
04/24/2025	4.0.7	MIS-10-015-15	ADD	N/A		Created
11/20/2025	4.0.22	MIS-10-014-14	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-10-014-14	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (MCR0000X) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the STATE-PLAN-ID-NUMs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular STATE-PLAN-ID-NUMSTEP 4: Calculate percentageDivide the count of unique STATE-PLAN-ID-NUMs from STEP 3 by the count of unique STATE-PLAN-ID-NUMs from STEP 1	N/A
04/24/2025	4.0.7	MIS-10-014-14	ADD	N/A		Created
11/20/2025	4.0.22	MIS-10-012-12	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-10-012-12	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (MCR0000X) STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the STATE-PLAN-ID-NUMs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular STATE-PLAN-ID-NUMSTEP 4: Calculate percentageDivide the count of unique STATE-PLAN-ID-NUMs from STEP 3 by the count of unique STATE-PLAN-ID-NUMs from STEP 1	N/A
04/24/2025	4.0.7	MIS-10-012-12	ADD	N/A		Created
11/20/2025	4.0.22	MIS-10-011-11	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-10-011-11	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (MCR0000X) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the STATE-PLAN-ID-NUMs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular STATE-PLAN-ID-NUMSTEP 4: Calculate percentageDivide the count of unique STATE-PLAN-ID-NUMs from STEP 3 by the count of unique STATE-PLAN-ID-NUMs from STEP 1	N/A
04/24/2025	4.0.7	MIS-10-011-11	ADD	N/A		Created
04/24/2025	4.0.7	EL-14-002-2	ADD	N/A		Created
11/20/2025	4.0.22	MIS-10-008-8	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-10-008-8	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (MCR0000X) STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the STATE-PLAN-ID-NUMs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular STATE-PLAN-ID-NUMSTEP 4: Calculate percentageDivide the count of unique STATE-PLAN-ID-NUMs from STEP 3 by the count of unique STATE-PLAN-ID-NUMs from STEP 1	N/A
04/24/2025	4.0.7	MIS-10-008-8	ADD	N/A		Created
11/20/2025	4.0.22	MIS-10-007-7	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-10-007-7	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (MCR0000X) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the STATE-PLAN-ID-NUMs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular STATE-PLAN-ID-NUMSTEP 4: Calculate percentageDivide the count of unique STATE-PLAN-ID-NUMs from STEP 3 by the count of unique STATE-PLAN-ID-NUMs from STEP 1	N/A
04/24/2025	4.0.7	MIS-10-007-7	ADD	N/A		Created
11/20/2025	4.0.22	MIS-10-006-6	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-10-006-6	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (MCR0000X) STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the STATE-PLAN-ID-NUMs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular STATE-PLAN-ID-NUMSTEP 4: Calculate percentageDivide the count of unique STATE-PLAN-ID-NUMs from STEP 3 by the count of unique STATE-PLAN-ID-NUMs from STEP 1	N/A
04/24/2025	4.0.7	MIS-10-006-6	ADD	N/A		Created
11/20/2025	4.0.22	MIS-10-004-4	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-10-004-4	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (MCR0000X) STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the STATE-PLAN-ID-NUMs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular STATE-PLAN-ID-NUMSTEP 4: Calculate percentageDivide the count of unique STATE-PLAN-ID-NUMs from STEP 3 by the count of unique STATE-PLAN-ID-NUMs from STEP 1	N/A
04/24/2025	4.0.7	MIS-10-004-4	ADD	N/A		Created
11/20/2025	4.0.22	MIS-10-003-3	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-10-003-3	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (MCR0000X) STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the STATE-PLAN-ID-NUMs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular STATE-PLAN-ID-NUMSTEP 4: Calculate percentageDivide the count of unique STATE-PLAN-ID-NUMs from STEP 3 by the count of unique STATE-PLAN-ID-NUMs from STEP 1	N/A
04/24/2025	4.0.7	MIS-10-003-3	ADD	N/A		Created
11/20/2025	4.0.22	MIS-10-002-2	UPDATE	Annotation	Alphanumeric	N/A
11/20/2025	4.0.22	MIS-10-002-2	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (MCR0000X) STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the STATE-PLAN-ID-NUMs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular STATE-PLAN-ID-NUMSTEP 4: Calculate percentageDivide the count of unique STATE-PLAN-ID-NUMs from STEP 3 by the count of unique STATE-PLAN-ID-NUMs from STEP 1	N/A
04/24/2025	4.0.7	MIS-10-002-2	ADD	N/A		Created
11/20/2025	4.0.22	MIS-10-001-1	UPDATE	Annotation	Numeric	N/A
11/20/2025	4.0.22	MIS-10-001-1	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (MCR0000X) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the STATE-PLAN-ID-NUMs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular STATE-PLAN-ID-NUMSTEP 4: Calculate percentageDivide the count of unique STATE-PLAN-ID-NUMs from STEP 3 by the count of unique STATE-PLAN-ID-NUMs from STEP 1	N/A
04/24/2025	4.0.7	MIS-10-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-9-006_2-19	ADD	N/A		Created
05/27/2025	4.0.9	MCR-9-006_1-18	UPDATE	Specification	STEP 1: Active non-duplicate paid individual capitation payment financial transactions during report monthDefine the FTX universe for the FTX0002 table by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 2: Managed Care Plan Payee ID TypeOf the records that meet the criteria from STEP 1, further restrict them by the following criteria:1. MCR-PLAN-TYPE - "02" or "03"2. PAYEE-ID-TYPE = "02"STEP 3: Non-missing Payee IDOf the records that meet the criteria from STEP 2, further restrict them by the following criteria: 1. PAYEE-ID is not missingSTEP 4: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 5: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 4, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 6: No managed care participation PCCM planOf the records that meet the criteria from STEP 3, further restrict them by attempting to merge them with the data from STEP 5 and keeping those that satisfy the following criteria:1a. PAYEE-ID = MANAGED-CARE-PLAN-ID2a. MSIS-IDENTIFICATION-NUM matches 3a. MANAGED-CARE-PLAN-TYPE does NOT equal "02" or "03" for any records where 1a and 2a are satisfiedORIt is not the case that:1b. PAYEE-ID = MANAGED-CARE-PLAN-ID2b. MSIS-IDENTIFICATION-NUM matches STEP 7: Calculate the percentage for the measureDivide the count of records from STEP 6 by the count of records from STEP 3	STEP 1: Active non-duplicate paid individual capitation payment financial transactions during report monthDefine the FTX universe for the FTX0002 table by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 2: Managed Care Plan Payee ID TypeOf the records that meet the criteria from STEP 1, further restrict them by the following criteria:1. PAYEE-MCR-PLAN-TYPE - "02" or "03"2. PAYEE-ID-TYPE = "02"STEP 3: Non-missing Payee IDOf the records that meet the criteria from STEP 2, further restrict them by the following criteria: 1. PAYEE-ID is not missingSTEP 4: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 5: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 4, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 6: No managed care participation PCCM planOf the records that meet the criteria from STEP 3, further restrict them by attempting to merge them with the data from STEP 5 and keeping those that satisfy the following criteria:1a. PAYEE-ID = MANAGED-CARE-PLAN-ID2a. MSIS-IDENTIFICATION-NUM matches 3a. MANAGED-CARE-PLAN-TYPE does NOT equal "02" or "03" for any records where 1a and 2a are satisfiedORIt is not the case that:1b. PAYEE-ID = MANAGED-CARE-PLAN-ID2b. MSIS-IDENTIFICATION-NUM matches STEP 7: Calculate the percentage for the measureDivide the count of records from STEP 6 by the count of records from STEP 3
04/24/2025	4.0.7	MCR-9-006_1-18	ADD	N/A		Created
04/24/2025	4.0.7	MCR-55-004-4	ADD	N/A		Created
08/13/2025	4.0.16	MCR-55-003-3	UPDATE	File type	COT	FTX
04/24/2025	4.0.7	MCR-55-003-3	ADD	N/A		Created
08/13/2025	4.0.16	MCR-55-002-2	UPDATE	File type	COT	FTX
04/24/2025	4.0.7	MCR-55-002-2	ADD	N/A		Created
08/13/2025	4.0.16	MCR-55-001-1	UPDATE	File type	COT	FTX
04/24/2025	4.0.7	MCR-55-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-54-012-12	ADD	N/A		Created
04/24/2025	4.0.7	MCR-54-011-11	ADD	N/A		Created
04/24/2025	4.0.7	MCR-54-010-10	ADD	N/A		Created
04/24/2025	4.0.7	MCR-54-009-9	ADD	N/A		Created
04/24/2025	4.0.7	MCR-54-008-8	ADD	N/A		Created
04/24/2025	4.0.7	MCR-54-007-7	ADD	N/A		Created
04/24/2025	4.0.7	MCR-54-006-6	ADD	N/A		Created
04/24/2025	4.0.7	MCR-54-005-5	ADD	N/A		Created
08/13/2025	4.0.16	MCR-54-004-4	UPDATE	File type	COT	FTX
04/24/2025	4.0.7	MCR-54-004-4	ADD	N/A		Created
08/13/2025	4.0.16	MCR-54-003-3	UPDATE	File type	COT	FTX
04/24/2025	4.0.7	MCR-54-003-3	ADD	N/A		Created
08/13/2025	4.0.16	MCR-54-002-2	UPDATE	File type	COT	FTX
04/24/2025	4.0.7	MCR-54-002-2	ADD	N/A		Created
04/24/2025	4.0.7	MCR-54-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-53-003-3	ADD	N/A		Created
08/13/2025	4.0.16	MCR-53-002-2	UPDATE	File type	COT	FTX
04/24/2025	4.0.7	MCR-53-002-2	ADD	N/A		Created
04/24/2025	4.0.7	MCR-53-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-13-006_2-19	ADD	N/A		Created
05/27/2025	4.0.9	MCR-13-006_1-18	UPDATE	Specification	STEP 1: Active non-duplicate paid individual capitation payment financial transactions during report monthDefine the FTX universe for the FTX0002 table by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 2: Managed Care Plan Payee ID TypeOf the records that meet the criteria from STEP 1, further restrict them by the following criteria:1. MCR-PLAN-TYPE - "02" or "03"2. PAYEE-ID-TYPE = "02"STEP 3: Non-missing Payee IDOf the records that meet the criteria from STEP 2, further restrict them by the following criteria: 1. PAYEE-ID is not missingSTEP 4: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 5: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 4, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 6: No managed care participation PCCM planOf the records that meet the criteria from STEP 3, further restrict them by attempting to merge them with the data from STEP 5 and keeping those that satisfy the following criteria:1a. PAYEE-ID = MANAGED-CARE-PLAN-ID2a. MSIS-IDENTIFICATION-NUM matches 3a. MANAGED-CARE-PLAN-TYPE does NOT equal "02" or "03" for any records where 1a and 2a are satisfiedORIt is not the case that:1b. PAYEE-ID = MANAGED-CARE-PLAN-ID2b. MSIS-IDENTIFICATION-NUM matches STEP 7: Calculate the percentage for the measureDivide the count of records from STEP 6 by the count of records from STEP 3	STEP 1: Active non-duplicate paid individual capitation payment financial transactions during report monthDefine the FTX universe for the FTX0002 table by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 2: Managed Care Plan Payee ID TypeOf the records that meet the criteria from STEP 1, further restrict them by the following criteria:1. PAYEE-MCR-PLAN-TYPE - "02" or "03"2. PAYEE-ID-TYPE = "02"STEP 3: Non-missing Payee IDOf the records that meet the criteria from STEP 2, further restrict them by the following criteria: 1. PAYEE-ID is not missingSTEP 4: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 5: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 4, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 6: No managed care participation PCCM planOf the records that meet the criteria from STEP 3, further restrict them by attempting to merge them with the data from STEP 5 and keeping those that satisfy the following criteria:1a. PAYEE-ID = MANAGED-CARE-PLAN-ID2a. MSIS-IDENTIFICATION-NUM matches 3a. MANAGED-CARE-PLAN-TYPE does NOT equal "02" or "03" for any records where 1a and 2a are satisfiedORIt is not the case that:1b. PAYEE-ID = MANAGED-CARE-PLAN-ID2b. MSIS-IDENTIFICATION-NUM matches STEP 7: Calculate the percentage for the measureDivide the count of records from STEP 6 by the count of records from STEP 3
04/24/2025	4.0.7	MCR-13-006_1-18	ADD	N/A		Created
11/20/2025	4.0.22	EL-S-003-3	UPDATE	Annotation	Count the total number of eligible MSIS IDs that are classified as CHIP	N/A
11/20/2025	4.0.22	EL-S-003-3	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment VARIABLE-DEMOGRAPHICS-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: CHIPOf the MSIS IDs which meet the criteria from STEP 2, restrict to:1. CHIP-CODE = "2" or "3"STEP 4: Count unique MSIS IDsCount the number of unique MSIS IDs from STEP 3	N/A
04/24/2025	4.0.7	EL-S-003-3	ADD	N/A		Created
11/20/2025	4.0.22	EL-3-003_1-15	UPDATE	Annotation	Calculate the percentage of eligibles that are duals	N/A
11/20/2025	4.0.22	EL-3-003_1-15	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: DualsOf the records that meet the criteria from STEP 2, further refine the population by keeping records with DUAL-ELIGIBLE-CODE=“01” or “02” or “03” or “04” or “05” or “06” or “08” or “09” or “10” STEP 4: PercentageDivide the count of unique MSIS IDs from STEP 3 by the count in STEP 1	N/A
04/24/2025	4.0.7	EL-3-003_1-15	ADD	N/A		Created
04/24/2025	4.0.7	EL-14-001-1	ADD	N/A		Created
11/20/2025	4.0.22	EL-1-021-21	UPDATE	Annotation	Calculate the percentage of unique MSIS IDs that have an age that is greater than 120 or less than -1	N/A
11/20/2025	4.0.22	EL-1-021-21	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Primary demographic on the last day of the DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment PRIMARY-DEMOGRAPHICS-ELG00002 by keeping records that satisfy the following criteria:1a. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE<= last day of the DQ report month2a. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: Calculate Age and keep Age <-1 or Age >120Of the MSIS IDs that meet the criteria from STEP 2, calculate Age:1a. If DATE-OF-DEATH is non-missing and occurs before the last day of the DQ report month, Age is equal to the years between DATE-OF-DEATH and DATE-OF-BIRTH.1b. Otherwise, Age is equal to the years between the last day of the DQ report month and DATE-OF-BIRTH.Note: perform calculations to count full years (e.g., 5/1/2015 – 8/1/1950 = 64)2. Only keep records where Age <-1 OR Age >120.STEP 4: PercentageDivide the count of unique MSIS IDs from STEP 3 by the count in STEP 1	N/A
04/24/2025	4.0.7	EL-1-021-21	ADD	N/A		Created
11/20/2025	4.0.22	EL-3-001_1-13	UPDATE	Annotation	Count the number mandatory eligibility groups with at least one MSIS ID with a primary eligibility group indicator associated with it	N/A
11/20/2025	4.0.22	EL-3-001_1-13	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Frequency of mandatory eligibility groupsOf the MSIS IDs that meet the criteria from STEP 2, count the number of unique MSIS IDs where ELIGIBILITY-GROUP is equal to each of the following values: 01-09, 11-26STEP 4: Count of CategoriesOf the 25 mandatory eligibility group categories referenced in STEP 3, count the number of categories with at least one MSIS ID	N/A
04/24/2025	4.0.7	EL-3-001_1-13	ADD	N/A		Created
11/20/2025	4.0.22	EL-1-005_1-20	UPDATE	Annotation	Calculate the percentage of SSNs with more than one MSIS ID	N/A
11/20/2025	4.0.22	EL-1-005_1-20	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: More than one MSIS ID per SSNOf the records meeting the criteria from STEP 2, further refine the population by keeping records with more than one MSIS-IDENTIFICATION-NUM per SSNSTEP 4: Calculate percentage for measureDIVIDE the count of SSNs from STEP 3 by the count from STEP 1	N/A
04/24/2025	4.0.7	EL-1-005_1-20	ADD	N/A		Created
11/20/2025	4.0.22	TPL-1-005-5	UPDATE	Annotation	The percentage of MSIS IDs in the TPL file that can be found on any Eligible file enrollment time span segment	N/A
11/20/2025	4.0.22	TPL-1-005-5	UPDATE	Specification	STEP 1: TPL any timeDefine the TPL population from segment TPL-MEDICAID-ELIGIBLE-PERSON-MAIN-TPL00002 by keeping active records that satisfy the following criteria:1. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Unique MSIS-IDs in TPLOf the records that meet the criteria from STEP 1, limit to unique MSIS-IDsSTEP 3: Enrolled any timeDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. MSIS-IDENTIFICATION-NUM is not missingSTEP 4: Unique MSIS-IDs from Eligible fileOf the records that meet the criteria from STEP 3, limit to unique MSIS-IDsSTEP 5: Link MSIS-IDs across filesCount the number of MSIS-IDs from STEP 2 that are also in STEP 4STEP 6: Calculate percentageDivide the count of MSIS-IDs from STEP 5 by the count of MSIS-IDs from STEP 2	N/A
04/24/2025	4.0.7	TPL-1-005-5	ADD	N/A		Created
04/24/2025	4.0.7	MCR-52-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-51-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-50-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-49-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-48-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-47-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-46-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-45-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-44-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-43-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-42-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-41-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-40-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-39-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-38-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-37-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-36-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-35-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-34-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-33-001-1	ADD	N/A		Created
11/20/2025	4.0.22	MCR-32-019-19	UPDATE	Annotation	Calculate the percentage of unique header records associated with S-CHIP Encounter: original and adjustment, paid RX claims with an invalid or missing adjustment indicator value	N/A
11/20/2025	4.0.22	MCR-32-019-19	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique header records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique header records with ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique header records from STEP 4 by the count in STEP 3	N/A
04/24/2025	4.0.7	MCR-32-019-19	ADD	N/A		Created
08/13/2025	4.0.16	MCR-32-018-18	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP FFS Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP FFS Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3
04/24/2025	4.0.7	MCR-32-018-18	ADD	N/A		Created
04/24/2025	4.0.7	MCR-32-017-17	ADD	N/A		Created
11/20/2025	4.0.22	MCR-32-016-16	UPDATE	Annotation	Calculate the percentage of unique header records associated with S-CHIP Encounter: original and adjustment, paid OT claims with an invalid or missing adjustment indicator value	N/A
11/20/2025	4.0.22	MCR-32-016-16	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique header records. STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique header records with ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique header records from STEP 4 by the count in STEP 3	N/A
04/24/2025	4.0.7	MCR-32-016-16	ADD	N/A		Created
04/24/2025	4.0.7	MCR-32-015-15	ADD	N/A		Created
08/13/2025	4.0.16	MCR-32-014-14	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3
04/24/2025	4.0.7	MCR-32-014-14	ADD	N/A		Created
11/20/2025	4.0.22	MCR-32-013-13	UPDATE	Annotation	Calculate the percentage of unique line records associated with Medicaid FFS: original and adjustment, paid IP claims with an invalid or missing adjustment indicator value	N/A
11/20/2025	4.0.22	MCR-32-013-13	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique header records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique header records with ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique header records from STEP 4 by the count in STEP 3	N/A
04/24/2025	4.0.7	MCR-32-013-13	ADD	N/A		Created
08/13/2025	4.0.16	MCR-32-012-12	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3
04/24/2025	4.0.7	MCR-32-012-12	ADD	N/A		Created
11/20/2025	4.0.22	MCR-32-011-11	UPDATE	Annotation	Calculate the percentage of unique header records associated with S-CHIP Encounter: original and adjustment, paid IP claims with an invalid or missing adjustment indicator value	N/A
11/20/2025	4.0.22	MCR-32-011-11	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique header records. STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique header records with ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique header records from STEP 4 by the count in STEP 3	N/A
04/24/2025	4.0.7	MCR-32-011-11	ADD	N/A		Created
08/13/2025	4.0.16	MCR-32-010-20	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3
04/24/2025	4.0.7	MCR-32-010-20	ADD	N/A		Created
08/13/2025	4.0.16	MCR-32-010-10	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3
04/24/2025	4.0.7	MCR-32-010-10	ADD	N/A		Created
11/20/2025	4.0.22	MCR-32-009-9	UPDATE	Annotation	Calculate the percentage of unique header records associated with Medicaid Encounter: original and adjustment, paid RX claims with an invalid or missing adjustment indicator value	N/A
11/20/2025	4.0.22	MCR-32-009-9	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique header records. STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique header records with ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique header records from STEP 4 by the count in STEP 3	N/A
04/24/2025	4.0.7	MCR-32-009-9	ADD	N/A		Created
08/13/2025	4.0.16	MCR-32-008-8	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3
04/24/2025	4.0.7	MCR-32-008-8	ADD	N/A		Created
04/24/2025	4.0.7	MCR-32-007-7	ADD	N/A		Created
11/20/2025	4.0.22	MCR-32-006-6	UPDATE	Annotation	Calculate the percentage of unique header records associated with Medicaid Encounter: original and adjustment, paid OT claims with an invalid or missing adjustment indicator value	N/A
11/20/2025	4.0.22	MCR-32-006-6	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique header records. STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique header records with ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique header records from STEP 4 by the count in STEP 3	N/A
04/24/2025	4.0.7	MCR-32-006-6	ADD	N/A		Created
04/24/2025	4.0.7	MCR-32-005-5	ADD	N/A		Created
08/13/2025	4.0.16	MCR-32-004-4	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3
04/24/2025	4.0.7	MCR-32-004-4	ADD	N/A		Created
11/20/2025	4.0.22	MCR-32-003-3	UPDATE	Annotation	Calculate the percentage of unique header records associated with Medicaid Encounter: original and adjustment, paid LT claims with an invalid or missing adjustment indicator value	N/A
11/20/2025	4.0.22	MCR-32-003-3	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique header records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique header records with ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique header records from STEP 4 by the count in STEP 3	N/A
04/24/2025	4.0.7	MCR-32-003-3	ADD	N/A		Created
08/13/2025	4.0.16	MCR-32-002-2	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3
04/24/2025	4.0.7	MCR-32-002-2	ADD	N/A		Created
11/20/2025	4.0.22	MCR-32-001-1	UPDATE	Annotation	Calculate the percentage of unique header records associated with Medicaid Encounter: original and adjustment, paid IP claims with an invalid or missing adjustment indicator value	N/A
11/20/2025	4.0.22	MCR-32-001-1	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique header records. STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique header records with ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique header records from STEP 4 by the count in STEP 3	N/A
04/24/2025	4.0.7	MCR-32-001-1	ADD	N/A		Created
11/20/2025	4.0.22	MCR-31-010-10	UPDATE	Annotation	Calculate the percentage of MSIS IDs on S-CHIP Encounter: original and adjustment, paid RX claims that can be found on an Eligible file enrollment time span segment that spans the prescription fill date on the claims file	N/A
11/20/2025	4.0.22	MCR-31-010-10	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"STEP 3: Non-missing prescription fill dateOf the claims that meet the criteria from STEP 2, restrict to non-missing PRESCRIPTION-FILL-DATESTEP 4: Eligible any time and links to claimsDefine the ENROLLMENT-TIME-SPAN-ELG00021 file segment records that have an MSIS-ID that links to one of the claims identified in STEP 3STEP 5: Eligible during prescription fill dateFurther refine the eligible population by linking on MSIS-ID and keeping records that satisfy the following criteria:1. Claims PRESCRIPTION-FILL-DATE >= ENROLLMENT-EFF-DATE2. Claims PRESCRIPTION-FILL-DATE <= ENROLLMENT-END DATE OR ENROLLMENT-END DATE is missing STEP 6: Unique MSIS-IDs in eligibilityFrom the MSIS-IDs in STEP 5, limit to unique MSIS-IDs STEP 7: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 3, limit to unique MSIS-IDsSTEP 8: Calculate percentageDivide the count of MSIS-IDs from STEP 6 by the count of MSIS-IDs from STEP 7	N/A
04/24/2025	4.0.7	MCR-31-010-10	ADD	N/A		Created
11/20/2025	4.0.22	MCR-31-009-9	UPDATE	Annotation	Calculate the percentage of MSIS IDs on S-CHIP Encounter: original and adjustment, paid OT claims that can be found on an Eligible file enrollment time span segment that spans the date of service on the claims file	N/A
11/20/2025	4.0.22	MCR-31-009-9	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"STEP 3: Non-missing beginning date of serviceOf the claims that meet the criteria from STEP 2, restrict to non-missing BEGINNING-DATE-OF-SERVICESTEP 4: Eligible any time and links to claimsDefine the ENROLLMENT-TIME-SPAN-ELG00021 file segment records that have an MSIS-ID that links to one of the claims identified in STEP 3STEP 5: Eligible during date of serviceFurther refine the eligible population by linking on MSIS-ID and keeping records that satisfy the following criteria:1. Claims BEGINNING-DATE-OF-SERVICE >= ENROLLMENT-EFF-DATE2. Claims BEGINNING-DATE-OF-SERVICE <= ENROLLMENT-END DATE OR ENROLLMENT-END DATE is missing STEP 6: Unique MSIS-IDs in eligibilityFrom the MSIS-IDs in STEP 5, limit to unique MSIS-IDs STEP 7: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 3, limit to unique MSIS-IDsSTEP 8: Calculate percentageDivide the count of MSIS-IDs from STEP 6 by the count of MSIS-IDs from STEP 7	N/A
04/24/2025	4.0.7	MCR-31-009-9	ADD	N/A		Created
04/24/2025	4.0.7	MCR-31-008-8	ADD	N/A		Created
11/20/2025	4.0.22	MCR-31-007-7	UPDATE	Annotation	Calculate the percentage of MSIS IDs on S-CHIP Encounter: original and adjustment, paid LT claims that can be found on an Eligible file enrollment time span segment that spans the date of service on the claims file	N/A
11/20/2025	4.0.22	MCR-31-007-7	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"STEP 3: Non-missing beginning date of serviceOf the claims that meet the criteria from STEP 2, restrict to non-missing BEGINNING-DATE-OF-SERVICESTEP 4: Eligible any time and links to claimsDefine the ENROLLMENT-TIME-SPAN-ELG00021 file segment records that have an MSIS-ID that links to one of the claims identified in STEP 3STEP 5: Eligible during date of serviceFurther refine the eligible population by linking on MSIS-ID and keeping records that satisfy the following criteria:1. Claims BEGINNING-DATE-OF-SERVICE >= ENROLLMENT-EFF-DATE2. Claims BEGINNING-DATE-OF-SERVICE <= ENROLLMENT-END DATE OR ENROLLMENT-END DATE is missing STEP 6: Unique MSIS-IDs in eligibilityFrom the MSIS-IDs in STEP 5, limit to unique MSIS-IDs STEP 7: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 3, limit to unique MSIS-IDsSTEP 8: Calculate percentageDivide the count of MSIS-IDs from STEP 6 by the count of MSIS-IDs from STEP 7	N/A
04/24/2025	4.0.7	MCR-31-007-7	ADD	N/A		Created
11/20/2025	4.0.22	MCR-31-006-6	UPDATE	Annotation	Calculate the percentage of MSIS IDs on S-CHIP Encounter: original and adjustment, paid IP claims that can be found on an Eligible file enrollment time span segment that spans the admission date on the claims file	N/A
11/20/2025	4.0.22	MCR-31-006-6	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"STEP 3: Non-missing admission dateOf the claims that meet the criteria from STEP 2, restrict to non-missing ADMISSION-DATESTEP 4: Eligible any time and links to claimsDefine the ENROLLMENT-TIME-SPAN-ELG00021 file segment records that have an MSIS-ID that links to one of the claims identified in STEP 3STEP 5: Eligible during admission dateFurther refine the eligible population by linking on MSIS-ID and keeping records that satisfy the following criteria:1. Claims ADMISSION-DATE >= ENROLLMENT-EFF-DATE2. Claims ADMISSION-DATE <= ENROLLMENT-END DATE OR ENROLLMENT-END DATE is missing STEP 6: Unique MSIS-IDs in eligibilityFrom the MSIS-IDs in STEP 5, limit to unique MSIS-IDs STEP 7: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 3, limit to unique MSIS-IDsSTEP 8: Calculate percentageDivide the count of MSIS-IDs from STEP 6 by the count of MSIS-IDs from STEP 7	N/A
04/24/2025	4.0.7	MCR-31-006-6	ADD	N/A		Created
11/20/2025	4.0.22	MCR-31-005-5	UPDATE	Annotation	Calculate the percentage of MSIS IDs on Medicaid Encounter: original and adjustment, paid RX claims that can be found on an Eligible file enrollment time span segment that spans the prescription fill date on the claims file	N/A
11/20/2025	4.0.22	MCR-31-005-5	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Non-missing prescription fill dateOf the claims that meet the criteria from STEP 2, restrict to non-missing PRESCRIPTION-FILL-DATESTEP 4: Eligible any time and links to claimsDefine the ENROLLMENT-TIME-SPAN-ELG00021 file segment records that have an MSIS-ID that links to one of the claims identified in STEP 3STEP 5: Eligible during prescription fill dateFurther refine the eligible population by linking on MSIS-ID and keeping records that satisfy the following criteria:1. Claims PRESCRIPTION-FILL-DATE >= ENROLLMENT-EFF-DATE2. Claims PRESCRIPTION-FILL-DATE <= ENROLLMENT-END DATE OR ENROLLMENT-END DATE is missing STEP 6: Unique MSIS-IDs in eligibilityFrom the MSIS-IDs in STEP 5, limit to unique MSIS-IDs STEP 7: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 3, limit to unique MSIS-IDsSTEP 8: Calculate percentageDivide the count of MSIS-IDs from STEP 6 by the count of MSIS-IDs from STEP 7	N/A
04/24/2025	4.0.7	MCR-31-005-5	ADD	N/A		Created
11/20/2025	4.0.22	MCR-31-004-4	UPDATE	Annotation	Calculate the percentage of MSIS IDs on Medicaid Encounter: original and adjustment, paid OT claims that can be found on an Eligible file enrollment time span segment that spans the date of service on the claims file	N/A
11/20/2025	4.0.22	MCR-31-004-4	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Non-missing beginning date of serviceOf the claims that meet the criteria from STEP 2, restrict to non-missing BEGINNING-DATE-OF-SERVICESTEP 4: Eligible any time and links to claimsDefine the ENROLLMENT-TIME-SPAN-ELG00021 file segment records that have an MSIS-ID that links to one of the claims identified in STEP 3STEP 5: Eligible during date of serviceFurther refine the eligible population by linking on MSIS-ID and keeping records that satisfy the following criteria:1. Claims BEGINNING-DATE-OF-SERVICE >= ENROLLMENT-EFF-DATE2. Claims BEGINNING-DATE-OF-SERVICE <= ENROLLMENT-END DATE OR ENROLLMENT-END DATE is missing STEP 6: Unique MSIS-IDs in eligibilityFrom the MSIS-IDs in STEP 5, limit to unique MSIS-IDs STEP 7: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 3, limit to unique MSIS-IDsSTEP 8: Calculate percentageDivide the count of MSIS-IDs from STEP 6 by the count of MSIS-IDs from STEP 7	N/A
04/24/2025	4.0.7	MCR-31-004-4	ADD	N/A		Created
04/24/2025	4.0.7	MCR-31-003-3	ADD	N/A		Created
11/20/2025	4.0.22	MCR-31-002-2	UPDATE	Annotation	Calculate the percentage of MSIS IDs on Medicaid Encounter: original and adjustment, paid LT claims that can be found on an Eligible file enrollment time span segment that spans the date of service on the claims file	N/A
11/20/2025	4.0.22	MCR-31-002-2	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Non-missing beginning date of serviceOf the claims that meet the criteria from STEP 2, restrict to non-missing BEGINNING-DATE-OF-SERVICESTEP 4: Eligible any time and links to claimsDefine the ENROLLMENT-TIME-SPAN-ELG00021 file segment records that have an MSIS-ID that links to one of the claims identified in STEP 3STEP 5: Eligible during date of serviceFurther refine the eligible population by linking on MSIS-ID and keeping records that satisfy the following criteria:1. Claims BEGINNING-DATE-OF-SERVICE >= ENROLLMENT-EFF-DATE2. Claims BEGINNING-DATE-OF-SERVICE <= ENROLLMENT-END DATE OR ENROLLMENT-END DATE is missing STEP 6: Unique MSIS-IDs in eligibilityFrom the MSIS-IDs in STEP 5, limit to unique MSIS-IDs STEP 7: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 3, limit to unique MSIS-IDsSTEP 8: Calculate percentageDivide the count of MSIS-IDs from STEP 6 by the count of MSIS-IDs from STEP 7	N/A
04/24/2025	4.0.7	MCR-31-002-2	ADD	N/A		Created
11/20/2025	4.0.22	MCR-31-001-1	UPDATE	Annotation	Calculate the percentage of MSIS IDs on Medicaid Encounter: original and adjustment, paid IP claims that can be found on an Eligible file enrollment time span segment that spans the admission date on the claims file	N/A
11/20/2025	4.0.22	MCR-31-001-1	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Non-missing admission dateOf the claims that meet the criteria from STEP 2, restrict to non-missing ADMISSION-DATESTEP 4: Eligible any time and links to claimsDefine the ENROLLMENT-TIME-SPAN-ELG00021 file segment records that have an MSIS-ID that links to one of the claims identified in STEP 3STEP 5: Eligible during admission dateFurther refine the eligible population by linking on MSIS-ID and keeping records that satisfy the following criteria:1. Claims ADMISSION-DATE >= ENROLLMENT-EFF-DATE2. Claims ADMISSION-DATE <= ENROLLMENT-END DATE OR ENROLLMENT-END DATE is missing STEP 6: Unique MSIS-IDs in eligibilityFrom the MSIS-IDs in STEP 5, limit to unique MSIS-IDs STEP 7: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 3, limit to unique MSIS-IDsSTEP 8: Calculate percentageDivide the count of MSIS-IDs from STEP 6 by the count of MSIS-IDs from STEP 7	N/A
04/24/2025	4.0.7	MCR-31-001-1	ADD	N/A		Created
11/20/2025	4.0.22	MCR-30-010-10	UPDATE	Annotation	Calculate the percentage of MSIS IDs on S-CHIP Encounter: original and adjustment, paid RX claims that can be found on any Eligible file enrollment time span segment	N/A
11/20/2025	4.0.22	MCR-30-010-10	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"STEP 3: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 2, limit to unique MSIS-IDsSTEP 4: Unique MSIS-IDs from Eligible fileIdentify the unique MSIS-IDs reported on the ENROLLMENT-TIME-SPAN-ELG00021 file segmentSTEP 5: Link MSIS-IDs across filesCount the number of MSIS-IDs from STEP 3 that are also in STEP 4STEP 6: Calculate percentageDivide the count of MSIS-IDs from STEP 5 by the count of MSIS-IDs from STEP 3	N/A
04/24/2025	4.0.7	MCR-30-010-10	ADD	N/A		Created
11/20/2025	4.0.22	MCR-30-009-9	UPDATE	Annotation	Calculate the percentage of MSIS IDs on S-CHIP Encounter: original and adjustment, paid OT claims that can be found on any Eligible file enrollment time span segment	N/A
11/20/2025	4.0.22	MCR-30-009-9	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"STEP 3: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 2, limit to unique MSIS-IDsSTEP 4: Unique MSIS-IDs from Eligible fileIdentify the unique MSIS-IDs reported on the ENROLLMENT-TIME-SPAN-ELG00021 file segmentSTEP 5: Link MSIS-IDs across filesCount the number of MSIS-IDs from STEP 3 that are also in STEP 4STEP 6: Calculate percentageDivide the count of MSIS-IDs from STEP 5 by the count of MSIS-IDs from STEP 3	N/A
04/24/2025	4.0.7	MCR-30-009-9	ADD	N/A		Created
04/24/2025	4.0.7	MCR-30-008-8	ADD	N/A		Created
11/20/2025	4.0.22	MCR-30-007-7	UPDATE	Annotation	Calculate the percentage of MSIS IDs on S-CHIP Encounter: original and adjustment, paid LT claims that can be found on any Eligible file enrollment time span segment	N/A
11/20/2025	4.0.22	MCR-30-007-7	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"STEP 3: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 2, limit to unique MSIS-IDsSTEP 4: Unique MSIS-IDs from Eligible fileIdentify the unique MSIS-IDs reported on the ENROLLMENT-TIME-SPAN-ELG00021 file segmentSTEP 5: Link MSIS-IDs across filesCount the number of MSIS-IDs from STEP 3 that are also in STEP 4STEP 6: Calculate percentageDivide the count of MSIS-IDs from STEP 5 by the count of MSIS-IDs from STEP 3	N/A
04/24/2025	4.0.7	MCR-30-007-7	ADD	N/A		Created
11/20/2025	4.0.22	MCR-30-006-6	UPDATE	Annotation	Calculate the percentage of MSIS IDs on S-CHIP Encounter: original and adjustment, paid IP claims that can be found on any Eligible file enrollment time span segment	N/A
11/20/2025	4.0.22	MCR-30-006-6	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"STEP 3: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 2, limit to unique MSIS-IDsSTEP 4: Unique MSIS-IDs from Eligible fileIdentify the unique MSIS-IDs reported on the ENROLLMENT-TIME-SPAN-ELG00021 file segmentSTEP 5: Link MSIS-IDs across filesCount the number of MSIS-IDs from STEP 3 that are also in STEP 4STEP 6: Calculate percentageDivide the count of MSIS-IDs from STEP 5 by the count of MSIS-IDs from STEP 3	N/A
04/24/2025	4.0.7	MCR-30-006-6	ADD	N/A		Created
11/20/2025	4.0.22	MCR-30-005-5	UPDATE	Annotation	Calculate the percentage of MSIS IDs on Medicaid Encounter: original and adjustment, paid RX claims that can be found on any Eligible file enrollment time span segment	N/A
11/20/2025	4.0.22	MCR-30-005-5	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 2, limit to unique MSIS-IDsSTEP 4: Unique MSIS-IDs from Eligible fileIdentify the unique MSIS-IDs reported on the ENROLLMENT-TIME-SPAN-ELG00021 file segmentSTEP 5: Link MSIS-IDs across filesCount the number of MSIS-IDs from STEP 3 that are also in STEP 4STEP 6: Calculate percentageDivide the count of MSIS-IDs from STEP 5 by the count of MSIS-IDs from STEP 3	N/A
04/24/2025	4.0.7	MCR-30-005-5	ADD	N/A		Created
11/20/2025	4.0.22	MCR-30-004-4	UPDATE	Annotation	Calculate the percentage of MSIS IDs on Medicaid Encounter: original and adjustment, paid OT claims that can be found on any Eligible file enrollment time span segment	N/A
11/20/2025	4.0.22	MCR-30-004-4	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 2, limit to unique MSIS-IDsSTEP 4: Unique MSIS-IDs from Eligible fileIdentify the unique MSIS-IDs reported on the ENROLLMENT-TIME-SPAN-ELG00021 file segmentSTEP 5: Link MSIS-IDs across filesCount the number of MSIS-IDs from STEP 3 that are also in STEP 4STEP 6: Calculate percentageDivide the count of MSIS-IDs from STEP 5 by the count of MSIS-IDs from STEP 3	N/A
04/24/2025	4.0.7	MCR-30-004-4	ADD	N/A		Created
04/24/2025	4.0.7	MCR-30-003-3	ADD	N/A		Created
11/20/2025	4.0.22	MCR-30-002-2	UPDATE	Annotation	Calculate the percentage of MSIS IDs on Medicaid Encounter: original and adjustment, paid LT claims that can be found on any Eligible file enrollment time span segment	N/A
11/20/2025	4.0.22	MCR-30-002-2	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 2, limit to unique MSIS-IDsSTEP 4: Unique MSIS-IDs from Eligible fileIdentify the unique MSIS-IDs reported on the ENROLLMENT-TIME-SPAN-ELG00021 file segmentSTEP 5: Link MSIS-IDs across filesCount the number of MSIS-IDs from STEP 3 that are also in STEP 4STEP 6: Calculate percentageDivide the count of MSIS-IDs from STEP 5 by the count of MSIS-IDs from STEP 3	N/A
04/24/2025	4.0.7	MCR-30-002-2	ADD	N/A		Created
11/20/2025	4.0.22	MCR-30-001-1	UPDATE	Annotation	Calculate the percentage of MSIS IDs on Medicaid Encounter: original and adjustment, paid IP claims that can be found on any Eligible file enrollment time span segment	N/A
11/20/2025	4.0.22	MCR-30-001-1	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 2, limit to unique MSIS-IDsSTEP 4: Unique MSIS-IDs from Eligible fileIdentify the unique MSIS-IDs reported on the ENROLLMENT-TIME-SPAN-ELG00021 file segmentSTEP 5: Link MSIS-IDs across filesCount the number of MSIS-IDs from STEP 3 that are also in STEP 4STEP 6: Calculate percentageDivide the count of MSIS-IDs from STEP 5 by the count of MSIS-IDs from STEP 3	N/A
04/24/2025	4.0.7	MCR-30-001-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-42-001-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-41-001-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-40-001-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-39-001-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-38-001-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-37-001-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-36-001-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-35-001-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-34-001-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-33-001-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-32-001-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-31-001-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-30-001-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-29-001-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-28-001-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-27-001-1	ADD	N/A		Created
08/13/2025	4.0.16	FFS-26-016-16	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3
04/24/2025	4.0.7	FFS-26-016-16	ADD	N/A		Created
11/20/2025	4.0.22	FFS-26-015-15	UPDATE	Annotation	Calculate the percentage of unique header records associated with S-CHIP FFS: original and adjustment, paid RX claims with an invalid or missing adjustment indicator value	N/A
11/20/2025	4.0.22	FFS-26-015-15	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique header records. STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique header records with ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique header records from STEP 4 by the count in STEP 3Of the claims that meet the criteria from STEP 2, count the number of unique header records.	N/A
04/24/2025	4.0.7	FFS-26-015-15	ADD	N/A		Created
08/13/2025	4.0.16	FFS-26-014-14	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A" STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A" STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3
04/24/2025	4.0.7	FFS-26-014-14	ADD	N/A		Created
11/20/2025	4.0.22	FFS-26-013-13	UPDATE	Annotation	Calculate the percentage of unique header records associated with S-CHIP FFS: original and adjustment, paid OT claims with an invalid or missing adjustment indicator value	N/A
11/20/2025	4.0.22	FFS-26-013-13	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique header records. STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique header records with ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique header records from STEP 4 by the count in STEP 3	N/A
04/24/2025	4.0.7	FFS-26-013-13	ADD	N/A		Created
08/13/2025	4.0.16	FFS-26-012-12	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3
04/24/2025	4.0.7	FFS-26-012-12	ADD	N/A		Created
11/20/2025	4.0.22	FFS-26-011-11	UPDATE	Annotation	Calculate the percentage of unique header records associated with S-CHIP FFS: original and adjustment, paid LT claims with an invalid or missing adjustment indicator value	N/A
11/20/2025	4.0.22	FFS-26-011-11	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique header records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique header records with ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique header records from STEP 4 by the count in STEP 3	N/A
04/24/2025	4.0.7	FFS-26-011-11	ADD	N/A		Created
08/13/2025	4.0.16	FFS-26-010-10	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3
04/24/2025	4.0.7	FFS-26-010-10	ADD	N/A		Created
11/20/2025	4.0.22	FFS-26-009-9	UPDATE	Annotation	Calculate the percentage of unique header records associated with S-CHIP FFS: original and adjustment, paid IP claims with an invalid or missing adjustment indicator value	N/A
11/20/2025	4.0.22	FFS-26-009-9	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique header records. STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique header records with ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique header records from STEP 4 by the count in STEP 3	N/A
04/24/2025	4.0.7	FFS-26-009-9	ADD	N/A		Created
08/13/2025	4.0.16	FFS-26-008-8	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3
04/24/2025	4.0.7	FFS-26-008-8	ADD	N/A		Created
11/20/2025	4.0.22	FFS-26-007-7	UPDATE	Annotation	Calculate the percentage of unique header records associated with Medicaid FFS: original and adjustment, paid RX claims with an invalid or missing adjustment indicator value	N/A
11/20/2025	4.0.22	FFS-26-007-7	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique header records. STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique header records with ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique header records from STEP 4 by the count in STEP 3STEP 3: Total Count	N/A
04/24/2025	4.0.7	FFS-26-007-7	ADD	N/A		Created
08/13/2025	4.0.16	FFS-26-006-6	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3
04/24/2025	4.0.7	FFS-26-006-6	ADD	N/A		Created
11/20/2025	4.0.22	FFS-26-005-5	UPDATE	Annotation	Calculate the percentage of unique header records associated with Medicaid FFS: original and adjustment, paid OT claims with an invalid or missing adjustment indicator value	N/A
11/20/2025	4.0.22	FFS-26-005-5	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS Payment: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique header records. STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique header records with ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique header records from STEP 4 by the count in STEP 3	N/A
04/24/2025	4.0.7	FFS-26-005-5	ADD	N/A		Created
08/13/2025	4.0.16	FFS-26-004-4	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3
04/24/2025	4.0.7	FFS-26-004-4	ADD	N/A		Created
11/20/2025	4.0.22	FFS-26-003-3	UPDATE	Annotation	Calculate the percentage of unique header records associated with Medicaid FFS: original and adjustment, paid LT claims with an invalid or missing adjustment indicator value	N/A
11/20/2025	4.0.22	FFS-26-003-3	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique header records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique header records with ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique header records from STEP 4 by the count in STEP 3	N/A
04/24/2025	4.0.7	FFS-26-003-3	ADD	N/A		Created
08/13/2025	4.0.16	FFS-26-002-2	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3
04/24/2025	4.0.7	FFS-26-002-2	ADD	N/A		Created
11/20/2025	4.0.22	FFS-26-001-1	UPDATE	Annotation	Calculate the percentage of unique header records associated with Medicaid FFS: original and adjustment, paid IP claims with an invalid or missing adjustment indicator value	N/A
11/20/2025	4.0.22	FFS-26-001-1	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique header records. STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique header records with ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique header records from STEP 4 by the count in STEP 3	N/A
04/24/2025	4.0.7	FFS-26-001-1	ADD	N/A		Created
11/20/2025	4.0.22	FFS-25-008-8	UPDATE	Annotation	Calculate the percentage of MSIS IDs on S-CHIP FFS: original and adjustment, paid RX claims that can be found on an Eligible file enrollment time span segment that spans the prescription fill date on the claims file	N/A
11/20/2025	4.0.22	FFS-25-008-8	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"STEP 3: Non-missing prescription fill dateOf the claims that meet the criteria from STEP 2, restrict to non-missing PRESCRIPTION-FILL-DATESTEP 4: Eligible any time and links to claimsDefine the ENROLLMENT-TIME-SPAN-ELG00021 file segment records that have an MSIS-ID that links to one of the claims identified in STEP 3STEP 5: Eligible during prescription fill dateFurther refine the eligible population by linking on MSIS-ID and keeping records that satisfy the following criteria:1. Claims PRESCRIPTION-FILL-DATE >= ENROLLMENT-EFF-DATE2. Claims PRESCRIPTION-FILL-DATE <= ENROLLMENT-END DATE OR ENROLLMENT-END DATE is missing STEP 6: Unique MSIS-IDs in eligibilityFrom the MSIS-IDs in STEP 5, limit to unique MSIS-IDs STEP 7: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 3, limit to unique MSIS-IDsSTEP 8: Calculate percentageDivide the count of MSIS-IDs from STEP 6 by the count of MSIS-IDs from STEP 7	N/A
04/24/2025	4.0.7	FFS-25-008-8	ADD	N/A		Created
11/20/2025	4.0.22	FFS-25-007-7	UPDATE	Annotation	Calculate the percentage of MSIS IDs on S-CHIP FFS: original and adjustment, paid OT claims that can be found on an Eligible file enrollment time span segment that spans the date of service on the claims file	N/A
11/20/2025	4.0.22	FFS-25-007-7	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"STEP 3: Non-missing beginning date of serviceOf the claims that meet the criteria from STEP 2, restrict to non-missing BEGINNING-DATE-OF-SERVICESTEP 4: Eligible any time and links to claimsDefine the ENROLLMENT-TIME-SPAN-ELG00021 file segment records that have an MSIS-ID that links to one of the claims identified in STEP 3STEP 5: Eligible during date of serviceFurther refine the eligible population by linking on MSIS-ID and keeping records that satisfy the following criteria:1. Claims BEGINNING-DATE-OF-SERVICE >= ENROLLMENT-EFF-DATE2. Claims BEGINNING-DATE-OF-SERVICE <= ENROLLMENT-END DATE OR ENROLLMENT-END DATE is missing STEP 6: Unique MSIS-IDs in eligibilityFrom the MSIS-IDs in STEP 5, limit to unique MSIS-IDs STEP 7: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 3, limit to unique MSIS-IDsSTEP 8: Calculate percentageDivide the count of MSIS-IDs from STEP 6 by the count of MSIS-IDs from STEP 7	N/A
04/24/2025	4.0.7	FFS-25-007-7	ADD	N/A		Created
11/20/2025	4.0.22	FFS-25-006-6	UPDATE	Annotation	Calculate the percentage of MSIS IDs on S-CHIP FFS: original and adjustment, paid LT claims that can be found on an Eligible file enrollment time span segment that spans the date of service on the claims file	N/A
11/20/2025	4.0.22	FFS-25-006-6	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"STEP 3: Non-missing beginning date of serviceOf the claims that meet the criteria from STEP 2, restrict to non-missing BEGINNING-DATE-OF-SERVICESTEP 4: Eligible any time and links to claimsDefine the ENROLLMENT-TIME-SPAN-ELG00021 file segment records that have an MSIS-ID that links to one of the claims identified in STEP 3STEP 5: Eligible during date of serviceFurther refine the eligible population by linking on MSIS-ID and keeping records that satisfy the following criteria:1. Claims BEGINNING-DATE-OF-SERVICE >= ENROLLMENT-EFF-DATE2. Claims BEGINNING-DATE-OF-SERVICE <= ENROLLMENT-END DATE OR ENROLLMENT-END DATE is missing STEP 6: Unique MSIS-IDs in eligibilityFrom the MSIS-IDs in STEP 5, limit to unique MSIS-IDs STEP 7: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 3, limit to unique MSIS-IDsSTEP 8: Calculate percentageDivide the count of MSIS-IDs from STEP 6 by the count of MSIS-IDs from STEP 7	N/A
04/24/2025	4.0.7	FFS-25-006-6	ADD	N/A		Created
11/20/2025	4.0.22	FFS-25-005-5	UPDATE	Annotation	Calculate the percentage of MSIS IDs on S-CHIP FFS: original and adjustment, paid IP claims that can be found on an Eligible file enrollment time span segment that spans the admission date on the claims file	N/A
11/20/2025	4.0.22	FFS-25-005-5	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"STEP 3: Non-missing admission dateOf the claims that meet the criteria from STEP 2, restrict to non-missing ADMISSION-DATESTEP 4: Eligible any time and links to claimsDefine the ENROLLMENT-TIME-SPAN-ELG00021 file segment records that have an MSIS-ID that links to one of the claims identified in STEP 3STEP 5: Eligible during admission dateFurther refine the eligible population by linking on MSIS-ID and keeping records that satisfy the following criteria:1. Claims ADMISSION-DATE >= ENROLLMENT-EFF-DATE2. Claims ADMISSION-DATE <= ENROLLMENT-END DATE OR ENROLLMENT-END DATE is missing STEP 6: Unique MSIS-IDs in eligibilityFrom the MSIS-IDs in STEP 5, limit to unique MSIS-IDs STEP 7: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 3, limit to unique MSIS-IDsSTEP 8: Calculate percentageDivide the count of MSIS-IDs from STEP 6 by the count of MSIS-IDs from STEP 7	N/A
04/24/2025	4.0.7	FFS-25-005-5	ADD	N/A		Created
11/20/2025	4.0.22	FFS-25-004-4	UPDATE	Annotation	Calculate the percentage of MSIS IDs on Medicaid FFS: original and adjustment, paid RX claims that can be found on an Eligible file enrollment time span segment that spans the prescription fill date on the claims file	N/A
11/20/2025	4.0.22	FFS-25-004-4	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Non-missing prescription fill dateOf the claims that meet the criteria from STEP 2, restrict to non-missing PRESCRIPTION-FILL-DATESTEP 4: Eligible any time and links to claimsDefine the ENROLLMENT-TIME-SPAN-ELG00021 file segment records that have an MSIS-ID that links to one of the claims identified in STEP 3STEP 5: Eligible during prescription fill dateFurther refine the eligible population by linking on MSIS-ID and keeping records that satisfy the following criteria:1. Claims PRESCRIPTION-FILL-DATE >= ENROLLMENT-EFF-DATE2. Claims PRESCRIPTION-FILL-DATE <= ENROLLMENT-END DATE OR ENROLLMENT-END DATE is missing STEP 6: Unique MSIS-IDs in eligibilityFrom the MSIS-IDs in STEP 5, limit to unique MSIS-IDs STEP 7: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 3, limit to unique MSIS-IDsSTEP 8: Calculate percentageDivide the count of MSIS-IDs from STEP 6 by the count of MSIS-IDs from STEP 7	N/A
04/24/2025	4.0.7	FFS-25-004-4	ADD	N/A		Created
11/20/2025	4.0.22	FFS-25-003-3	UPDATE	Annotation	Calculate the percentage of MSIS IDs on Medicaid FFS: original and adjustment, paid OT claims that can be found on an Eligible file enrollment time span segment that spans the date of service on the claims file	N/A
11/20/2025	4.0.22	FFS-25-003-3	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Non-missing beginning date of serviceOf the claims that meet the criteria from STEP 2, restrict to non-missing BEGINNING-DATE-OF-SERVICESTEP 4: Eligible any time and links to claimsDefine the ENROLLMENT-TIME-SPAN-ELG00021 file segment records that have an MSIS-ID that links to one of the claims identified in STEP 3STEP 5: Eligible during date of serviceFurther refine the eligible population by linking on MSIS-ID and keeping records that satisfy the following criteria:1. Claims BEGINNING-DATE-OF-SERVICE >= ENROLLMENT-EFF-DATE2. Claims BEGINNING-DATE-OF-SERVICE <= ENROLLMENT-END DATE OR ENROLLMENT-END DATE is missing STEP 6: Unique MSIS-IDs in eligibilityFrom the MSIS-IDs in STEP 5, limit to unique MSIS-IDs STEP 7: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 3, limit to unique MSIS-IDsSTEP 8: Calculate percentageDivide the count of MSIS-IDs from STEP 6 by the count of MSIS-IDs from STEP 7	N/A
04/24/2025	4.0.7	FFS-25-003-3	ADD	N/A		Created
11/20/2025	4.0.22	FFS-25-002-2	UPDATE	Annotation	Calculate the percentage of MSIS IDs on Medicaid FFS: original and adjustment, paid LT claims that can be found on an Eligible file enrollment time span segment that spans the date of service on the claims file	N/A
11/20/2025	4.0.22	FFS-25-002-2	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Non-missing beginning date of serviceOf the claims that meet the criteria from STEP 2, restrict to non-missing BEGINNING-DATE-OF-SERVICESTEP 4: Eligible any time and links to claimsDefine the ENROLLMENT-TIME-SPAN-ELG00021 file segment records that have an MSIS-ID that links to one of the claims identified in STEP 3STEP 5: Eligible during date of serviceFurther refine the eligible population by linking on MSIS-ID and keeping records that satisfy the following criteria:1. Claims BEGINNING-DATE-OF-SERVICE >= ENROLLMENT-EFF-DATE2. Claims BEGINNING-DATE-OF-SERVICE <= ENROLLMENT-END DATE OR ENROLLMENT-END DATE is missing STEP 6: Unique MSIS-IDs in eligibilityFrom the MSIS-IDs in STEP 5, limit to unique MSIS-IDs STEP 7: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 3, limit to unique MSIS-IDsSTEP 8: Calculate percentageDivide the count of MSIS-IDs from STEP 6 by the count of MSIS-IDs from STEP 7	N/A
04/24/2025	4.0.7	FFS-25-002-2	ADD	N/A		Created
11/20/2025	4.0.22	FFS-25-001-1	UPDATE	Annotation	Calculate the percentage of MSIS IDs on Medicaid FFS: original and adjustment, paid IP claims that can be found on an Eligible file enrollment time span segment that spans the admission date on the claims file	N/A
11/20/2025	4.0.22	FFS-25-001-1	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Non-missing admission dateOf the claims that meet the criteria from STEP 2, restrict to non-missing ADMISSION-DATESTEP 4: Eligible any time and links to claimsDefine the ENROLLMENT-TIME-SPAN-ELG00021 file segment records that have an MSIS-ID that links to one of the claims identified in STEP 3STEP 5: Eligible during admission dateFurther refine the eligible population by linking on MSIS-ID and keeping records that satisfy the following criteria:1. Claims ADMISSION-DATE >= ENROLLMENT-EFF-DATE2. Claims ADMISSION-DATE <= ENROLLMENT-END DATE OR ENROLLMENT-END DATE is missing STEP 6: Unique MSIS-IDs in eligibilityFrom the MSIS-IDs in STEP 5, limit to unique MSIS-IDs STEP 7: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 3, limit to unique MSIS-IDsSTEP 8: Calculate percentageDivide the count of MSIS-IDs from STEP 6 by the count of MSIS-IDs from STEP 7	N/A
04/24/2025	4.0.7	FFS-25-001-1	ADD	N/A		Created
11/20/2025	4.0.22	FFS-24-008-8	UPDATE	Annotation	Calculate the percentage of MSIS IDs on S-CHIP FFS: original and adjustment, paid RX claims that can be found on any Eligible file enrollment time span segment	N/A
11/20/2025	4.0.22	FFS-24-008-8	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"STEP 3: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 2, limit to unique MSIS-IDsSTEP 4: Unique MSIS-IDs from Eligible fileIdentify the unique MSIS-IDs reported on the ENROLLMENT-TIME-SPAN-ELG00021 file segmentSTEP 5: Link MSIS-IDs across filesCount the number of MSIS-IDs from STEP 3 that are also in STEP 4STEP 6: Calculate percentageDivide the count of MSIS-IDs from STEP 5 by the count of MSIS-IDs from STEP 3	N/A
04/24/2025	4.0.7	FFS-24-008-8	ADD	N/A		Created
11/20/2025	4.0.22	FFS-24-007-7	UPDATE	Annotation	Calculate the percentage of MSIS IDs on S-CHIP FFS: original and adjustment, paid OT claims that can be found on any Eligible file enrollment time span segment	N/A
11/20/2025	4.0.22	FFS-24-007-7	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"STEP 3: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 2, limit to unique MSIS-IDsSTEP 4: Unique MSIS-IDs from Eligible fileIdentify the unique MSIS-IDs reported on the ENROLLMENT-TIME-SPAN-ELG00021 file segmentSTEP 5: Link MSIS-IDs across filesCount the number of MSIS-IDs from STEP 3 that are also in STEP 4STEP 6: Calculate percentageDivide the count of MSIS-IDs from STEP 5 by the count of MSIS-IDs from STEP 3	N/A
04/24/2025	4.0.7	FFS-24-007-7	ADD	N/A		Created
11/20/2025	4.0.22	FFS-24-006-6	UPDATE	Annotation	Calculate the percentage of MSIS IDs on S-CHIP FFS: original and adjustment, paid LT claims that can be found on any Eligible file enrollment time span segment	N/A
11/20/2025	4.0.22	FFS-24-006-6	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"STEP 3: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 2, limit to unique MSIS-IDsSTEP 4: Unique MSIS-IDs from Eligible fileIdentify the unique MSIS-IDs reported on the ENROLLMENT-TIME-SPAN-ELG00021 file segmentSTEP 5: Link MSIS-IDs across filesCount the number of MSIS-IDs from STEP 3 that are also in STEP 4STEP 6: Calculate percentageDivide the count of MSIS-IDs from STEP 5 by the count of MSIS-IDs from STEP 3	N/A
04/24/2025	4.0.7	FFS-24-006-6	ADD	N/A		Created
11/20/2025	4.0.22	FFS-24-005-5	UPDATE	Annotation	Calculate the percentage of MSIS IDs on S-CHIP FFS: original and adjustment, paid IP claims that can be found on any Eligible file enrollment time span segment	N/A
11/20/2025	4.0.22	FFS-24-005-5	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"STEP 3: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 2, limit to unique MSIS-IDsSTEP 4: Unique MSIS-IDs from Eligible fileIdentify the unique MSIS-IDs reported on the ENROLLMENT-TIME-SPAN-ELG00021 file segmentSTEP 5: Link MSIS-IDs across filesCount the number of MSIS-IDs from STEP 3 that are also in STEP 4STEP 6: Calculate percentageDivide the count of MSIS-IDs from STEP 5 by the count of MSIS-IDs from STEP 3	N/A
04/24/2025	4.0.7	FFS-24-005-5	ADD	N/A		Created
11/20/2025	4.0.22	FFS-24-004-4	UPDATE	Annotation	Calculate the percentage of MSIS IDs on Medicaid FFS: original and adjustment, paid RX claims that can be found on any Eligible file enrollment time span segment	N/A
11/20/2025	4.0.22	FFS-24-004-4	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 2, limit to unique MSIS-IDsSTEP 4: Unique MSIS-IDs from Eligible fileIdentify the unique MSIS-IDs reported on the ENROLLMENT-TIME-SPAN-ELG00021 file segmentSTEP 5: Link MSIS-IDs across filesCount the number of MSIS-IDs from STEP 3 that are also in STEP 4STEP 6: Calculate percentageDivide the count of MSIS-IDs from STEP 5 by the count of MSIS-IDs from STEP 3	N/A
04/24/2025	4.0.7	FFS-24-004-4	ADD	N/A		Created
11/20/2025	4.0.22	FFS-24-003-3	UPDATE	Annotation	Calculate the percentage of MSIS IDs on Medicaid FFS: original and adjustment, paid OT claims that can be found on any Eligible file enrollment time span segment	N/A
11/20/2025	4.0.22	FFS-24-003-3	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 2, limit to unique MSIS-IDsSTEP 4: Unique MSIS-IDs from Eligible fileIdentify the unique MSIS-IDs reported on the ENROLLMENT-TIME-SPAN-ELG00021 file segmentSTEP 5: Link MSIS-IDs across filesCount the number of MSIS-IDs from STEP 3 that are also in STEP 4STEP 6: Calculate percentageDivide the count of MSIS-IDs from STEP 5 by the count of MSIS-IDs from STEP 3	N/A
04/24/2025	4.0.7	FFS-24-003-3	ADD	N/A		Created
11/20/2025	4.0.22	FFS-24-002-2	UPDATE	Annotation	Calculate the percentage of MSIS IDs on Medicaid FFS: original and adjustment, paid LT claims that can be found on any Eligible file enrollment time span segment	N/A
11/20/2025	4.0.22	FFS-24-002-2	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 2, limit to unique MSIS-IDsSTEP 4: Unique MSIS-IDs from Eligible fileIdentify the unique MSIS-IDs reported on the ENROLLMENT-TIME-SPAN-ELG00021 file segmentSTEP 5: Link MSIS-IDs across filesCount the number of MSIS-IDs from STEP 3 that are also in STEP 4STEP 6: Calculate percentageDivide the count of MSIS-IDs from STEP 5 by the count of MSIS-IDs from STEP 3	N/A
04/24/2025	4.0.7	FFS-24-002-2	ADD	N/A		Created
11/20/2025	4.0.22	FFS-24-001-1	UPDATE	Annotation	Calculate the percentage of MSIS IDs on Medicaid FFS: original and adjustment, paid IP claims that can be found on any Eligible file enrollment time span segment	N/A
11/20/2025	4.0.22	FFS-24-001-1	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 2, limit to unique MSIS-IDsSTEP 4: Unique MSIS-IDs from Eligible fileIdentify the unique MSIS-IDs reported on the ENROLLMENT-TIME-SPAN-ELG00021 file segmentSTEP 5: Link MSIS-IDs across filesCount the number of MSIS-IDs from STEP 3 that are also in STEP 4STEP 6: Calculate percentageDivide the count of MSIS-IDs from STEP 5 by the count of MSIS-IDs from STEP 3	N/A
04/24/2025	4.0.7	FFS-24-001-1	ADD	N/A		Created
04/24/2025	4.0.7	EL-10-008-8	ADD	N/A		Created
04/24/2025	4.0.7	EL-12-001-1	ADD	N/A		Created
08/13/2025	4.0.16	ALL-5-008-8	UPDATE	Specification	STEP 1: Active paid RX claims during DQ report monthDefine the RX claims universe at the line level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND, and keep all claims, including orphan lines1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines)1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Total CountOf the claims that meet the criteria from STEP 1, count the number of unique line records. A unique line record is defined by distinct combinations of the following data elements: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND. STEP 3: Count duplicatesFrom the records in STEP 1, count unique line records that appear more than onceSTEP 4: PercentageDivide the count of unique line records from STEP 3 by the count in STEP 2	STEP 1: Active paid RX claims during DQ report monthDefine the RX claims universe at the line level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND, and keep all claims, including orphan lines1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines)1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Total CountOf the claims that meet the criteria from STEP 1, count the number of unique line records. A unique line record is defined by distinct combinations of the following data elements: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND. STEP 3: Count duplicatesFrom the records in STEP 1, count unique line records that appear more than onceSTEP 4: PercentageDivide the count of unique line records from STEP 3 by the count in STEP 2
04/24/2025	4.0.7	ALL-5-008-8	ADD	N/A		Created
08/13/2025	4.0.16	ALL-5-007-7	UPDATE	Specification	STEP 1: Active paid OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND, and keep all claims, including orphan lines1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines)1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Total CountOf the claims that meet the criteria from STEP 1, count the number of unique line records. A unique line record is defined by distinct combinations of the following data elements: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND. STEP 3: Count duplicatesFrom the records in STEP 1, count unique line records that appear more than onceSTEP 4: PercentageDivide the count of unique line records from STEP 3 by the count in STEP 2	STEP 1: Active paid OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND, and keep all claims, including orphan lines1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines)1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Total CountOf the claims that meet the criteria from STEP 1, count the number of unique line records. A unique line record is defined by distinct combinations of the following data elements: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND. STEP 3: Count duplicatesFrom the records in STEP 1, count unique line records that appear more than onceSTEP 4: PercentageDivide the count of unique line records from STEP 3 by the count in STEP 2
04/24/2025	4.0.7	ALL-5-007-7	ADD	N/A		Created
08/13/2025	4.0.16	ALL-5-006-6	UPDATE	Specification	STEP 1: Active paid LT claims during DQ report monthDefine the LT claims universe at the line level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND, and keep all claims, including orphan lines1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines)1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Total CountOf the claims that meet the criteria from STEP 1, count the number of unique line records. A unique line record is defined by distinct combinations of the following data elements: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND. STEP 3: Count duplicatesFrom the records in STEP 1, count unique line records that appear more than onceSTEP 4: PercentageDivide the count of unique line records from STEP 3 by the count in STEP 2	STEP 1: Active paid LT claims during DQ report monthDefine the LT claims universe at the line level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND, and keep all claims, including orphan lines1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines)1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Total CountOf the claims that meet the criteria from STEP 1, count the number of unique line records. A unique line record is defined by distinct combinations of the following data elements: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND. STEP 3: Count duplicatesFrom the records in STEP 1, count unique line records that appear more than onceSTEP 4: PercentageDivide the count of unique line records from STEP 3 by the count in STEP 2
04/24/2025	4.0.7	ALL-5-006-6	ADD	N/A		Created
08/13/2025	4.0.16	ALL-5-005-5	UPDATE	Specification	STEP 1: Active paid IP claims during DQ report monthDefine the IP claims universe at the line level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND, and keep all claims, including orphan lines1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines)1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Total CountOf the claims that meet the criteria from STEP 1, count the number of unique line records. A unique line record is defined by distinct combinations of the following data elements: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND. STEP 3: Count duplicatesFrom the records in STEP 1, count unique line records that appear more than onceSTEP 4: PercentageDivide the count of unique line records from STEP 3 by the count in STEP 2	STEP 1: Active paid IP claims during DQ report monthDefine the IP claims universe at the line level by importing both headers and lines that satisfy the following criteria:1a. Limit to Report MonthReporting Period from the filename = DQ report month1b. Join Headers and LinesMerge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND, and keep all claims, including orphan lines1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines)1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing3. TYPE-OF-CLAIM is not equal to "Z" or is missing4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing1d. Keep line if line is not denied1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Total CountOf the claims that meet the criteria from STEP 1, count the number of unique line records. A unique line record is defined by distinct combinations of the following data elements: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND. STEP 3: Count duplicatesFrom the records in STEP 1, count unique line records that appear more than onceSTEP 4: PercentageDivide the count of unique line records from STEP 3 by the count in STEP 2
04/24/2025	4.0.7	ALL-5-005-5	ADD	N/A		Created
11/20/2025	4.0.22	ALL-5-004-4	UPDATE	Annotation	Calculate the percentage of unique RX claim header records that appear more than once	N/A
11/20/2025	4.0.22	ALL-5-004-4	UPDATE	Specification	STEP 1: Active RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Total CountFrom the records in STEP 1, count the number of unique header records. A unique header record is defined by distinct combinations of the following data elements: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND. STEP 3: Count duplicatesFrom the records in STEP 1, count unique header records that appear more than onceSTEP 4: PercentageDivide the count of unique header records from STEP 3 by the count in STEP 2	N/A
04/24/2025	4.0.7	ALL-5-004-4	ADD	N/A		Created
11/20/2025	4.0.22	ALL-5-003-3	UPDATE	Annotation	Calculate the percentage of unique OT claim header records that appear more than once	N/A
11/20/2025	4.0.22	ALL-5-003-3	UPDATE	Specification	STEP 1: Active OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Total CountFrom the records in STEP 1, count the number of unique header records. A unique header record is defined by distinct combinations of the following data elements: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND. STEP 3: Count duplicatesFrom the records in STEP 1, count unique header records that appear more than onceSTEP 4: PercentageDivide the count of unique header records from STEP 3 by the count in STEP 2	N/A
04/24/2025	4.0.7	ALL-5-003-3	ADD	N/A		Created
11/20/2025	4.0.22	ALL-5-002-2	UPDATE	Annotation	Calculate the percentage of unique LT claim header records that appear more than once	N/A
11/20/2025	4.0.22	ALL-5-002-2	UPDATE	Specification	STEP 1: Active LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Total CountFrom the records in STEP 1, count the number of unique header records. A unique header record is defined by distinct combinations of the following data elements: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND. STEP 3: Count duplicatesFrom the records in STEP 1, count unique header records that appear more than onceSTEP 4: PercentageDivide the count of unique header records from STEP 3 by the count in STEP 2	N/A
04/24/2025	4.0.7	ALL-5-002-2	ADD	N/A		Created
11/20/2025	4.0.22	ALL-5-001-1	UPDATE	Annotation	Calculate the percentage of unique IP claim header records that appear more than once	N/A
11/20/2025	4.0.22	ALL-5-001-1	UPDATE	Specification	STEP 1: Active IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missingSTEP 2: Total CountFrom the records in STEP 1, count the number of unique header records. A unique header record is defined by distinct combinations of the following data elements: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND. STEP 3: Count duplicatesFrom the records in STEP 1, count unique header records that appear more than onceSTEP 4: PercentageDivide the count of unique header records from STEP 3 by the count in STEP 2	N/A
04/24/2025	4.0.7	ALL-5-001-1	ADD	N/A		Created
08/13/2025	4.0.16	ALL-4-004-4	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX claims universe at the line level by importing both headers and lines that satisfy the following criteria: For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Unique state-assigned provider IDsFor each of the RX claims identified in STEP 1, create a list of unique state-assigned provider IDs using the following data elements:1. BILLING-PROV-NUM2. DISPENSING-PRESCRIPTION-DRUG-PROV-NUMSTEP 3: Match state-assigned provider IDs to provider file IDsMatch the unique state assigned provider IDs identified in STEP 2 to the SUBMITTING-STATE-PROV-ID in the PROV-ATTRIBUTES-MAIN-PRV00002 segment OR the PROV-IDENTIFIER in the PROV-IDENTIFIERS-PRV00005 segmentSTEP 4: Number of non-matchesCount the number of unique state assigned provider IDs from STEP 2 that fail to match in STEP 3STEP 5: Percentage of non-matchesDivide the count from STEP 4 by the total number of unique state assigned provider IDs identified in STEP 2	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX claims universe at the line level by importing both headers and lines that satisfy the following criteria: For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Unique state-assigned provider IDsFor each of the RX claims identified in STEP 1, create a list of unique state-assigned provider IDs using the following data elements:1. BILLING-PROV-NUM2. DISPENSING-PRESCRIPTION-DRUG-PROV-NUMSTEP 3: Match state-assigned provider IDs to provider file IDsMatch the unique state assigned provider IDs identified in STEP 2 to the SUBMITTING-STATE-PROV-ID in the PROV-ATTRIBUTES-MAIN-PRV00002 segment OR the PROV-IDENTIFIER in the PROV-IDENTIFIERS-PRV00005 segmentSTEP 4: Number of non-matchesCount the number of unique state assigned provider IDs from STEP 2 that fail to match in STEP 3STEP 5: Percentage of non-matchesDivide the count from STEP 4 by the total number of unique state assigned provider IDs identified in STEP 2
04/24/2025	4.0.7	ALL-4-004-4	ADD	N/A		Created
08/13/2025	4.0.16	ALL-4-003-3	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria: For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Unique state-assigned provider IDsFor each of the OT claims identified in STEP 1, create a list of unique state-assigned provider IDs using the following data elements:1. BILLING-PROV-NUM2. SERVICING-PROV-NUMSTEP 3: Match state-assigned provider IDs to provider file IDsMatch the unique state assigned provider IDs identified in STEP 2 to the SUBMITTING-STATE-PROV-ID in the PROV-ATTRIBUTES-MAIN-PRV00002 segment OR the PROV-IDENTIFIER in the PROV-IDENTIFIERS-PRV00005 segmentSTEP 4: Number of non-matchesCount the number of unique state assigned provider IDs from STEP 2 that fail to match in STEP 3STEP 5: Percentage of non-matchesDivide the count from STEP 4 by the total number of unique state assigned provider IDs identified in STEP 2	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria: For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Unique state-assigned provider IDsFor each of the OT claims identified in STEP 1, create a list of unique state-assigned provider IDs using the following data elements:1. BILLING-PROV-NUM2. SERVICING-PROV-NUMSTEP 3: Match state-assigned provider IDs to provider file IDsMatch the unique state assigned provider IDs identified in STEP 2 to the SUBMITTING-STATE-PROV-ID in the PROV-ATTRIBUTES-MAIN-PRV00002 segment OR the PROV-IDENTIFIER in the PROV-IDENTIFIERS-PRV00005 segmentSTEP 4: Number of non-matchesCount the number of unique state assigned provider IDs from STEP 2 that fail to match in STEP 3STEP 5: Percentage of non-matchesDivide the count from STEP 4 by the total number of unique state assigned provider IDs identified in STEP 2
04/24/2025	4.0.7	ALL-4-003-3	ADD	N/A		Created
08/13/2025	4.0.16	ALL-4-002-2	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT claims universe at the line level by importing both headers and lines that satisfy the following criteria: For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Unique state-assigned provider IDsFor each of the LT claims identified in STEP 1, create a list of unique state-assigned provider IDs using the following data elements:1. BILLING-PROV-NUM2. SERVICING-PROV-NUMSTEP 3: Match state-assigned provider IDs to provider file IDsMatch the unique state assigned provider IDs identified in STEP 2 to the SUBMITTING-STATE-PROV-ID in the PROV-ATTRIBUTES-MAIN-PRV00002 segment OR the PROV-IDENTIFIER in the PROV-IDENTIFIERS-PRV00005 segmentSTEP 4: Number of non-matchesCount the number of unique state assigned provider IDs from STEP 2 that fail to match in STEP 3STEP 5: Percentage of non-matchesDivide the count from STEP 4 by the total number of unique state assigned provider IDs identified in STEP 2	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT claims universe at the line level by importing both headers and lines that satisfy the following criteria: For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Unique state-assigned provider IDsFor each of the LT claims identified in STEP 1, create a list of unique state-assigned provider IDs using the following data elements:1. BILLING-PROV-NUM2. SERVICING-PROV-NUMSTEP 3: Match state-assigned provider IDs to provider file IDsMatch the unique state assigned provider IDs identified in STEP 2 to the SUBMITTING-STATE-PROV-ID in the PROV-ATTRIBUTES-MAIN-PRV00002 segment OR the PROV-IDENTIFIER in the PROV-IDENTIFIERS-PRV00005 segmentSTEP 4: Number of non-matchesCount the number of unique state assigned provider IDs from STEP 2 that fail to match in STEP 3STEP 5: Percentage of non-matchesDivide the count from STEP 4 by the total number of unique state assigned provider IDs identified in STEP 2
04/24/2025	4.0.7	ALL-4-002-2	ADD	N/A		Created
08/13/2025	4.0.16	ALL-4-001-1	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP claims universe at the line level by importing both headers and lines that satisfy the following criteria.For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Unique state-assigned provider IDsFor each of the IP claims identified in STEP 1, create a list of unique state-assigned provider IDs using the following data elements:1. BILLING-PROV-NUM2. SERVICING-PROV-NUMSTEP 3: Match state-assigned provider IDs to provider file IDsMatch the unique state assigned provider IDs identified in STEP 2 to the SUBMITTING-STATE-PROV-ID in the PROV-ATTRIBUTES-MAIN-PRV00002 segment OR the PROV-IDENTIFIER in the PROV-IDENTIFIERS-PRV00005 segmentSTEP 4: Number of non-matchesCount the number of unique state assigned provider IDs from STEP 2 that fail to match in STEP 3STEP 5: Percentage of non-matchesDivide the count from STEP 4 by the total number of unique state assigned provider IDs identified in STEP 2	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP claims universe at the line level by importing both headers and lines that satisfy the following criteria.For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Unique state-assigned provider IDsFor each of the IP claims identified in STEP 1, create a list of unique state-assigned provider IDs using the following data elements:1. BILLING-PROV-NUM2. SERVICING-PROV-NUMSTEP 3: Match state-assigned provider IDs to provider file IDsMatch the unique state assigned provider IDs identified in STEP 2 to the SUBMITTING-STATE-PROV-ID in the PROV-ATTRIBUTES-MAIN-PRV00002 segment OR the PROV-IDENTIFIER in the PROV-IDENTIFIERS-PRV00005 segmentSTEP 4: Number of non-matchesCount the number of unique state assigned provider IDs from STEP 2 that fail to match in STEP 3STEP 5: Percentage of non-matchesDivide the count from STEP 4 by the total number of unique state assigned provider IDs identified in STEP 2
04/24/2025	4.0.7	ALL-4-001-1	ADD	N/A		Created
04/24/2025	4.0.7	TPL-7-004-2	ADD	N/A		Created
04/24/2025	4.0.7	TPL-7-003-3	ADD	N/A		Created
04/24/2025	4.0.7	TPL-7-002-4	ADD	N/A		Created
04/24/2025	4.0.7	TPL-7-001-1	ADD	N/A		Created
04/24/2025	4.0.7	TPL-6-004-2	ADD	N/A		Created
04/24/2025	4.0.7	TPL-6-003-3	ADD	N/A		Created
04/24/2025	4.0.7	TPL-6-002-4	ADD	N/A		Created
04/24/2025	4.0.7	TPL-6-001-1	ADD	N/A		Created
04/24/2025	4.0.7	TPL-5-008-8	ADD	N/A		Created
04/24/2025	4.0.7	TPL-5-007-4	ADD	N/A		Created
04/24/2025	4.0.7	TPL-5-006-6	ADD	N/A		Created
04/24/2025	4.0.7	TPL-5-005-2	ADD	N/A		Created
04/24/2025	4.0.7	TPL-5-004-7	ADD	N/A		Created
04/24/2025	4.0.7	TPL-5-003-3	ADD	N/A		Created
04/24/2025	4.0.7	TPL-5-002-5	ADD	N/A		Created
04/24/2025	4.0.7	TPL-5-001-1	ADD	N/A		Created
04/24/2025	4.0.7	TPL-4-008-8	ADD	N/A		Created
04/24/2025	4.0.7	TPL-4-007-4	ADD	N/A		Created
04/24/2025	4.0.7	TPL-4-006-6	ADD	N/A		Created
04/24/2025	4.0.7	TPL-4-005-2	ADD	N/A		Created
04/24/2025	4.0.7	TPL-4-004-7	ADD	N/A		Created
04/24/2025	4.0.7	TPL-4-003-3	ADD	N/A		Created
04/24/2025	4.0.7	TPL-4-002-5	ADD	N/A		Created
04/24/2025	4.0.7	TPL-4-001-1	ADD	N/A		Created
11/20/2025	4.0.22	TPL-3-008-8	UPDATE	Annotation	Calculate the percentage of Medicaid Encounter: original, non-crossover, paid RX claims with any valid value for other TPL collection code	N/A
11/20/2025	4.0.22	TPL-3-008-8	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Other TPL collection codeOf the claims that meet the criteria from STEP 2, select claims with a valid value for other TPL collection code:1. OTHER-TPL-COLLECTION = (“001” or “002” or “003” or “004” or “005” or “006” or “007”)STEP 4 : Calculate percentage for measureDivide the count of claims from STEP 3 by the count of claims from STEP 2.	N/A
04/24/2025	4.0.7	TPL-3-008-8	ADD	N/A		Created
11/20/2025	4.0.22	TPL-3-007-4	UPDATE	Annotation	Calculate the percentage of Medicaid Encounter: original, non-crossover, paid LT claims with any valid value for other TPL collection code	N/A
11/20/2025	4.0.22	TPL-3-007-4	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Other TPL collection codeOf the claims that meet the criteria from STEP 2, select claims with a valid value for other TPL collection code:1. OTHER-TPL-COLLECTION = (“001” or “002” or “003” or “004” or “005” or “006” or “007”)STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	TPL-3-007-4	ADD	N/A		Created
08/13/2025	4.0.16	TPL-3-006-6	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Other TPL collection codeOf the claims that meet the criteria from STEP 2, select claims with a valid value for other TPL collection code:1. OTHER-TPL-COLLECTION = (“001” or “002” or “003” or “004” or “005” or “006” or “007”)STEP 4: Calculate the percentage for the measureDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Other TPL collection codeOf the claims that meet the criteria from STEP 2, select claims with a valid value for other TPL collection code:1. OTHER-TPL-COLLECTION = (“001” or “002” or “003” or “004” or “005” or “006” or “007”)STEP 4: Calculate the percentage for the measureDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2
04/24/2025	4.0.7	TPL-3-006-6	ADD	N/A		Created
11/20/2025	4.0.22	TPL-3-005-2	UPDATE	Annotation	Calculate the percentage of Medicaid Encounter: original, non-crossover, paid IP claims with any valid value for other TPL collection code	N/A
11/20/2025	4.0.22	TPL-3-005-2	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Other TPL collection codeOf the claims that meet the criteria from STEP 2, select claims with a valid value for other TPL collection code:1. OTHER-TPL-COLLECTION = (“001” or “002” or “003” or “004” or “005” or “006” or “007”)STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	TPL-3-005-2	ADD	N/A		Created
11/20/2025	4.0.22	TPL-3-004-7	UPDATE	Annotation	Calculate the percentage of Medicaid Encounter: original, non-crossover, paid RX claims with other insurance	N/A
11/20/2025	4.0.22	TPL-3-004-7	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Other insuranceOf the claims that meet the criteria from STEP 2, select claims with other insurance:1. OTHER-INSURANCE-IND = "1"STEP 4 : Calculate percentage for measureDivide the count of claims from STEP 3 by the count of claims from STEP 2.	N/A
04/24/2025	4.0.7	TPL-3-004-7	ADD	N/A		Created
11/20/2025	4.0.22	TPL-3-003-3	UPDATE	Annotation	Calculate the percentage of Medicaid Encounter: original, non-crossover, paid LT claims with other insurance	N/A
11/20/2025	4.0.22	TPL-3-003-3	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Other insuranceOf the claims that meet the criteria from STEP 2, select records with 1. OTHER-INSURANCE-IND = "1"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	TPL-3-003-3	ADD	N/A		Created
08/13/2025	4.0.16	TPL-3-002-5	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Other insuranceOf the claims that meet the criteria from STEP 2, select line records with 1. OTHER-INSURANCE-IND = "1"STEP 4: Calculate the percentage for the measureDivide the count of line records from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Other insuranceOf the claims that meet the criteria from STEP 2, select line records with 1. OTHER-INSURANCE-IND = "1"STEP 4: Calculate the percentage for the measureDivide the count of line records from STEP 3 by the count of claim lines from STEP 2
04/24/2025	4.0.7	TPL-3-002-5	ADD	N/A		Created
11/20/2025	4.0.22	TPL-3-001-1	UPDATE	Annotation	Calculate the percentage of Medicaid Encounter: original, non-crossover, paid IP claims with other insurance	N/A
11/20/2025	4.0.22	TPL-3-001-1	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Other insuranceOf the claims that meet the criteria from STEP 2, select records with 1. OTHER-INSURANCE-IND = "1"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	TPL-3-001-1	ADD	N/A		Created
11/20/2025	4.0.22	TPL-2-008-8	UPDATE	Annotation	Calculate the percentage of Medicaid FFS: original, non-crossover, paid RX claims with any valid value for other TPL collection code	N/A
11/20/2025	4.0.22	TPL-2-008-8	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Other TPL collection codeOf the claims that meet the criteria from STEP 2, select claims with a valid value for other TPL collection code:1. OTHER-TPL-COLLECTION = (“001” or “002” or “003” or “004” or “005” or “006” or “007”)STEP 4 : Calculate percentage for measureDivide the count of claims from STEP 3 by the count of claims from STEP 2.	N/A
04/24/2025	4.0.7	TPL-2-008-8	ADD	N/A		Created
11/20/2025	4.0.22	TPL-2-007-4	UPDATE	Annotation	Percentage of Medicaid FFS: original, non-crossover, paid LT claims with any valid value for other TPL collection code	N/A
11/20/2025	4.0.22	TPL-2-007-4	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Other TPL collection codeOf the claims that meet the criteria from STEP 2, select claims with a valid value for other TPL collection code:1. OTHER-TPL-COLLECTION = (“001” or “002” or “003” or “004” or “005” or “006” or “007”)STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	TPL-2-007-4	ADD	N/A		Created
08/13/2025	4.0.16	TPL-2-006-6	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Other TPL collection codeOf the claims that meet the criteria from STEP 2, select claims with a valid value for other TPL collection code:1. OTHER-TPL-COLLECTION = (“001” or “002” or “003” or “004” or “005” or “006” or “007”)STEP 4: Calculate the percentage for the measureDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Other TPL collection codeOf the claims that meet the criteria from STEP 2, select claims with a valid value for other TPL collection code:1. OTHER-TPL-COLLECTION = (“001” or “002” or “003” or “004” or “005” or “006” or “007”)STEP 4: Calculate the percentage for the measureDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2
04/24/2025	4.0.7	TPL-2-006-6	ADD	N/A		Created
11/20/2025	4.0.22	TPL-2-005-2	UPDATE	Annotation	Calculate the percentage of Medicaid FFS: original, non-crossover, paid IP claims with any valid value for other TPL collection code	N/A
11/20/2025	4.0.22	TPL-2-005-2	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Other TPL collection codeOf the claims that meet the criteria from STEP 2, select claims with a valid value for other TPL collection code:1. OTHER-TPL-COLLECTION = (“001” or “002” or “003” or “004” or “005” or “006” or “007”)STEP 4 : Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2.	N/A
04/24/2025	4.0.7	TPL-2-005-2	ADD	N/A		Created
11/20/2025	4.0.22	TPL-2-004-7	UPDATE	Annotation	Calculate the percentage of Medicaid FFS: original, non-crossover, paid RX claims with other insurance	N/A
11/20/2025	4.0.22	TPL-2-004-7	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Other insuranceOf the claims that meet the criteria from STEP 2, select records with 1. OTHER-INSURANCE-IND = "1"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	TPL-2-004-7	ADD	N/A		Created
11/20/2025	4.0.22	TPL-2-003-3	UPDATE	Annotation	Percentage of Medicaid FFS: original, non-crossover, paid LT claims with other insurance	N/A
11/20/2025	4.0.22	TPL-2-003-3	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Other insuranceOf the claims that meet the criteria from STEP 2, select records where 1. OTHER-INSURANCE-IND = "1"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	TPL-2-003-3	ADD	N/A		Created
08/13/2025	4.0.16	TPL-2-002-5	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Other insuranceOf the claim lines that meet the criteria from STEP 2, select records where 1. OTHER-INSURANCE-IND = "1"STEP 4: Calculate the percentage for the measureDivide the count of claim lines from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Other insuranceOf the claim lines that meet the criteria from STEP 2, select records where 1. OTHER-INSURANCE-IND = "1"STEP 4: Calculate the percentage for the measureDivide the count of claim lines from STEP 3 by the count of claims from STEP 2
04/24/2025	4.0.7	TPL-2-002-5	ADD	N/A		Created
11/20/2025	4.0.22	TPL-2-001-1	UPDATE	Annotation	Calculate the percentage of Medicaid FFS: original, non-crossover, paid IP claims with other insurance	N/A
11/20/2025	4.0.22	TPL-2-001-1	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Other insuranceOf the claims that meet the criteria from STEP 2, select claims with other insurance:1. OTHER-INSURANCE-IND = "1"STEP 4 : Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2.	N/A
04/24/2025	4.0.7	TPL-2-001-1	ADD	N/A		Created
04/24/2025	4.0.7	TPL-1-004-3	ADD	N/A		Created
04/24/2025	4.0.7	TPL-1-003-2	ADD	N/A		Created
04/24/2025	4.0.7	TPL-1-002-4	ADD	N/A		Created
04/24/2025	4.0.7	TPL-1-001-1	ADD	N/A		Created
04/24/2025	4.0.7	PRV-S-003-3	ADD	N/A		Created
04/24/2025	4.0.7	PRV-S-002-2	ADD	N/A		Created
04/24/2025	4.0.7	PRV-S-001-1	ADD	N/A		Created
11/20/2025	4.0.22	PRV-4-001-1	UPDATE	Annotation	For the data element, provider classification type code, run the frequency of unique state submitting provider IDs for each valid value, any valid value, and any invalid value, including missing	N/A
11/20/2025	4.0.22	PRV-4-001-1	UPDATE	Specification	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 2: Provider taxonomy on the last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROV-TAXONOMY-CLASSIFICATION-PRV00006 by keeping records that satisfy the following criteria:1a. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= last day of the reporting month2a. PROV-TAXONOMY-CLASSIFICATION-END-DATE >= last day of the reporting month OR missingOR1b. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE is missing2b. PROV-TAXONOMY-CLASSIFICATION-END-DATE is missingSTEP 3: FrequencyCount the number of unique SUBMITTING-STATE-PROV-IDs from STEP 2 for:1. (1,2,3,4) Each valid value: PROV-CLASSIFICATION-TYPE = ("1", "2", "3", "4", respectively)2. (A) Any valid value: PROV-CLASSIFICATION-TYPE = ("1" or "2" or "3" or "4")3. (N) No valid value: PROV-CLASSIFICATION-TYPE (NOT ("1" or "2" or "3" or "4") or missing4. (T) total: PROV-CLASSIFICATION-TYPE = (any missing or non-missing value)	N/A
04/24/2025	4.0.7	PRV-4-001-1	ADD	N/A		Created
04/24/2025	4.0.7	PRV-3-006-2	ADD	N/A		Created
04/24/2025	4.0.7	PRV-3-005-1	ADD	N/A		Created
04/24/2025	4.0.7	PRV-3-004-6	ADD	N/A		Created
04/24/2025	4.0.7	PRV-3-003-5	ADD	N/A		Created
04/24/2025	4.0.7	PRV-3-002-4	ADD	N/A		Created
04/24/2025	4.0.7	PRV-3-001-3	ADD	N/A		Created
04/24/2025	4.0.7	PRV-2-008-8	ADD	N/A		Created
04/24/2025	4.0.7	PRV-2-007-7	ADD	N/A		Created
04/24/2025	4.0.7	PRV-2-006-6	ADD	N/A		Created
04/24/2025	4.0.7	PRV-2-005-5	ADD	N/A		Created
04/24/2025	4.0.7	PRV-2-004-4	ADD	N/A		Created
04/24/2025	4.0.7	PRV-2-003-3	ADD	N/A		Created
11/20/2025	4.0.22	PRV-2-002-2	UPDATE	Annotation	Calculate the percent of submitting state provider IDs that have an NPI	N/A
11/20/2025	4.0.22	PRV-2-002-2	UPDATE	Specification	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missing STEP 2: Provider identifier is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROV-IDENTIFIER-PRV00005 by keeping records that satisfy the following criteria:1a. PROV-IDENTIFIER-EFF-DATE <= last day of the reporting month2a. PROV-IDENTIFIER-END-DATE >= last day of the reporting month OR missingOR1b. PROV-IDENTIFIER-EFF-DATE is missing2b. PROV-IDENTIFIER-END-DATE is missingSTEP 3: Provider classification type is "NPI"Of the providers that meet the criteria from STEP 2, keep records that satisfy the following criteria: 1. PROV-IDENTIFIER-TYPE = 2STEP 4: Calculate percent that have NPIDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count from STEP 2	N/A
04/24/2025	4.0.7	PRV-2-002-2	ADD	N/A		Created
04/24/2025	4.0.7	PRV-2-001-1	ADD	N/A		Created
04/24/2025	4.0.7	PRV-1-016-6	ADD	N/A		Created
04/24/2025	4.0.7	PRV-1-015-3	ADD	N/A		Created
04/24/2025	4.0.7	PRV-1-014-5	ADD	N/A		Created
04/24/2025	4.0.7	PRV-1-013-4	ADD	N/A		Created
04/24/2025	4.0.7	PRV-1-012-10	ADD	N/A		Created
04/24/2025	4.0.7	PRV-1-011-7	ADD	N/A		Created
04/24/2025	4.0.7	PRV-1-010-9	ADD	N/A		Created
04/24/2025	4.0.7	PRV-1-009-8	ADD	N/A		Created
04/24/2025	4.0.7	PRV-1-008-2	ADD	N/A		Created
04/24/2025	4.0.7	PRV-1-007-1	ADD	N/A		Created
04/24/2025	4.0.7	PRV-1-006-15	ADD	N/A		Created
04/24/2025	4.0.7	PRV-1-005-16	ADD	N/A		Created
04/24/2025	4.0.7	PRV-1-004-13	ADD	N/A		Created
04/24/2025	4.0.7	PRV-1-003-14	ADD	N/A		Created
04/24/2025	4.0.7	PRV-1-002-11	ADD	N/A		Created
04/24/2025	4.0.7	PRV-1-001-12	ADD	N/A		Created
04/24/2025	4.0.7	MCR-S-027-24	ADD	N/A		Created
04/24/2025	4.0.7	MCR-S-026-23	ADD	N/A		Created
04/24/2025	4.0.7	MCR-S-025-15	ADD	N/A		Created
04/24/2025	4.0.7	MCR-S-024-18	ADD	N/A		Created
04/24/2025	4.0.7	MCR-S-023-12	ADD	N/A		Created
11/20/2025	4.0.22	MCR-S-022-4	UPDATE	Annotation	Calculate the percentage of Medicaid Encounter: original, paid LT claims that are crossover claims	N/A
11/20/2025	4.0.22	MCR-S-022-4	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"STEP 3: Medicaid Encounter: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 2, select crossover claims:1. CROSSOVER-INDICATOR = "1"STEP 4 : Calculate percentage for measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MCR-S-022-4	ADD	N/A		Created
08/13/2025	4.0.16	MCR-S-021-7	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"STEP 3: Medicaid Encounter: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 2, select crossover claims:1. CROSSOVER-INDICATOR = "1"STEP 4 : Calculate percentage for measureDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"STEP 3: Medicaid Encounter: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 2, select crossover claims:1. CROSSOVER-INDICATOR = "1"STEP 4 : Calculate percentage for measureDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2
04/24/2025	4.0.7	MCR-S-021-7	ADD	N/A		Created
11/20/2025	4.0.22	MCR-S-020-1	UPDATE	Annotation	Calculate the percentage of Original, Paid IP Medicaid Encounter that are crossover claims	N/A
11/20/2025	4.0.22	MCR-S-020-1	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-CATEGORY is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Paid ClaimsOf the claims that meet the criteria specified in STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT_IND = "0"STEP 3: Medicaid Encounter: Original, Crossover, Paid ClaimsOf the claims that meet the criteria in STEP2, select crossover claims:1. CROSSOVER_IND = "1"Step 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2.	N/A
04/24/2025	4.0.7	MCR-S-020-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-S-019-21	ADD	N/A		Created
04/24/2025	4.0.7	MCR-S-018-16	ADD	N/A		Created
04/24/2025	4.0.7	MCR-S-017-19	ADD	N/A		Created
04/24/2025	4.0.7	MCR-S-016-13	ADD	N/A		Created
11/20/2025	4.0.22	MCR-S-015-10	UPDATE	Annotation	Percentage of Medicaid Encounter: original and adjustment, paid RX claims that are original	N/A
11/20/2025	4.0.22	MCR-S-015-10	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Original claimsOf the claims that meet the criteria from STEP 2, select records where 1. ADJUSTMENT-IND = "0"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MCR-S-015-10	ADD	N/A		Created
11/20/2025	4.0.22	MCR-S-014-5	UPDATE	Annotation	Percentage of Medicaid Encounter: original and adjustment, paid LT claims that are original	N/A
11/20/2025	4.0.22	MCR-S-014-5	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Original claimsOf the claims that meet the criteria from STEP 2, select records where 1. ADJUSTMENT-IND = "0"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MCR-S-014-5	ADD	N/A		Created
08/13/2025	4.0.16	MCR-S-013-8	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Original linesOf the records that meet the criteria from STEP 2, select records where1. LINE-ADJUSTMENT-IND = "0"STEP 4: Calculate the percentage for the measureDivide the count of line records from STEP 3 by the number of line records in STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Original linesOf the records that meet the criteria from STEP 2, select records where1. LINE-ADJUSTMENT-IND = "0"STEP 4: Calculate the percentage for the measureDivide the count of line records from STEP 3 by the number of line records in STEP 2
04/24/2025	4.0.7	MCR-S-013-8	ADD	N/A		Created
11/20/2025	4.0.22	MCR-S-012-2	UPDATE	Annotation	Percentage of Medicaid Encounter: original and adjustment, paid IP claims that are original	N/A
11/20/2025	4.0.22	MCR-S-012-2	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-CATEGORY is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Medicaid Encounter: Original claimsOf the claims that meet the criteria in STEP 2, select records where:1. ADJUSTMENT_IND = "0"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2.	N/A
04/24/2025	4.0.7	MCR-S-012-2	ADD	N/A		Created
04/24/2025	4.0.7	MCR-S-011-22	ADD	N/A		Created
04/24/2025	4.0.7	MCR-S-010-17	ADD	N/A		Created
04/24/2025	4.0.7	MCR-S-009-20	ADD	N/A		Created
04/24/2025	4.0.7	MCR-S-008-14	ADD	N/A		Created
04/24/2025	4.0.7	MCR-S-007-11	ADD	N/A		Created
04/24/2025	4.0.7	MCR-S-006-6	ADD	N/A		Created
04/24/2025	4.0.7	MCR-S-005-9	ADD	N/A		Created
04/24/2025	4.0.7	MCR-S-004-3	ADD	N/A		Created
04/24/2025	4.0.7	MCR-S-003-26	ADD	N/A		Created
04/24/2025	4.0.7	MCR-S-002-25	ADD	N/A		Created
04/24/2025	4.0.7	MCR-S-001-27	ADD	N/A		Created
04/24/2025	4.0.7	MCR-9-017-8	ADD	N/A		Created
04/24/2025	4.0.7	MCR-9-016-9	ADD	N/A		Created
04/24/2025	4.0.7	MCR-9-015-10	ADD	N/A		Created
04/24/2025	4.0.7	MCR-9-014-11	ADD	N/A		Created
04/24/2025	4.0.7	MCR-9-013-12	ADD	N/A		Created
04/24/2025	4.0.7	MCR-9-012-13	ADD	N/A		Created
04/24/2025	4.0.7	MCR-9-011-14	ADD	N/A		Created
04/24/2025	4.0.7	MCR-9-010-15	ADD	N/A		Created
04/24/2025	4.0.7	MCR-9-009-16	ADD	N/A		Created
04/24/2025	4.0.7	MCR-9-008-5	ADD	N/A		Created
04/24/2025	4.0.7	MCR-9-007-6	ADD	N/A		Created
04/24/2025	4.0.7	MCR-9-006-7	ADD	N/A		Created
04/24/2025	4.0.7	MCR-9-005-4	ADD	N/A		Created
04/24/2025	4.0.7	MCR-9-004-2	ADD	N/A		Created
04/24/2025	4.0.7	MCR-9-003-3	ADD	N/A		Created
04/24/2025	4.0.7	MCR-9-002-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-9-001-17	ADD	N/A		Created
04/24/2025	4.0.7	MCR-8-009-7	ADD	N/A		Created
04/24/2025	4.0.7	MCR-8-008-6	ADD	N/A		Created
04/24/2025	4.0.7	MCR-8-007-5	ADD	N/A		Created
04/24/2025	4.0.7	MCR-8-006-4	ADD	N/A		Created
04/24/2025	4.0.7	MCR-8-005-3	ADD	N/A		Created
04/24/2025	4.0.7	MCR-8-004-2	ADD	N/A		Created
04/24/2025	4.0.7	MCR-8-003-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-8-002-8	ADD	N/A		Created
04/24/2025	4.0.7	MCR-8-001-9	ADD	N/A		Created
04/24/2025	4.0.7	MCR-7-020-8	ADD	N/A		Created
04/24/2025	4.0.7	MCR-7-019-7	ADD	N/A		Created
04/24/2025	4.0.7	MCR-7-018-6	ADD	N/A		Created
04/24/2025	4.0.7	MCR-7-017-5	ADD	N/A		Created
04/24/2025	4.0.7	MCR-7-016-4	ADD	N/A		Created
04/24/2025	4.0.7	MCR-7-015-3	ADD	N/A		Created
04/24/2025	4.0.7	MCR-7-014-2	ADD	N/A		Created
04/24/2025	4.0.7	MCR-7-013-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-7-012-12	ADD	N/A		Created
04/24/2025	4.0.7	MCR-7-011-19	ADD	N/A		Created
04/24/2025	4.0.7	MCR-7-010-14	ADD	N/A		Created
04/24/2025	4.0.7	MCR-7-009-16	ADD	N/A		Created
04/24/2025	4.0.7	MCR-7-008-13	ADD	N/A		Created
04/24/2025	4.0.7	MCR-7-007-9	ADD	N/A		Created
04/24/2025	4.0.7	MCR-7-006-11	ADD	N/A		Created
04/24/2025	4.0.7	MCR-7-005-15	ADD	N/A		Created
05/27/2025	4.0.9	MCR-7-004-18	UPDATE	Ta max	5	37
05/27/2025	4.0.9	MCR-7-004-18	UPDATE	Threshold maximum	5	37
04/24/2025	4.0.7	MCR-7-004-18	ADD	N/A		Created
08/13/2025	4.0.16	MCR-7-003-17	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-TYPE-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 2, select records where 1. There is at least one CLAIM-DX-LT (CLT00004) segment where DIAGNOSIS-CODE is not missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 2	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 2, select records where 1. There is at least one CLAIM-DX-LT (CLT00004) segment where DIAGNOSIS-CODE is not missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 2
04/24/2025	4.0.7	MCR-7-003-17	ADD	N/A		Created
04/24/2025	4.0.7	MCR-7-002-10	ADD	N/A		Created
11/20/2025	4.0.22	MCR-7-001-20	UPDATE	Annotation	Total number of S-CHIP Encounter: original and adjustment, paid LT claims	N/A
11/20/2025	4.0.22	MCR-7-001-20	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Count claimsCount the number of unique records that satisfy the constraints of STEP 2	N/A
04/24/2025	4.0.7	MCR-7-001-20	ADD	N/A		Created
04/24/2025	4.0.7	MCR-6-026-18	ADD	N/A		Created
04/24/2025	4.0.7	MCR-6-025-25	ADD	N/A		Created
04/24/2025	4.0.7	MCR-6-024-24	ADD	N/A		Created
04/24/2025	4.0.7	MCR-6-023-23	ADD	N/A		Created
04/24/2025	4.0.7	MCR-6-022-22	ADD	N/A		Created
04/24/2025	4.0.7	MCR-6-021-21	ADD	N/A		Created
04/24/2025	4.0.7	MCR-6-020-20	ADD	N/A		Created
04/24/2025	4.0.7	MCR-6-019-19	ADD	N/A		Created
04/24/2025	4.0.7	MCR-6-018-17	ADD	N/A		Created
04/24/2025	4.0.7	MCR-6-017-15	ADD	N/A		Created
04/24/2025	4.0.7	MCR-6-016-14	ADD	N/A		Created
04/24/2025	4.0.7	MCR-6-015-13	ADD	N/A		Created
04/24/2025	4.0.7	MCR-6-014-12	ADD	N/A		Created
04/24/2025	4.0.7	MCR-6-013-11	ADD	N/A		Created
04/24/2025	4.0.7	MCR-6-012-10	ADD	N/A		Created
04/24/2025	4.0.7	MCR-6-011-9	ADD	N/A		Created
04/24/2025	4.0.7	MCR-6-010-16	ADD	N/A		Created
04/24/2025	4.0.7	MCR-6-009-7	ADD	N/A		Created
04/24/2025	4.0.7	MCR-6-008-6	ADD	N/A		Created
04/24/2025	4.0.7	MCR-6-007-5	ADD	N/A		Created
04/24/2025	4.0.7	MCR-6-006-4	ADD	N/A		Created
04/24/2025	4.0.7	MCR-6-005-3	ADD	N/A		Created
04/24/2025	4.0.7	MCR-6-004-2	ADD	N/A		Created
04/24/2025	4.0.7	MCR-6-003-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-6-002-8	ADD	N/A		Created
04/24/2025	4.0.7	MCR-6-001-26	ADD	N/A		Created
08/13/2025	4.0.16	MCR-5-021-8	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DenominatorOf the records that satisfy STEP 2, count those with the following criteria:1. TYPE-OF-SERVICE = "059"STEP 4: NumeratorOf the records that satisfy STEP 3, count those with the following criteria:1. NURSING-FACILITY-DAYS = "0" or missingSTEP 5: Calculate the percentage for the measureDivide the count of records from STEP 4 by the count of records in STEP 3	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DenominatorOf the records that satisfy STEP 2, count those with the following criteria:1. TYPE-OF-SERVICE = "059"STEP 4: NumeratorOf the records that satisfy STEP 3, count those with the following criteria:1. NURSING-FACILITY-DAYS = "0" or missingSTEP 5: Calculate the percentage for the measureDivide the count of records from STEP 4 by the count of records in STEP 3
04/24/2025	4.0.7	MCR-5-021-8	ADD	N/A		Created
08/13/2025	4.0.16	MCR-5-020-7	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Inpatient and residential substance abuseOf the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "050"STEP 4: No IP daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1a. MEDICAID-COV-INPATIENT-DAYS = "0"OR1b. MEDICAID-COV-INPATIENT-DAYS is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Inpatient and residential substance abuseOf the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "050"STEP 4: No IP daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1a. MEDICAID-COV-INPATIENT-DAYS = "0"OR1b. MEDICAID-COV-INPATIENT-DAYS is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3
04/24/2025	4.0.7	MCR-5-020-7	ADD	N/A		Created
08/13/2025	4.0.16	MCR-5-019-6	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Inpatient psychiatric services under 21Of the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "048"STEP 4: No IP daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1a. MEDICAID-COV-INPATIENT-DAYS = "0"OR1b. MEDICAID-COV-INPATIENT-DAYS is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Inpatient psychiatric services under 21Of the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "048"STEP 4: No IP daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1a. MEDICAID-COV-INPATIENT-DAYS = "0"OR1b. MEDICAID-COV-INPATIENT-DAYS is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3
04/24/2025	4.0.7	MCR-5-019-6	ADD	N/A		Created
08/13/2025	4.0.16	MCR-5-018-5	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Nursing Facility services other than mental diseasesOf the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "047"STEP 4: No NF daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1a. NURSING-FACILITY-DAYS = "0"OR1b. NURSING-FACILITY-DAYS is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Nursing Facility services other than mental diseasesOf the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "047"STEP 4: No NF daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1a. NURSING-FACILITY-DAYS = "0"OR1b. NURSING-FACILITY-DAYS is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3
04/24/2025	4.0.7	MCR-5-018-5	ADD	N/A		Created
08/13/2025	4.0.16	MCR-5-017-4	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Intermediate Care Facility ServicesOf the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "046"STEP 4: No ICF daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1a. ICF-IID-DAYS = "0"OR1b. ICF-IID-DAYS is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Intermediate Care Facility ServicesOf the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "046"STEP 4: No ICF daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1a. ICF-IID-DAYS = "0"OR1b. ICF-IID-DAYS is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3
04/24/2025	4.0.7	MCR-5-017-4	ADD	N/A		Created
08/13/2025	4.0.16	MCR-5-016-3	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Skilled nursing facility services 65+ for mental diseasesOf the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "045"STEP 4: No NF daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1a. NURSING-FACILITY-DAYS = "0"OR1b. NURSING-FACILITY-DAYS is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Skilled nursing facility services 65+ for mental diseasesOf the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "045"STEP 4: No NF daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1a. NURSING-FACILITY-DAYS = "0"OR1b. NURSING-FACILITY-DAYS is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3
04/24/2025	4.0.7	MCR-5-016-3	ADD	N/A		Created
08/13/2025	4.0.16	MCR-5-015-2	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Inpatient Hospital Services for individuals age 65+ for mental diseasesOf the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "044"STEP 4: No IP daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1a. MEDICAID-COV-INPATIENT-DAYS = "0"OR1b. MEDICAID-COV-INPATIENT-DAYS is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Inpatient Hospital Services for individuals age 65+ for mental diseasesOf the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "044"STEP 4: No IP daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1a. MEDICAID-COV-INPATIENT-DAYS = "0"OR1b. MEDICAID-COV-INPATIENT-DAYS is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3
04/24/2025	4.0.7	MCR-5-015-2	ADD	N/A		Created
08/13/2025	4.0.16	MCR-5-014-1	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DenominatorOf the records that satisfy STEP 2, count those where 1. TYPE-OF-SERVICE = "009"STEP 4: NumeratorOf the records that satisfy STEP 3, count those with the following criteria:1. NURSING-FACILITY-DAYS = "0" or missingSTEP 5: Calculate the percentage for the measureDivide the count of records from STEP 4 by the count of records in STEP 3	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DenominatorOf the records that satisfy STEP 2, count those where 1. TYPE-OF-SERVICE = "009"STEP 4: NumeratorOf the records that satisfy STEP 3, count those with the following criteria:1. NURSING-FACILITY-DAYS = "0" or missingSTEP 5: Calculate the percentage for the measureDivide the count of records from STEP 4 by the count of records in STEP 3
04/24/2025	4.0.7	MCR-5-014-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-5-013-15	ADD	N/A		Created
11/20/2025	4.0.22	MCR-5-012-12	UPDATE	Annotation	Percentage of Medicaid Encounter: original, non-crossover, paid LT claims with leave days	N/A
11/20/2025	4.0.22	MCR-5-012-12	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Leave daysOf the claims that meet the criteria from STEP 2, select records where 1. LEAVE-DAYS is greater than 0STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MCR-5-012-12	ADD	N/A		Created
11/20/2025	4.0.22	MCR-5-011-20	UPDATE	Annotation	Average number of long-term care days (exclude 0) for Medicaid Encounter: original, non-crossover, paid LT claims	N/A
11/20/2025	4.0.22	MCR-5-011-20	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Total long-term care days is positiveOf the claims that meet the criteria from STEP 2:1. Create Total_LTC_Days as the sum of LEAVE-DAYS, ICF-IID-DAYS, NURSING-FACILITY-DAYS and MEDICAID-COV-INPATIENT-DAYS2. Keep claims with Total_LTC_Days > 0STEP 4: Sum total LTC daysSum Total_LTC_Days for all claims in STEP 3STEP 5: Calculate the average for measureDivide the sum from STEP 4 by the count of claims from STEP 3	N/A
04/24/2025	4.0.7	MCR-5-011-20	ADD	N/A		Created
04/24/2025	4.0.7	MCR-5-010-14	ADD	N/A		Created
04/24/2025	4.0.7	MCR-5-009-17	ADD	N/A		Created
04/24/2025	4.0.7	MCR-5-008-13	ADD	N/A		Created
11/20/2025	4.0.22	MCR-5-007-9	UPDATE	Annotation	The percentage of Medicaid Encounter: original, non-crossover, paid LT claims where the patient died	N/A
11/20/2025	4.0.22	MCR-5-007-9	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Patient status codeOf the records that meet the criteria from STEP 2, select records with PATIENT-STATUS = ("20" or “40” or “41” or “42”)STEP 4 : Calculate percentage for measureDivide the count of records from STEP 3 by the count of records from STEP 2.	N/A
04/24/2025	4.0.7	MCR-5-007-9	ADD	N/A		Created
11/20/2025	4.0.22	MCR-5-006-11	UPDATE	Annotation	Calculate the percentage of Medicaid Encounter: original, non-crossover, paid LT claims with patient status discharged to home	N/A
11/20/2025	4.0.22	MCR-5-006-11	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Patient status of discharged to homeOf the claims that meet the criteria from STEP 2, select claims with home patient status:1. PATIENT-STATUS = “01” or “06” or “08” or “50” or “81” or “86”STEP 4: Calculate percentage for measureDivide the count of claims from STEP 3 by the count of claims from STEP 2.	N/A
04/24/2025	4.0.7	MCR-5-006-11	ADD	N/A		Created
11/20/2025	4.0.22	MCR-5-005-16	UPDATE	Annotation	Calculate the percentage of Medicaid Encounter: original, non-crossover, paid LT claims with 'still patient' patient status	N/A
11/20/2025	4.0.22	MCR-5-005-16	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Patient status is 'still patient'Of the claims that meet the criteria from STEP 2, count records with1. PATIENT-STATUS = '30'STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2.	N/A
04/24/2025	4.0.7	MCR-5-005-16	ADD	N/A		Created
05/27/2025	4.0.9	MCR-5-004-19	UPDATE	Ta max	5	37
05/27/2025	4.0.9	MCR-5-004-19	UPDATE	Threshold maximum	5	37
04/24/2025	4.0.7	MCR-5-004-19	ADD	N/A		Created
08/13/2025	4.0.16	MCR-5-003-18	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-TYPE-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 2, select records where 1. There is at least one CLAIM-DX-LT (CLT00004) segment where DIAGNOSIS-CODE is not missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 2	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 2, select records where 1. There is at least one CLAIM-DX-LT (CLT00004) segment where DIAGNOSIS-CODE is not missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 2
04/24/2025	4.0.7	MCR-5-003-18	ADD	N/A		Created
11/20/2025	4.0.22	MCR-5-002-10	UPDATE	Annotation	Percentage of Medicaid Encounter: original, non-crossover, paid LT claims with service end date within the past year	N/A
11/20/2025	4.0.22	MCR-5-002-10	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Service end date in past yearOf the claims that meet the criteria from STEP 2, select records where 1. ENDING-DATE-OF-SERVICE >-= Measure_Month_End minus 365STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MCR-5-002-10	ADD	N/A		Created
11/20/2025	4.0.22	MCR-5-001-21	UPDATE	Annotation	Total number of Medicaid Encounter: original, non-crossover, paid LT claims	N/A
11/20/2025	4.0.22	MCR-5-001-21	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Count claimsCount the number of unique records that satisfy the constraints of STEP 2	N/A
04/24/2025	4.0.7	MCR-5-001-21	ADD	N/A		Created
04/24/2025	4.0.7	MCR-4-013-4	ADD	N/A		Created
04/24/2025	4.0.7	MCR-4-012-3	ADD	N/A		Created
04/24/2025	4.0.7	MCR-4-011-2	ADD	N/A		Created
04/24/2025	4.0.7	MCR-4-010-12	ADD	N/A		Created
04/24/2025	4.0.7	MCR-4-009-11	ADD	N/A		Created
04/24/2025	4.0.7	MCR-4-008-10	ADD	N/A		Created
04/24/2025	4.0.7	MCR-4-007-9	ADD	N/A		Created
04/24/2025	4.0.7	MCR-4-006-8	ADD	N/A		Created
04/24/2025	4.0.7	MCR-4-005-7	ADD	N/A		Created
04/24/2025	4.0.7	MCR-4-004-6	ADD	N/A		Created
04/24/2025	4.0.7	MCR-4-003-5	ADD	N/A		Created
04/24/2025	4.0.7	MCR-4-002-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-4-001-13	ADD	N/A		Created
04/24/2025	4.0.7	MCR-3-018-15	ADD	N/A		Created
04/24/2025	4.0.7	MCR-3-017-14	ADD	N/A		Created
04/24/2025	4.0.7	MCR-3-016-13	ADD	N/A		Created
04/24/2025	4.0.7	MCR-3-015-12	ADD	N/A		Created
04/24/2025	4.0.7	MCR-3-014-7	ADD	N/A		Created
04/24/2025	4.0.7	MCR-3-013-8	ADD	N/A		Created
04/24/2025	4.0.7	MCR-3-012-6	ADD	N/A		Created
04/24/2025	4.0.7	MCR-3-011-2	ADD	N/A		Created
04/24/2025	4.0.7	MCR-3-010-5	ADD	N/A		Created
04/24/2025	4.0.7	MCR-3-009-4	ADD	N/A		Created
04/24/2025	4.0.7	MCR-3-008-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-3-007-17	ADD	N/A		Created
11/20/2025	4.0.22	MCR-3-006-11	UPDATE	Annotation	Percentage of S-CHIP Encounter: original, non-crossover, paid IP claims with principal procedure code	N/A
11/20/2025	4.0.22	MCR-3-006-11	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Procedure codeOf the claims that meet the criteria from STEP 2, select records where 1. PROCEDURE-CODE-1 is not missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MCR-3-006-11	ADD	N/A		Created
08/13/2025	4.0.16	MCR-3-005-10	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-TYPE-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 3, select records where:1. There is only one CLAIM-DX-IP (CIP00004) segment where DIAGNOSIS-CODE is not missing STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of header claims from STEP 2.	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 3, select records where:1. There is only one CLAIM-DX-IP (CIP00004) segment where DIAGNOSIS-CODE is not missing STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 2.
04/24/2025	4.0.7	MCR-3-005-10	ADD	N/A		Created
05/27/2025	4.0.9	MCR-3-004-16	UPDATE	Ta max	12	37
05/27/2025	4.0.9	MCR-3-004-16	UPDATE	Threshold maximum	12	37
04/24/2025	4.0.7	MCR-3-004-16	ADD	N/A		Created
08/13/2025	4.0.16	MCR-3-003-9	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-TYPE-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 2, select records where 1. There is at least one CLAIM-DX-IP (CIP00004) segment where DIAGNOSIS-CODE is not missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 2	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 2, select records where 1. There is at least one CLAIM-DX-IP (CIP00004) segment where DIAGNOSIS-CODE is not missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 2
04/24/2025	4.0.7	MCR-3-003-9	ADD	N/A		Created
04/24/2025	4.0.7	MCR-3-002-3	ADD	N/A		Created
11/20/2025	4.0.22	MCR-3-001-18	UPDATE	Annotation	Total number of S-CHIP Encounter: original, non-crossover, paid IP claims	N/A
11/20/2025	4.0.22	MCR-3-001-18	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Count claimsCount the number of unique records that satisfy the constraints of STEP 2	N/A
04/24/2025	4.0.7	MCR-3-001-18	ADD	N/A		Created
04/24/2025	4.0.7	MCR-29-002-2	ADD	N/A		Created
04/24/2025	4.0.7	MCR-29-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-28-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-27-002-2	ADD	N/A		Created
04/24/2025	4.0.7	MCR-27-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-26-009-9	ADD	N/A		Created
04/24/2025	4.0.7	MCR-26-008-6	ADD	N/A		Created
04/24/2025	4.0.7	MCR-26-007-3	ADD	N/A		Created
04/24/2025	4.0.7	MCR-26-006-8	ADD	N/A		Created
04/24/2025	4.0.7	MCR-26-005-5	ADD	N/A		Created
04/24/2025	4.0.7	MCR-26-004-2	ADD	N/A		Created
04/24/2025	4.0.7	MCR-26-003-7	ADD	N/A		Created
04/24/2025	4.0.7	MCR-26-002-4	ADD	N/A		Created
04/24/2025	4.0.7	MCR-26-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-25-002-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-25-001-2	ADD	N/A		Created
04/24/2025	4.0.7	MCR-24-004-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-24-003-2	ADD	N/A		Created
04/24/2025	4.0.7	MCR-24-002-4	ADD	N/A		Created
04/24/2025	4.0.7	MCR-24-001-3	ADD	N/A		Created
04/24/2025	4.0.7	MCR-23-010-10	ADD	N/A		Created
04/24/2025	4.0.7	MCR-23-009-7	ADD	N/A		Created
04/24/2025	4.0.7	MCR-23-008-3	ADD	N/A		Created
04/24/2025	4.0.7	MCR-23-007-9	ADD	N/A		Created
04/24/2025	4.0.7	MCR-23-006-6	ADD	N/A		Created
04/24/2025	4.0.7	MCR-23-005-2	ADD	N/A		Created
04/24/2025	4.0.7	MCR-23-004-8	ADD	N/A		Created
04/24/2025	4.0.7	MCR-23-003-4	ADD	N/A		Created
04/24/2025	4.0.7	MCR-23-002-5	ADD	N/A		Created
04/24/2025	4.0.7	MCR-23-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-22-002-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-22-001-2	ADD	N/A		Created
08/13/2025	4.0.16	MCR-21-004-1	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Physician claimsOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. TYPE-OF-SERVICE = "012"STEP 4: SpecialtyOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. SERVICING-PROV-SPECIALTY is not missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Physician claimsOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. TYPE-OF-SERVICE = "012"STEP 4: SpecialtyOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. SERVICING-PROV-SPECIALTY is not missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3
04/24/2025	4.0.7	MCR-21-004-1	ADD	N/A		Created
08/13/2025	4.0.16	MCR-21-003-2	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = "012"or "029" or "015" "002" or "061" or "028" or "041"STEP 4: Same service provider ID and billing provider IDOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. SERVICING-PROV-NUM = BILLING-PROV-NUMSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = "012"or "029" or "015" "002" or "061" or "028" or "041"STEP 4: Same service provider ID and billing provider IDOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. SERVICING-PROV-NUM = BILLING-PROV-NUMSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3
04/24/2025	4.0.7	MCR-21-003-2	ADD	N/A		Created
04/24/2025	4.0.7	MCR-21-002-4	ADD	N/A		Created
04/24/2025	4.0.7	MCR-21-001-3	ADD	N/A		Created
04/24/2025	4.0.7	MCR-2-025-16	ADD	N/A		Created
04/24/2025	4.0.7	MCR-2-024-15	ADD	N/A		Created
04/24/2025	4.0.7	MCR-2-023-14	ADD	N/A		Created
04/24/2025	4.0.7	MCR-2-022-24	ADD	N/A		Created
04/24/2025	4.0.7	MCR-2-021-23	ADD	N/A		Created
04/24/2025	4.0.7	MCR-2-020-22	ADD	N/A		Created
04/24/2025	4.0.7	MCR-2-019-21	ADD	N/A		Created
04/24/2025	4.0.7	MCR-2-018-20	ADD	N/A		Created
04/24/2025	4.0.7	MCR-2-017-19	ADD	N/A		Created
04/24/2025	4.0.7	MCR-2-016-18	ADD	N/A		Created
04/24/2025	4.0.7	MCR-2-015-17	ADD	N/A		Created
04/24/2025	4.0.7	MCR-2-014-13	ADD	N/A		Created
04/24/2025	4.0.7	MCR-2-013-4	ADD	N/A		Created
04/24/2025	4.0.7	MCR-2-012-3	ADD	N/A		Created
04/24/2025	4.0.7	MCR-2-011-2	ADD	N/A		Created
04/24/2025	4.0.7	MCR-2-010-12	ADD	N/A		Created
04/24/2025	4.0.7	MCR-2-009-11	ADD	N/A		Created
04/24/2025	4.0.7	MCR-2-008-10	ADD	N/A		Created
04/24/2025	4.0.7	MCR-2-007-9	ADD	N/A		Created
04/24/2025	4.0.7	MCR-2-006-8	ADD	N/A		Created
04/24/2025	4.0.7	MCR-2-005-7	ADD	N/A		Created
04/24/2025	4.0.7	MCR-2-004-6	ADD	N/A		Created
04/24/2025	4.0.7	MCR-2-003-5	ADD	N/A		Created
04/24/2025	4.0.7	MCR-2-002-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-2-001-25	ADD	N/A		Created
04/24/2025	4.0.7	MCR-20-008-2	ADD	N/A		Created
04/24/2025	4.0.7	MCR-20-007-8	ADD	N/A		Created
04/24/2025	4.0.7	MCR-20-006-7	ADD	N/A		Created
04/24/2025	4.0.7	MCR-20-005-6	ADD	N/A		Created
04/24/2025	4.0.7	MCR-20-004-5	ADD	N/A		Created
04/24/2025	4.0.7	MCR-20-003-4	ADD	N/A		Created
04/24/2025	4.0.7	MCR-20-002-3	ADD	N/A		Created
04/24/2025	4.0.7	MCR-20-001-1	ADD	N/A		Created
08/13/2025	4.0.16	MCR-19-008-2	UPDATE	Specification	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Missing Prescription Quantity ActualOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. PRESCRIPTION-QUANTITY-ACTUAL is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Missing Prescription Quantity ActualOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. PRESCRIPTION-QUANTITY-ACTUAL is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2
04/24/2025	4.0.7	MCR-19-008-2	ADD	N/A		Created
08/13/2025	4.0.16	MCR-19-007-3	UPDATE	Specification	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: National drug codeOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. NATIONAL-DRUG-CODE character is 11 numeric digitsSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: National drug codeOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. NATIONAL-DRUG-CODE character is 11 numeric digitsSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2
04/24/2025	4.0.7	MCR-19-007-3	ADD	N/A		Created
05/27/2025	4.0.9	MCR-19-006-4	UPDATE	Priority	N/A	Medium
05/27/2025	4.0.9	MCR-19-006-4	UPDATE	Category	N/A	Utilization
05/27/2025	4.0.9	MCR-19-006-4	UPDATE	For ta comprehensive	No	TA- Inferential
05/27/2025	4.0.9	MCR-19-006-4	UPDATE	For ta inferential	No	Yes
05/27/2025	4.0.9	MCR-19-006-4	UPDATE	Ta min		0
05/27/2025	4.0.9	MCR-19-006-4	UPDATE	Ta max		0.2
04/24/2025	4.0.7	MCR-19-006-4	ADD	N/A		Created
08/13/2025	4.0.16	MCR-19-005-1	UPDATE	Specification	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Prescription supply daysOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. DAYS-SUPPLY is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Prescription supply daysOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. DAYS-SUPPLY is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2
04/24/2025	4.0.7	MCR-19-005-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-19-004-5	ADD	N/A		Created
04/24/2025	4.0.7	MCR-19-003-6	ADD	N/A		Created
04/24/2025	4.0.7	MCR-19-002-7	ADD	N/A		Created
11/20/2025	4.0.22	MCR-19-001-8	UPDATE	Annotation	Total number of S-CHIP Encounter: original, non-crossover, paid RX claims	N/A
11/20/2025	4.0.22	MCR-19-001-8	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Count claimsCount the number of unique records that satisfy the constraints of STEP 2	N/A
04/24/2025	4.0.7	MCR-19-001-8	ADD	N/A		Created
04/24/2025	4.0.7	MCR-18-016-10	ADD	N/A		Created
04/24/2025	4.0.7	MCR-18-015-16	ADD	N/A		Created
04/24/2025	4.0.7	MCR-18-014-15	ADD	N/A		Created
04/24/2025	4.0.7	MCR-18-013-14	ADD	N/A		Created
04/24/2025	4.0.7	MCR-18-012-13	ADD	N/A		Created
04/24/2025	4.0.7	MCR-18-011-12	ADD	N/A		Created
04/24/2025	4.0.7	MCR-18-010-11	ADD	N/A		Created
04/24/2025	4.0.7	MCR-18-009-9	ADD	N/A		Created
04/24/2025	4.0.7	MCR-18-008-2	ADD	N/A		Created
04/24/2025	4.0.7	MCR-18-007-8	ADD	N/A		Created
04/24/2025	4.0.7	MCR-18-006-7	ADD	N/A		Created
04/24/2025	4.0.7	MCR-18-005-6	ADD	N/A		Created
04/24/2025	4.0.7	MCR-18-004-5	ADD	N/A		Created
04/24/2025	4.0.7	MCR-18-003-4	ADD	N/A		Created
04/24/2025	4.0.7	MCR-18-002-3	ADD	N/A		Created
04/24/2025	4.0.7	MCR-18-001-1	ADD	N/A		Created
08/13/2025	4.0.16	MCR-17-008-2	UPDATE	Specification	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Missing Prescription Quantity ActualOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. PRESCRIPTION-QUANTITY-ACTUAL is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Missing Prescription Quantity ActualOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. PRESCRIPTION-QUANTITY-ACTUAL is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2
04/24/2025	4.0.7	MCR-17-008-2	ADD	N/A		Created
08/13/2025	4.0.16	MCR-17-007-4	UPDATE	Specification	STEP 1: Active non-duplicate paid RX records during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3”2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Drugs, services, or products rendered is 1Of the records that meet the criteria from STEP 2, count line records with1. PRESCRIPTION-QUANTITY-ACTUAL = 1STEP 4 : Calculate percentage for measureDivide the count of line records from STEP 3 by the count of line records from STEP 2.	STEP 1: Active non-duplicate paid RX records during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3”2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Drugs, services, or products rendered is 1Of the records that meet the criteria from STEP 2, count line records with1. PRESCRIPTION-QUANTITY-ACTUAL = 1STEP 4 : Calculate percentage for measureDivide the count of line records from STEP 3 by the count of line records from STEP 2.
04/24/2025	4.0.7	MCR-17-007-4	ADD	N/A		Created
08/13/2025	4.0.16	MCR-17-006-3	UPDATE	Specification	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: National drug codeOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. NATIONAL-DRUG-CODE character is 11 numeric digitsSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: National drug codeOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. NATIONAL-DRUG-CODE character is 11 numeric digitsSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2
04/24/2025	4.0.7	MCR-17-006-3	ADD	N/A		Created
08/13/2025	4.0.16	MCR-17-005-1	UPDATE	Specification	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Prescription supply daysOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. DAYS-SUPPLY is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Prescription supply daysOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. DAYS-SUPPLY is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2
04/24/2025	4.0.7	MCR-17-005-1	ADD	N/A		Created
08/13/2025	4.0.16	MCR-17-004-5	UPDATE	Specification	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Days of supplyOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. DAYS-SUPPLY > 30STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Days of supplyOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. DAYS-SUPPLY > 30STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2
04/24/2025	4.0.7	MCR-17-004-5	ADD	N/A		Created
11/20/2025	4.0.22	MCR-17-003-6	UPDATE	Annotation	The percentage of Medicaid Encounter: original, non-crossover, paid RX claims where the fill date is equal to the prescribed date	N/A
11/20/2025	4.0.22	MCR-17-003-6	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Fill date equals prescribed dateOf the claims that meet the criteria from STEP 2, select records where 1. PRESCRIPTION-FILL-DATE = DATE-PRESCRIBEDSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MCR-17-003-6	ADD	N/A		Created
11/20/2025	4.0.22	MCR-17-002-7	UPDATE	Annotation	Percentage of Medicaid Encounter: original, non-crossover, paid RX claims with prescription fill date within the past 12 months	N/A
11/20/2025	4.0.22	MCR-17-002-7	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Fill date in past 12 monthsOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. Claims PRESCRIPTION-FILL-DATE >= Measure_Month_End minus 365STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MCR-17-002-7	ADD	N/A		Created
11/20/2025	4.0.22	MCR-17-001-8	UPDATE	Annotation	Total number of Medicaid Encounter: original, non-crossover, paid RX claims	N/A
11/20/2025	4.0.22	MCR-17-001-8	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Count claimsCount the number of unique records that satisfy the constraints of STEP 2	N/A
04/24/2025	4.0.7	MCR-17-001-8	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-078-6	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-077-4	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-076-78	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-075-77	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-074-76	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-073-75	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-072-74	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-071-73	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-070-72	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-069-71	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-068-69	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-067-68	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-066-67	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-065-66	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-064-65	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-063-64	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-062-63	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-061-62	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-060-61	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-059-60	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-058-58	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-057-57	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-056-56	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-055-55	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-054-54	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-053-53	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-052-52	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-051-51	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-050-50	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-049-48	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-048-47	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-047-46	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-046-45	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-045-44	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-044-43	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-043-42	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-042-41	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-041-39	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-040-38	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-039-37	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-038-36	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-037-35	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-036-33	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-035-32	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-034-31	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-033-30	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-032-29	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-031-28	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-030-27	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-029-26	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-028-24	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-027-23	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-026-22	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-025-21	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-024-20	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-023-19	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-022-18	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-021-17	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-020-16	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-019-15	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-018-13	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-017-12	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-016-11	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-015-10	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-014-9	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-013-8	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-012-7	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-011-5	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-010-3	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-009-2	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-008-70	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-007-59	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-006-49	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-005-40	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-004-34	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-003-25	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-002-14	ADD	N/A		Created
04/24/2025	4.0.7	MCR-16-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-15-005-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-15-004-3	ADD	N/A		Created
04/24/2025	4.0.7	MCR-15-003-4	ADD	N/A		Created
04/24/2025	4.0.7	MCR-15-002-2	ADD	N/A		Created
04/24/2025	4.0.7	MCR-15-001-5	ADD	N/A		Created
05/27/2025	4.0.9	MCR-14-024-2	UPDATE	Priority	N/A	Medium
05/27/2025	4.0.9	MCR-14-024-2	UPDATE	Category	N/A	Utilization
05/27/2025	4.0.9	MCR-14-024-2	UPDATE	For ta comprehensive	No	TA- Inferential
05/27/2025	4.0.9	MCR-14-024-2	UPDATE	For ta inferential	No	Yes
05/27/2025	4.0.9	MCR-14-024-2	UPDATE	Ta min		0.4
05/27/2025	4.0.9	MCR-14-024-2	UPDATE	Ta max		0.99
04/24/2025	4.0.7	MCR-14-024-2	ADD	N/A		Created
04/24/2025	4.0.7	MCR-14-023-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-14-022-17	ADD	N/A		Created
04/24/2025	4.0.7	MCR-14-021-5	ADD	N/A		Created
04/24/2025	4.0.7	MCR-14-020-6	ADD	N/A		Created
04/24/2025	4.0.7	MCR-14-019-7	ADD	N/A		Created
04/24/2025	4.0.7	MCR-14-018-16	ADD	N/A		Created
04/24/2025	4.0.7	MCR-14-017-13	ADD	N/A		Created
04/24/2025	4.0.7	MCR-14-016-14	ADD	N/A		Created
04/24/2025	4.0.7	MCR-14-015-15	ADD	N/A		Created
04/24/2025	4.0.7	MCR-14-014-11	ADD	N/A		Created
04/24/2025	4.0.7	MCR-14-013-12	ADD	N/A		Created
04/24/2025	4.0.7	MCR-14-012-10	ADD	N/A		Created
04/24/2025	4.0.7	MCR-14-011-4	ADD	N/A		Created
04/24/2025	4.0.7	MCR-14-010-3	ADD	N/A		Created
04/24/2025	4.0.7	MCR-14-009-18	ADD	N/A		Created
04/24/2025	4.0.7	MCR-14-008-19	ADD	N/A		Created
04/24/2025	4.0.7	MCR-14-007-9	ADD	N/A		Created
04/24/2025	4.0.7	MCR-14-006-22	ADD	N/A		Created
04/24/2025	4.0.7	MCR-14-005-20	ADD	N/A		Created
08/13/2025	4.0.16	MCR-14-004-21	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.DX Segments:1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-TYPE-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = “012” or “002” or “061” or "028" or "041"STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 3, select records where 1. There is at least one CLAIM-DX-OT (COT00004) segment where DIAGNOSIS-CODE is not missingSTEP 5: Link claim lines to claim DX recordsMerge the lines from STEP 3 with the DX records from STEP 4 by header.STEP 6: Drop lines without diagnosis codesOf the claim lines from STEP 5, keep only lines linked to a DX record from STEP 4STEP 7: Calculate the percentage for the measureDivide the count of claim lines from STEP 6 by the count of claim lines from STEP 3	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.DX Segments:1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = “012” or “002” or “061” or "028" or "041"STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 3, select records where 1. There is at least one CLAIM-DX-OT (COT00004) segment where DIAGNOSIS-CODE is not missingSTEP 5: Link claim lines to claim DX recordsMerge the lines from STEP 3 with the DX records from STEP 4 by header.STEP 6: Drop lines without diagnosis codesOf the claim lines from STEP 5, keep only lines linked to a DX record from STEP 4STEP 7: Calculate the percentage for the measureDivide the count of claim lines from STEP 6 by the count of claim lines from STEP 3
04/24/2025	4.0.7	MCR-14-004-21	ADD	N/A		Created
04/24/2025	4.0.7	MCR-14-003-8	ADD	N/A		Created
04/24/2025	4.0.7	MCR-14-002-23	ADD	N/A		Created
08/13/2025	4.0.16	MCR-14-001-24	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Count claim linesCount the number of unique line records that satisfy STEP 2	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Count claim linesCount the number of unique line records that satisfy STEP 2
04/24/2025	4.0.7	MCR-14-001-24	ADD	N/A		Created
04/24/2025	4.0.7	MCR-13-017-8	ADD	N/A		Created
04/24/2025	4.0.7	MCR-13-016-9	ADD	N/A		Created
04/24/2025	4.0.7	MCR-13-015-10	ADD	N/A		Created
04/24/2025	4.0.7	MCR-13-014-11	ADD	N/A		Created
04/24/2025	4.0.7	MCR-13-013-12	ADD	N/A		Created
04/24/2025	4.0.7	MCR-13-012-13	ADD	N/A		Created
04/24/2025	4.0.7	MCR-13-011-14	ADD	N/A		Created
04/24/2025	4.0.7	MCR-13-010-15	ADD	N/A		Created
04/24/2025	4.0.7	MCR-13-009-16	ADD	N/A		Created
04/24/2025	4.0.7	MCR-13-008-5	ADD	N/A		Created
04/24/2025	4.0.7	MCR-13-007-6	ADD	N/A		Created
04/24/2025	4.0.7	MCR-13-006-7	ADD	N/A		Created
04/24/2025	4.0.7	MCR-13-005-4	ADD	N/A		Created
04/24/2025	4.0.7	MCR-13-004-2	ADD	N/A		Created
04/24/2025	4.0.7	MCR-13-003-3	ADD	N/A		Created
04/24/2025	4.0.7	MCR-13-002-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-13-001-17	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-155-83	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-154-81	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-153-155	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-152-154	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-151-153	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-150-152	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-149-151	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-148-150	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-147-149	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-146-148	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-145-146	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-144-145	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-143-144	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-142-143	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-141-142	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-140-141	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-139-140	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-138-139	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-137-138	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-136-137	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-135-135	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-134-134	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-133-133	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-132-132	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-131-131	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-130-130	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-129-129	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-128-128	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-127-127	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-126-125	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-125-124	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-124-123	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-123-122	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-122-121	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-121-120	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-120-119	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-119-118	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-118-116	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-117-115	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-116-114	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-115-113	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-114-112	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-113-110	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-112-109	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-111-108	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-110-107	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-109-106	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-108-105	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-107-104	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-106-103	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-105-101	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-104-100	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-103-99	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-102-98	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-101-97	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-100-96	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-099-95	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-098-94	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-097-93	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-096-92	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-095-90	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-094-89	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-093-88	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-092-87	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-091-86	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-090-85	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-089-84	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-088-82	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-087-80	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-086-79	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-085-147	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-084-136	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-083-126	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-082-117	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-081-111	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-080-102	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-079-91	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-078-6	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-077-4	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-076-78	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-075-77	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-074-76	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-073-75	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-072-74	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-071-73	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-070-72	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-069-71	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-068-69	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-067-68	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-066-67	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-065-66	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-064-65	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-063-64	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-062-63	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-061-62	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-060-61	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-059-60	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-058-58	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-057-57	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-056-56	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-055-55	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-054-54	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-053-53	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-052-52	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-051-51	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-050-50	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-049-48	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-048-47	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-047-46	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-046-45	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-045-44	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-044-43	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-043-42	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-042-41	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-041-39	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-040-38	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-039-37	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-038-36	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-037-35	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-036-33	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-035-32	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-034-31	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-033-30	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-032-29	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-031-28	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-030-27	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-029-26	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-028-24	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-027-23	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-026-22	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-025-21	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-024-20	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-023-19	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-022-18	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-021-17	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-020-16	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-019-15	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-018-13	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-017-12	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-016-11	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-015-10	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-014-9	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-013-8	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-012-7	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-011-5	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-010-3	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-009-2	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-008-70	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-007-59	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-006-49	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-005-40	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-004-34	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-003-25	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-002-14	ADD	N/A		Created
04/24/2025	4.0.7	MCR-12-001-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-11-006-2	ADD	N/A		Created
04/24/2025	4.0.7	MCR-11-005-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-11-004-4	ADD	N/A		Created
04/24/2025	4.0.7	MCR-11-003-5	ADD	N/A		Created
04/24/2025	4.0.7	MCR-11-002-3	ADD	N/A		Created
04/24/2025	4.0.7	MCR-11-001-6	ADD	N/A		Created
04/24/2025	4.0.7	MCR-1-017-15	ADD	N/A		Created
04/24/2025	4.0.7	MCR-1-016-14	ADD	N/A		Created
08/13/2025	4.0.16	MCR-1-015-13	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Revenue codesOf the claims that meet the criteria from STEP 2, select records where 1. REVENUE-CODE = “0220” through “0998”STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Revenue codesOf the claims that meet the criteria from STEP 2, select records where 1. REVENUE-CODE = “0220” through “0998”STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2
04/24/2025	4.0.7	MCR-1-015-13	ADD	N/A		Created
08/13/2025	4.0.16	MCR-1-014-12	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3”2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Accommodation revenue codesOf the claims that meet the criteria from STEP 2, select records where: 1. REVENUE-CODE = "0100" through "0219"STEP 4: Calculate the percentage for the measureDivide the count of header claims from STEP 3 by the count of header claims from STEP 2	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3”2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Accommodation revenue codesOf the claims that meet the criteria from STEP 2, select records where: 1. REVENUE-CODE = "0100" through "0219"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2
04/24/2025	4.0.7	MCR-1-014-12	ADD	N/A		Created
04/24/2025	4.0.7	MCR-1-013-7	ADD	N/A		Created
04/24/2025	4.0.7	MCR-1-012-8	ADD	N/A		Created
11/20/2025	4.0.22	MCR-1-011-6	UPDATE	Annotation	Calculate the percentage of Medicaid Encounter: original, non-crossover, paid IP claims with 'still patient' patient status	N/A
11/20/2025	4.0.22	MCR-1-011-6	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Patient status is 'still patient'Of the claims that meet the criteria from STEP 2, count records with1. PATIENT-STATUS = '30'STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2.	N/A
04/24/2025	4.0.7	MCR-1-011-6	ADD	N/A		Created
11/20/2025	4.0.22	MCR-1-010-5	UPDATE	Annotation	Calculate the percentage of Medicaid Encounter: original, non-crossover, paid IP claims with patient status of discharged to other institution	N/A
11/20/2025	4.0.22	MCR-1-010-5	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Patient status of discharged to other institutionOf the claims that meet the criteria from STEP 2, select claims with patient status of other institution:1. PATIENT-STATUS = “02” or “03” or “04” or “05” or “43” or “51” or “61” or “62” or “63” or “64” or “65” or “66” or “70” or “82” or “83” or “84” or “85” or “88” or “89” or “90” or “91” or “92” or “93” or “94” or “95”STEP 4 : Calculate percentage for measureDivide the count of claims from STEP 3 by the count of claims from STEP 2.	N/A
04/24/2025	4.0.7	MCR-1-010-5	ADD	N/A		Created
11/20/2025	4.0.22	MCR-1-010-2	UPDATE	Annotation	The percentage of Medicaid Encounter: original, non-crossover, paid IP claims where the patient died	N/A
11/20/2025	4.0.22	MCR-1-010-2	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Patient status codeOf the records that meet the criteria from STEP 2, select records with PATIENT-STATUS = ("20" or “40” or “41” or “42”)STEP 4 : Calculate percentage for measureDivide the count of records from STEP 3 by the count of records from STEP 2.	N/A
04/24/2025	4.0.7	MCR-1-010-2	ADD	N/A		Created
11/20/2025	4.0.22	MCR-1-009-4	UPDATE	Annotation	Calculate the percentage of Medicaid Encounter: original, non-crossover, paid IP claims with patient status discharged to home	N/A
11/20/2025	4.0.22	MCR-1-009-4	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Patient status of discharged to homeOf the claims that meet the criteria from STEP 2, select claims with home patient status:1. PATIENT-STATUS = “01” or “06” or “08” or “50” or “81” or “86”STEP 4 : Calculate percentage for measureDivide the count of claims from STEP 3 by the count of claims from STEP 2.	N/A
04/24/2025	4.0.7	MCR-1-009-4	ADD	N/A		Created
11/20/2025	4.0.22	MCR-1-008-1	UPDATE	Annotation	Percentage of Medicaid Encounter: original, non-crossover, paid IP claims with admission date within the past year	N/A
11/20/2025	4.0.22	MCR-1-008-1	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Admission dateOf the claims that meet the criteria from STEP 2, select records where 1. ADMISSION - DATE >-= Measure_Month_End minus 365STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MCR-1-008-1	ADD	N/A		Created
04/24/2025	4.0.7	MCR-1-007-17	ADD	N/A		Created
11/20/2025	4.0.22	MCR-1-006-11	UPDATE	Annotation	Percentage of Medicaid Encounter: original, non-crossover, paid IP claims with principal procedure code	N/A
11/20/2025	4.0.22	MCR-1-006-11	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Procedure codeOf the claims that meet the criteria from STEP 2, select records where 1. PROCEDURE-CODE-1 is not missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	MCR-1-006-11	ADD	N/A		Created
08/13/2025	4.0.16	MCR-1-005-10	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-TYPE-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 3, select records where:1. There is only one CLAIM-DX-IP (CIP00004) segment where DIAGNOSIS-CODE is not missing STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of header claims from STEP 2.	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 3, select records where:1. There is only one CLAIM-DX-IP (CIP00004) segment where DIAGNOSIS-CODE is not missing STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 2.
04/24/2025	4.0.7	MCR-1-005-10	ADD	N/A		Created
05/27/2025	4.0.9	MCR-1-004-16	UPDATE	Ta max	12	37
05/27/2025	4.0.9	MCR-1-004-16	UPDATE	Threshold maximum	12	37
04/24/2025	4.0.7	MCR-1-004-16	ADD	N/A		Created
08/13/2025	4.0.16	MCR-1-003-9	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-TYPE-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 2, select records where 1. There is at least one CLAIM-DX-IP (CIP00004) segment where DIAGNOSIS-CODE is not missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 2	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 2, select records where 1. There is at least one CLAIM-DX-IP (CIP00004) segment where DIAGNOSIS-CODE is not missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 2
04/24/2025	4.0.7	MCR-1-003-9	ADD	N/A		Created
08/13/2025	4.0.16	MCR-10-024-2	UPDATE	Specification	STEP 1: Active non-duplicated OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Drugs, services, or products rendered is 1Of the records that meet the criteria from STEP 2, count line records with1. SERVICE-QUANTITY-ACTUAL = 1STEP 4 : Calculate percentage for measureDivide the count of line records from STEP 3 by the count of line records from STEP 2.	STEP 1: Active non-duplicated OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Drugs, services, or products rendered is 1Of the records that meet the criteria from STEP 2, count line records with1. SERVICE-QUANTITY-ACTUAL = 1STEP 4 : Calculate percentage for measureDivide the count of line records from STEP 3 by the count of line records from STEP 2.
04/24/2025	4.0.7	MCR-10-024-2	ADD	N/A		Created
08/13/2025	4.0.16	MCR-10-023-1	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = "002" or "061"STEP 4: Accommodation revenue codesOf the claim lines that meet the criteria from STEP 3, further restrict them by the following criteria:1. REVENUE-CODE = "0100" through "0219"STEP 5: Calculate the percentage for the measureDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 3	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = "002" or "061"STEP 4: Accommodation revenue codesOf the claim lines that meet the criteria from STEP 3, further restrict them by the following criteria:1. REVENUE-CODE = "0100" through "0219"STEP 5: Calculate the percentage for the measureDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 3
04/24/2025	4.0.7	MCR-10-023-1	ADD	N/A		Created
08/13/2025	4.0.16	MCR-1-002-3	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Service end date in past yearOf the claims that meet the criteria from STEP 2, select records where 1. ENDING-DATE-OF-SERVICE >-= Measure_Month_End minus 365STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Service end date in past yearOf the claims that meet the criteria from STEP 2, select records where 1. ENDING-DATE-OF-SERVICE >-= Measure_Month_End minus 365STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2
04/24/2025	4.0.7	MCR-1-002-3	ADD	N/A		Created
08/13/2025	4.0.16	MCR-10-022-17	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = "012" or "025" or "026"STEP 4: Procedure code Of the claim lines that meet the criteria from STEP 3, further restrict them by the following criteria:PROCEDURE-CODE-FLAG = "10" through "87"STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = "012" or "025" or "026"STEP 4: Procedure code Of the claim lines that meet the criteria from STEP 3, further restrict them by the following criteria:PROCEDURE-CODE-FLAG = "10" through "87"STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3
04/24/2025	4.0.7	MCR-10-022-17	ADD	N/A		Created
04/24/2025	4.0.7	MCR-10-021-5	ADD	N/A		Created
04/24/2025	4.0.7	MCR-10-020-6	ADD	N/A		Created
04/24/2025	4.0.7	MCR-10-019-7	ADD	N/A		Created
04/24/2025	4.0.7	MCR-10-018-16	ADD	N/A		Created
04/24/2025	4.0.7	MCR-10-017-13	ADD	N/A		Created
04/24/2025	4.0.7	MCR-10-016-14	ADD	N/A		Created
04/24/2025	4.0.7	MCR-10-015-15	ADD	N/A		Created
04/24/2025	4.0.7	MCR-10-014-11	ADD	N/A		Created
04/24/2025	4.0.7	MCR-10-013-12	ADD	N/A		Created
04/24/2025	4.0.7	MCR-10-012-10	ADD	N/A		Created
11/20/2025	4.0.22	MCR-1-001-18	UPDATE	Annotation	Count the total number of Medicaid Encounter: Original, Non-Crossover, Paid IP claims	N/A
11/20/2025	4.0.22	MCR-1-001-18	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Count recordsCount the total number of unique records that satisfy STEP 1 and 2.	N/A
04/24/2025	4.0.7	MCR-1-001-18	ADD	N/A		Created
04/24/2025	4.0.7	MCR-10-011-4	ADD	N/A		Created
04/24/2025	4.0.7	MCR-10-010-3	ADD	N/A		Created
04/24/2025	4.0.7	MCR-10-009-18	ADD	N/A		Created
08/13/2025	4.0.16	MCR-10-008-19	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Office place of serviceOf the claims that meet the criteria from STEP 2, select records where 1. PLACE-OF-SERVICE = "11"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Office place of serviceOf the claims that meet the criteria from STEP 2, select records where 1. PLACE-OF-SERVICE = "11"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2
04/24/2025	4.0.7	MCR-10-008-19	ADD	N/A		Created
08/13/2025	4.0.16	MCR-10-007-9	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: ER place of serviceOf the claims that meet the criteria from STEP 2, select records where 1. PLACE-OF-SERVICE = "23"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: ER place of serviceOf the claims that meet the criteria from STEP 2, select records where 1. PLACE-OF-SERVICE = "23"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2
04/24/2025	4.0.7	MCR-10-007-9	ADD	N/A		Created
04/24/2025	4.0.7	MCR-10-006-22	ADD	N/A		Created
08/13/2025	4.0.16	MCR-10-005-21	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing headers, lines, and DX segments that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.DX Segments:1. DX segments merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-TYPE-CODE, and DIAGNOSIS-SEQUENCE-NUMBERSTEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = “012” or “002” or “061” or "028" or "041"STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 4, select records where1. There is at least one CLAIM-DX-OT (COT00004) segment where DIAGNOSIS-CODE is not missingSTEP 5: Link claim lines to claim DX recordsMerge the lines from STEP 3 with the DX records from STEP 4 by header.STEP 6: Drop lines without diagnosis codesOf the claim lines from STEP 5, keep only lines linked to a DX record from STEP 4STEP 7: Calculate the percentage for the measureDivide the count of claim lines from STEP 6 by the count of claim lines from STEP 3	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing headers, lines, and DX segments that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.DX Segments:1. DX segments merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBERSTEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = “012” or “002” or “061” or "028" or "041"STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 4, select records where1. There is at least one CLAIM-DX-OT (COT00004) segment where DIAGNOSIS-CODE is not missingSTEP 5: Link claim lines to claim DX recordsMerge the lines from STEP 3 with the DX records from STEP 4 by header.STEP 6: Drop lines without diagnosis codesOf the claim lines from STEP 5, keep only lines linked to a DX record from STEP 4STEP 7: Calculate the percentage for the measureDivide the count of claim lines from STEP 6 by the count of claim lines from STEP 3
04/24/2025	4.0.7	MCR-10-005-21	ADD	N/A		Created
04/24/2025	4.0.7	MCR-10-004-20	ADD	N/A		Created
08/13/2025	4.0.16	MCR-10-003-8	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claim lines that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Service end date in past yearOf the claim lines that meet the criteria from STEP 2, select records where 1. ENDING-DATE-OF-SERVICE >-= Measure_Month_End minus 365STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claim lines that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Service end date in past yearOf the claim lines that meet the criteria from STEP 2, select records where 1. ENDING-DATE-OF-SERVICE >-= Measure_Month_End minus 365STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2
04/24/2025	4.0.7	MCR-10-003-8	ADD	N/A		Created
08/13/2025	4.0.16	MCR-10-002-23	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Procedure codeOf the records that meet the criteria from STEP 2, count line records with1. PROCEDURE-CODE is not missingSTEP 4 : Calculate percentage for measureDivide the count of line records from STEP 3 by the count of line records from STEP 2.	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Procedure codeOf the records that meet the criteria from STEP 2, count line records with1. PROCEDURE-CODE is not missingSTEP 4 : Calculate percentage for measureDivide the count of line records from STEP 3 by the count of line records from STEP 2.
04/24/2025	4.0.7	MCR-10-002-23	ADD	N/A		Created
08/13/2025	4.0.16	MCR-10-001-24	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: CountCount the number of unique line records that satisfy STEP 2	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: CountCount the number of unique line records that satisfy STEP 2
04/24/2025	4.0.7	MCR-10-001-24	ADD	N/A		Created
04/24/2025	4.0.7	FFS-S-022-15	ADD	N/A		Created
04/24/2025	4.0.7	FFS-S-021-18	ADD	N/A		Created
04/24/2025	4.0.7	FFS-S-020-12	ADD	N/A		Created
11/20/2025	4.0.22	FFS-S-019-4	UPDATE	Annotation	Calculate the percentage of Medicaid FFS: original, paid LT claims that are crossover claims	N/A
11/20/2025	4.0.22	FFS-S-019-4	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"STEP 3: Medicaid FFS: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 2, select crossover claims:1. CROSSOVER-INDICATOR = "1"STEP 4 : Calculate percentage for measureDivide the count of claims from STEP 3 by the count of claims from STEP 2.	N/A
04/24/2025	4.0.7	FFS-S-019-4	ADD	N/A		Created
08/13/2025	4.0.16	FFS-S-018-7	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Paid ClaimsOf the claim that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"STEP 3: Medicaid FFS: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 2, select crossover claims:1. CROSSOVER-INDICATOR = "1"STEP 4 : Calculate percentage for measureDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Paid ClaimsOf the claim that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"STEP 3: Medicaid FFS: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 2, select crossover claims:1. CROSSOVER-INDICATOR = "1"STEP 4 : Calculate percentage for measureDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2
04/24/2025	4.0.7	FFS-S-018-7	ADD	N/A		Created
11/20/2025	4.0.22	FFS-S-017-1	UPDATE	Annotation	Calculate the percentage of Medicaid FFS: original, paid IP claims that are crossover claims	N/A
11/20/2025	4.0.22	FFS-S-017-1	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"STEP 3: Medicaid FFS: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 2, select crossover claims:1. CROSSOVER-INDICATOR = "1"STEP 4 : Calculate percentage for measureDivide the count of claims from STEP 3 by the count of claims from STEP 2.	N/A
04/24/2025	4.0.7	FFS-S-017-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-S-016-21	ADD	N/A		Created
04/24/2025	4.0.7	FFS-S-015-16	ADD	N/A		Created
04/24/2025	4.0.7	FFS-S-014-19	ADD	N/A		Created
04/24/2025	4.0.7	FFS-S-013-13	ADD	N/A		Created
11/20/2025	4.0.22	FFS-S-012-10	UPDATE	Annotation	Percentage of Medicaid FFS: original and adjustment, paid RX claims that are original	N/A
11/20/2025	4.0.22	FFS-S-012-10	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Original claimsOf the claims that meet the criteria from STEP 2, select records where 1. ADJUSTMENT-IND = "0"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	FFS-S-012-10	ADD	N/A		Created
11/20/2025	4.0.22	FFS-S-011-5	UPDATE	Annotation	Percentage of Medicaid FFS: original and adjustment, paid LT claims that are Original	N/A
11/20/2025	4.0.22	FFS-S-011-5	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Original claimsOf the claims that meet the criteria from STEP 2, select records where 1. ADJUSTMENT-IND = "0"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	FFS-S-011-5	ADD	N/A		Created
08/13/2025	4.0.16	FFS-S-010-8	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Original claim linesOf the claims that meet the criteria from STEP 2, select records where 1. LINE-ADJUSTMENT-IND = "0"STEP 4: Calculate the percentage for the measureDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Original claim linesOf the claims that meet the criteria from STEP 2, select records where 1. LINE-ADJUSTMENT-IND = "0"STEP 4: Calculate the percentage for the measureDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2
04/24/2025	4.0.7	FFS-S-010-8	ADD	N/A		Created
11/20/2025	4.0.22	FFS-S-009-2	UPDATE	Annotation	Percentage of Medicaid FFS: original and adjustment, paid IP claims that are original	N/A
11/20/2025	4.0.22	FFS-S-009-2	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Original claimsOf the claims that meet the criteria from STEP 2, select records where 1. ADJUSTMENT-IND = "0"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	FFS-S-009-2	ADD	N/A		Created
04/24/2025	4.0.7	FFS-S-008-22	ADD	N/A		Created
04/24/2025	4.0.7	FFS-S-007-17	ADD	N/A		Created
04/24/2025	4.0.7	FFS-S-006-20	ADD	N/A		Created
04/24/2025	4.0.7	FFS-S-005-14	ADD	N/A		Created
04/24/2025	4.0.7	FFS-S-004-11	ADD	N/A		Created
04/24/2025	4.0.7	FFS-S-003-6	ADD	N/A		Created
04/24/2025	4.0.7	FFS-S-002-9	ADD	N/A		Created
11/20/2025	4.0.22	FFS-S-001-3	UPDATE	Annotation	Total number of Medicaid FFS: original and adjustment, paid IP claims	N/A
11/20/2025	4.0.22	FFS-S-001-3	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Count claimsCount the number of claims from STEP 2	N/A
04/24/2025	4.0.7	FFS-S-001-3	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-103-26	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-102-24	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-101-22	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-100-97	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-099-96	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-098-95	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-097-94	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-096-93	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-095-92	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-094-91	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-093-90	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-092-88	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-091-87	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-090-86	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-089-85	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-088-84	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-087-83	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-086-82	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-085-81	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-084-80	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-083-79	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-082-77	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-081-76	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-080-75	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-079-74	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-078-73	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-077-72	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-076-71	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-075-70	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-074-69	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-073-67	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-072-66	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-071-65	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-070-64	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-069-63	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-068-62	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-067-61	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-066-60	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-065-58	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-064-57	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-063-56	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-062-55	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-061-54	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-060-52	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-059-51	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-058-50	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-057-49	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-056-48	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-055-47	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-054-46	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-053-45	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-052-43	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-051-42	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-050-41	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-049-40	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-048-39	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-047-38	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-046-37	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-045-36	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-044-35	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-043-34	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-042-32	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-041-31	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-040-30	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-039-29	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-038-28	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-037-27	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-036-25	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-035-23	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-034-21	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-033-20	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-032-89	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-031-78	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-030-68	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-029-59	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-028-53	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-027-44	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-026-33	ADD	N/A		Created
08/13/2025	4.0.16	FFS-9-025-2	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Drugs, services, or products rendered is 1Of the records that meet the criteria from STEP 2, count line records with1. SERVICE-QUANTITY-ACTUAL = 1STEP 4 : Calculate percentage for measureDivide the count of line records from STEP 3 by the count of line records from STEP 2.	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Drugs, services, or products rendered is 1Of the records that meet the criteria from STEP 2, count line records with1. SERVICE-QUANTITY-ACTUAL = 1STEP 4 : Calculate percentage for measureDivide the count of line records from STEP 3 by the count of line records from STEP 2.
04/24/2025	4.0.7	FFS-9-025-2	ADD	N/A		Created
08/13/2025	4.0.16	FFS-9-024-1	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Outpatient Department ClaimsOf the claims that meet the criteria from STEP 2, select records whereTYPE-OF-SERVICE = “002” or "061"STEP 4: Accommodation revenue codesOf the claims that meet the criteria from STEP 3, select records where: 1. REVENUE-CODE = "0100" through "0219"STEP 5: Calculate the percentage for the measureDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 3	STEP 1: Active non-duplicate paid OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Outpatient Department ClaimsOf the claims that meet the criteria from STEP 2, select records whereTYPE-OF-SERVICE = “002” or "061"STEP 4: Accommodation revenue codesOf the claims that meet the criteria from STEP 3, select records where: 1. REVENUE-CODE = "0100" through "0219"STEP 5: Calculate the percentage for the measureDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 3
04/24/2025	4.0.7	FFS-9-024-1	ADD	N/A		Created
08/13/2025	4.0.16	FFS-9-023-17	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = "012" or "025" or "026"STEP 4: Procedure code Of the claim lines that meet the criteria from STEP 3, further restrict them by the following criteria:PROCEDURE-CODE-FLAG = "10" through "87"STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = "012" or "025" or "026"STEP 4: Procedure code Of the claim lines that meet the criteria from STEP 3, further restrict them by the following criteria:PROCEDURE-CODE-FLAG = "10" through "87"STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3
04/24/2025	4.0.7	FFS-9-023-17	ADD	N/A		Created
08/13/2025	4.0.16	FFS-9-022-5	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = "012" or "025" or "026"STEP 4: Procedure code flag Of the claim lines that meet the criteria from STEP 3, further restrict them by the following criteria:1a. PROCEDURE-CODE-FLAG = "05”STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = "012" or "025" or "026"STEP 4: Procedure code flag Of the claim lines that meet the criteria from STEP 3, further restrict them by the following criteria:1a. PROCEDURE-CODE-FLAG = "05”STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3
04/24/2025	4.0.7	FFS-9-022-5	ADD	N/A		Created
08/13/2025	4.0.16	FFS-9-021-6	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = "012" or "025" or "026"STEP 4: Procedure code flag Of the claim lines that meet the criteria from STEP 3, further restrict them by the following criteria:1a. PROCEDURE-CODE-FLAG = "04”STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = "012" or "025" or "026"STEP 4: Procedure code flag Of the claim lines that meet the criteria from STEP 3, further restrict them by the following criteria:1a. PROCEDURE-CODE-FLAG = "04”STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3
04/24/2025	4.0.7	FFS-9-021-6	ADD	N/A		Created
08/13/2025	4.0.16	FFS-9-020-7	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = "012" or "025" or "026"STEP 4: Procedure code flag Of the claim lines that meet the criteria from STEP 3, further restrict them by the following criteria:1a. PROCEDURE-CODE-FLAG = "03”STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = "012" or "025" or "026"STEP 4: Procedure code flag Of the claim lines that meet the criteria from STEP 3, further restrict them by the following criteria:1a. PROCEDURE-CODE-FLAG = "03”STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3
04/24/2025	4.0.7	FFS-9-020-7	ADD	N/A		Created
08/13/2025	4.0.16	FFS-9-019-16	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = "012" or "025" or "026"STEP 4: Procedure code flag Of the claim lines that meet the criteria from STEP 3, further restrict them by the following criteria:1a. PROCEDURE-CODE-FLAG = "07" and “02”STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = "012" or "025" or "026"STEP 4: Procedure code flag Of the claim lines that meet the criteria from STEP 3, further restrict them by the following criteria:1a. PROCEDURE-CODE-FLAG = "07" and “02”STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3
04/24/2025	4.0.7	FFS-9-019-16	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-018-13	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-017-14	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-016-15	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-015-11	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-014-12	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-013-10	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-012-19	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-011-4	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-010-3	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-009-18	ADD	N/A		Created
08/13/2025	4.0.16	FFS-9-008-98	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Office place of serviceOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. PLACE-OF-SERVICE = "11"STEP 4: Calculate the percentage for the measureDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Office place of serviceOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. PLACE-OF-SERVICE = "11"STEP 4: Calculate the percentage for the measureDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2
04/24/2025	4.0.7	FFS-9-008-98	ADD	N/A		Created
08/13/2025	4.0.16	FFS-9-007-9	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Place of serviceOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. PLACE-OF-SERVICE = "23"STEP 4: Calculate the percentage for the measureDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Place of serviceOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. PLACE-OF-SERVICE = "23"STEP 4: Calculate the percentage for the measureDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2
04/24/2025	4.0.7	FFS-9-007-9	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-006-101	ADD	N/A		Created
04/24/2025	4.0.7	FFS-9-005-99	ADD	N/A		Created
08/13/2025	4.0.16	FFS-9-004-100	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing headers, lines, and DX segments that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.For DX segments: 1. DX segments merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-TYPE-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = “012” or “002” or “061” or "028" or "041"STEP 4: Non-missing diagnosis codeOf the claims that meet the criteria from STEP 3, select records where: 1. DIAGNOSIS-CODE is not missingSTEP 5: Link claim lines to claim DX recordsMerge the lines from STEP 3 with the DX records from STEP 4 by header.STEP 6: Drop lines without diagnosis codesOf the claim lines from STEP 5, keep only lines linked to a DX record from STEP 4STEP 7: Calculate the percentage for the measureDivide the count of claim lines from STEP 6 by the count of claim lines from STEP 3	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing headers, lines, and DX segments that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.For DX segments: 1. DX segments merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = “012” or “002” or “061” or "028" or "041"STEP 4: Non-missing diagnosis codeOf the claims that meet the criteria from STEP 3, select records where: 1. DIAGNOSIS-CODE is not missingSTEP 5: Link claim lines to claim DX recordsMerge the lines from STEP 3 with the DX records from STEP 4 by header.STEP 6: Drop lines without diagnosis codesOf the claim lines from STEP 5, keep only lines linked to a DX record from STEP 4STEP 7: Calculate the percentage for the measureDivide the count of claim lines from STEP 6 by the count of claim lines from STEP 3
04/24/2025	4.0.7	FFS-9-004-100	ADD	N/A		Created
08/13/2025	4.0.16	FFS-9-003-8	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Service end date in past yearOf the claims that meet the criteria from STEP 2, select records where 1. ENDING-DATE-OF-SERVICE >-= Measure_Month_End minus 365STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate paid OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Service end date in past yearOf the claims that meet the criteria from STEP 2, select records where 1. ENDING-DATE-OF-SERVICE >-= Measure_Month_End minus 365STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2
04/24/2025	4.0.7	FFS-9-003-8	ADD	N/A		Created
08/13/2025	4.0.16	FFS-9-002-102	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Procedure codeOf the records that meet the criteria from STEP 2, count line records with1. PROCEDURE-CODE is not missingSTEP 4 : Calculate percentage for measureDivide the count of line records from STEP 3 by the count of line records from STEP 2.	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Procedure codeOf the records that meet the criteria from STEP 2, count line records with1. PROCEDURE-CODE is not missingSTEP 4 : Calculate percentage for measureDivide the count of line records from STEP 3 by the count of line records from STEP 2.
04/24/2025	4.0.7	FFS-9-002-102	ADD	N/A		Created
08/13/2025	4.0.16	FFS-9-001-103	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claim lines that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Count claim linesCount the number of unique claim lines that satisfy the constraints of STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claim lines that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Count claim linesCount the number of unique claim lines that satisfy the constraints of STEP 2
04/24/2025	4.0.7	FFS-9-001-103	ADD	N/A		Created
04/24/2025	4.0.7	FFS-8-010-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-8-009-8	ADD	N/A		Created
04/24/2025	4.0.7	FFS-8-008-7	ADD	N/A		Created
04/24/2025	4.0.7	FFS-8-007-6	ADD	N/A		Created
04/24/2025	4.0.7	FFS-8-006-5	ADD	N/A		Created
04/24/2025	4.0.7	FFS-8-005-4	ADD	N/A		Created
04/24/2025	4.0.7	FFS-8-004-3	ADD	N/A		Created
04/24/2025	4.0.7	FFS-8-003-2	ADD	N/A		Created
04/24/2025	4.0.7	FFS-8-002-9	ADD	N/A		Created
04/24/2025	4.0.7	FFS-8-001-10	ADD	N/A		Created
04/24/2025	4.0.7	FFS-7-020-8	ADD	N/A		Created
04/24/2025	4.0.7	FFS-7-019-7	ADD	N/A		Created
04/24/2025	4.0.7	FFS-7-018-6	ADD	N/A		Created
04/24/2025	4.0.7	FFS-7-017-5	ADD	N/A		Created
04/24/2025	4.0.7	FFS-7-016-4	ADD	N/A		Created
04/24/2025	4.0.7	FFS-7-015-3	ADD	N/A		Created
04/24/2025	4.0.7	FFS-7-014-2	ADD	N/A		Created
04/24/2025	4.0.7	FFS-7-013-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-7-012-12	ADD	N/A		Created
04/24/2025	4.0.7	FFS-7-011-19	ADD	N/A		Created
04/24/2025	4.0.7	FFS-7-010-14	ADD	N/A		Created
04/24/2025	4.0.7	FFS-7-009-16	ADD	N/A		Created
04/24/2025	4.0.7	FFS-7-008-13	ADD	N/A		Created
04/24/2025	4.0.7	FFS-7-007-9	ADD	N/A		Created
04/24/2025	4.0.7	FFS-7-006-11	ADD	N/A		Created
04/24/2025	4.0.7	FFS-7-005-15	ADD	N/A		Created
05/27/2025	4.0.9	FFS-7-004-18	UPDATE	Ta max	5	37
05/27/2025	4.0.9	FFS-7-004-18	UPDATE	Threshold maximum	5	37
04/24/2025	4.0.7	FFS-7-004-18	ADD	N/A		Created
08/13/2025	4.0.16	FFS-7-003-17	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-TYPE-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 2, select records where 1. There is at least one CLAIM-DX-LT (CLT00004) segment where DIAGNOSIS-CODE is not missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 2	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 2, select records where 1. There is at least one CLAIM-DX-LT (CLT00004) segment where DIAGNOSIS-CODE is not missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 2
04/24/2025	4.0.7	FFS-7-003-17	ADD	N/A		Created
04/24/2025	4.0.7	FFS-7-002-10	ADD	N/A		Created
11/20/2025	4.0.22	FFS-7-001-20	UPDATE	Annotation	Total number of S-CHIP FFS: original, non-crossover, paid LT claims	N/A
11/20/2025	4.0.22	FFS-7-001-20	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Count ClaimsCount the number of unique records that satisfy the constraints of STEP 2	N/A
04/24/2025	4.0.7	FFS-7-001-20	ADD	N/A		Created
04/24/2025	4.0.7	FFS-6-010-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-6-009-8	ADD	N/A		Created
04/24/2025	4.0.7	FFS-6-008-7	ADD	N/A		Created
04/24/2025	4.0.7	FFS-6-007-6	ADD	N/A		Created
04/24/2025	4.0.7	FFS-6-006-5	ADD	N/A		Created
04/24/2025	4.0.7	FFS-6-005-4	ADD	N/A		Created
04/24/2025	4.0.7	FFS-6-004-3	ADD	N/A		Created
04/24/2025	4.0.7	FFS-6-003-2	ADD	N/A		Created
04/24/2025	4.0.7	FFS-6-002-9	ADD	N/A		Created
04/24/2025	4.0.7	FFS-6-001-10	ADD	N/A		Created
04/24/2025	4.0.7	FFS-5-030-14	ADD	N/A		Created
08/13/2025	4.0.16	FFS-5-029-8	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Skilled nursing facility services under 21Of the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "059"STEP 4: No NF daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1a. NURSING-FACILITY-DAYS = "0"OR1b. NURSING-FACILITY-DAYS is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Skilled nursing facility services under 21Of the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "059"STEP 4: No NF daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1a. NURSING-FACILITY-DAYS = "0"OR1b. NURSING-FACILITY-DAYS is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3
04/24/2025	4.0.7	FFS-5-029-8	ADD	N/A		Created
04/24/2025	4.0.7	FFS-5-028-21	ADD	N/A		Created
08/13/2025	4.0.16	FFS-5-027-7	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Inpatient and residential substance abuseOf the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "050"STEP 4: No IP daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1a. MEDICAID-COV-INPATIENT-DAYS = "0"OR1b. MEDICAID-COV-INPATIENT-DAYS is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Inpatient and residential substance abuseOf the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "050"STEP 4: No IP daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1a. MEDICAID-COV-INPATIENT-DAYS = "0"OR1b. MEDICAID-COV-INPATIENT-DAYS is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3
04/24/2025	4.0.7	FFS-5-027-7	ADD	N/A		Created
04/24/2025	4.0.7	FFS-5-026-20	ADD	N/A		Created
08/13/2025	4.0.16	FFS-5-025-6	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Inpatient psychiatric services under 21Of the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "048"STEP 4: No IP daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1a. MEDICAID-COV-INPATIENT-DAYS = "0"OR1b. MEDICAID-COV-INPATIENT-DAYS is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Inpatient psychiatric services under 21Of the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "048"STEP 4: No IP daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1a. MEDICAID-COV-INPATIENT-DAYS = "0"OR1b. MEDICAID-COV-INPATIENT-DAYS is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3
04/24/2025	4.0.7	FFS-5-025-6	ADD	N/A		Created
04/24/2025	4.0.7	FFS-5-024-19	ADD	N/A		Created
08/13/2025	4.0.16	FFS-5-023-5	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Nursing facility services other than mental diseasesOf the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "047"STEP 4: No NF daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1a. NURSING-FACILITY-DAYS = "0"OR1b. NURSING-FACILITY-DAYS is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Nursing facility services other than mental diseasesOf the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "047"STEP 4: No NF daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1a. NURSING-FACILITY-DAYS = "0"OR1b. NURSING-FACILITY-DAYS is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3
04/24/2025	4.0.7	FFS-5-023-5	ADD	N/A		Created
04/24/2025	4.0.7	FFS-5-022-18	ADD	N/A		Created
08/13/2025	4.0.16	FFS-5-021-4	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Intermediate Care Facility ServicesOf the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "046"STEP 4: No ICF daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1a. ICF-IID-DAYS = "0"OR1b. ICF-IID-DAYS is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Intermediate Care Facility ServicesOf the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "046"STEP 4: No ICF daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1a. ICF-IID-DAYS = "0"OR1b. ICF-IID-DAYS is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3
04/24/2025	4.0.7	FFS-5-021-4	ADD	N/A		Created
04/24/2025	4.0.7	FFS-5-020-17	ADD	N/A		Created
08/13/2025	4.0.16	FFS-5-019-3	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Nursing facility recordsOf the claims that meet the criteria from STEP 2, select those with 1. TYPE-OF-SERVICE = "45"STEP 4: Nursing facility records with zero covered daysOf the claims that meet the criteria from STEP 3, select those with 1. NURSING-FACILITY-DAYS = "0" or missingSTEP 5 : Calculate percentage for measureDivide the count of claims from STEP 4 by the count of claims from STEP 3.	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Nursing facility recordsOf the claims that meet the criteria from STEP 2, select those with 1. TYPE-OF-SERVICE = "45"STEP 4: Nursing facility records with zero covered daysOf the claims that meet the criteria from STEP 3, select those with 1. NURSING-FACILITY-DAYS = "0" or missingSTEP 5 : Calculate percentage for measureDivide the count of claims from STEP 4 by the count of claims from STEP 3.
04/24/2025	4.0.7	FFS-5-019-3	ADD	N/A		Created
04/24/2025	4.0.7	FFS-5-018-16	ADD	N/A		Created
08/13/2025	4.0.16	FFS-5-017-2	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Inpatient Hospital Services for individuals age 65+ for mental diseasesOf the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "044"STEP 4: No IP daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. MEDICAID-COV-INPATIENT-DAYS = "0" or missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Inpatient Hospital Services for individuals age 65+ for mental diseasesOf the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "044"STEP 4: No IP daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. MEDICAID-COV-INPATIENT-DAYS = "0" or missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3
04/24/2025	4.0.7	FFS-5-017-2	ADD	N/A		Created
04/24/2025	4.0.7	FFS-5-016-15	ADD	N/A		Created
08/13/2025	4.0.16	FFS-5-015-1	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Nursing facility services age 21+Of the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "009"STEP 4: No NF daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. NURSING-FACILITY-DAYS = "0" or missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Nursing facility services age 21+Of the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "009"STEP 4: No NF daysOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. NURSING-FACILITY-DAYS = "0" or missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3
04/24/2025	4.0.7	FFS-5-015-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-5-014-22	ADD	N/A		Created
11/20/2025	4.0.22	FFS-5-013-24	UPDATE	Annotation	Percentage of Medicaid FFS: original, non-crossover, paid LT claims with patient liability	N/A
11/20/2025	4.0.22	FFS-5-013-24	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Non-missing patient liabilityOf the claims that meet the criteria from STEP 2, select records where:1. LTC-RCP-LIAB-AMT is non-missingSTEP 4: Calculate percentageDivide the count from STEP 3 by the count from STEP 2	N/A
04/24/2025	4.0.7	FFS-5-013-24	ADD	N/A		Created
11/20/2025	4.0.22	FFS-5-012-12	UPDATE	Annotation	Percentage of Medicaid FFS: original, non-crossover, paid LT claims with Leave Days	N/A
11/20/2025	4.0.22	FFS-5-012-12	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Claims with Leave DaysOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. LEAVE-DAYS is greater than 0STEP 4: Calculate percentage for measureDivide the count of claims from STEP 3 by the count of claims from STEP 2.	N/A
04/24/2025	4.0.7	FFS-5-012-12	ADD	N/A		Created
11/20/2025	4.0.22	FFS-5-011-29	UPDATE	Annotation	Average number of long-term care days (exclude 0) for Medicaid FFS: original, non-crossover, paid LT claims	N/A
11/20/2025	4.0.22	FFS-5-011-29	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Total long-term care days is positiveOf the claims that meet the criteria from STEP 2:1. Create Total_LTC_Days as the sum of LEAVE-DAYS, ICF-IID-DAYS, NURSING-FACILITY-DAYS and MEDICAID-COV-INPATIENT-DAYS 2. Keep claims with Total_LTC_Days > 0STEP 4: Sum total LTC daysSum Total_LTC_Days for all claims in STEP 3STEP 5: Calculate the average for measureDivide the sum from STEP 4 by the count of claims from STEP 3	N/A
04/24/2025	4.0.7	FFS-5-011-29	ADD	N/A		Created
04/24/2025	4.0.7	FFS-5-010-23	ADD	N/A		Created
04/24/2025	4.0.7	FFS-5-009-26	ADD	N/A		Created
04/24/2025	4.0.7	FFS-5-008-13	ADD	N/A		Created
11/20/2025	4.0.22	FFS-5-007-9	UPDATE	Annotation	The percentage of Medicaid FFS: original, non-crossover, paid LT claims where the patient died	N/A
11/20/2025	4.0.22	FFS-5-007-9	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Patient status codeOf the records that meet the criteria from STEP 2, select records with PATIENT-STATUS = ("20" or “40” or “41” or “42”)STEP 4 : Calculate percentage for measureDivide the count of records from STEP 3 by the count of records from STEP 2.	N/A
04/24/2025	4.0.7	FFS-5-007-9	ADD	N/A		Created
11/20/2025	4.0.22	FFS-5-006-11	UPDATE	Annotation	Calculate the percentage of Medicaid FFS: original, non-crossover, paid LT claims with patient status discharged to home	N/A
11/20/2025	4.0.22	FFS-5-006-11	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Patient status of discharged to homeOf the claims that meet the criteria from STEP 2, select claims with home patient status:1. PATIENT-STATUS = “01” or “06” or “08” or “50” or “81” or “86”STEP 4: Calculate percentage for measureDivide the count of claims from STEP 3 by the count of claims in STEP 2	N/A
04/24/2025	4.0.7	FFS-5-006-11	ADD	N/A		Created
11/20/2025	4.0.22	FFS-5-005-25	UPDATE	Annotation	Calculate the percentage of Medicaid FFS: original, non-crossover, paid LT claims with 'still patient' patient status	N/A
11/20/2025	4.0.22	FFS-5-005-25	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Patient status is 'still patient'Of the claims that meet the criteria from STEP 2, count records with1. PATIENT-STATUS = '30'STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2.	N/A
04/24/2025	4.0.7	FFS-5-005-25	ADD	N/A		Created
05/27/2025	4.0.9	FFS-5-004-28	UPDATE	Ta max	5	37
05/27/2025	4.0.9	FFS-5-004-28	UPDATE	Threshold maximum	5	37
04/24/2025	4.0.7	FFS-5-004-28	ADD	N/A		Created
08/13/2025	4.0.16	FFS-5-003-27	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-TYPE-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 2, select records where 1. There is at least one CLAIM-DX-LT (CLT00004) segment where DIAGNOSIS-CODE is not missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 2	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 2, select records where 1. There is at least one CLAIM-DX-LT (CLT00004) segment where DIAGNOSIS-CODE is not missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 2
04/24/2025	4.0.7	FFS-5-003-27	ADD	N/A		Created
11/20/2025	4.0.22	FFS-5-002-10	UPDATE	Annotation	Percentage of Medicaid FFS: original, non-crossover, paid LT claims with service end date within the past year	N/A
11/20/2025	4.0.22	FFS-5-002-10	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Service end date in past yearOf the claims that meet the criteria from STEP 2, select records where 1. ENDING-DATE-OF-SERVICE >-= Measure_Month_End minus 365STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	FFS-5-002-10	ADD	N/A		Created
11/20/2025	4.0.22	FFS-5-001-30	UPDATE	Annotation	Total number of Medicaid FFS: original, non-crossover, paid LT claims	N/A
11/20/2025	4.0.22	FFS-5-001-30	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claim lines that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Count claimsCount the number of unique records that satisfy the constraints of step 2	N/A
04/24/2025	4.0.7	FFS-5-001-30	ADD	N/A		Created
04/24/2025	4.0.7	FFS-4-013-4	ADD	N/A		Created
04/24/2025	4.0.7	FFS-4-012-3	ADD	N/A		Created
04/24/2025	4.0.7	FFS-4-011-2	ADD	N/A		Created
04/24/2025	4.0.7	FFS-4-010-12	ADD	N/A		Created
04/24/2025	4.0.7	FFS-4-009-11	ADD	N/A		Created
04/24/2025	4.0.7	FFS-4-008-10	ADD	N/A		Created
04/24/2025	4.0.7	FFS-4-007-9	ADD	N/A		Created
04/24/2025	4.0.7	FFS-4-006-8	ADD	N/A		Created
04/24/2025	4.0.7	FFS-4-005-7	ADD	N/A		Created
04/24/2025	4.0.7	FFS-4-004-6	ADD	N/A		Created
04/24/2025	4.0.7	FFS-4-003-5	ADD	N/A		Created
04/24/2025	4.0.7	FFS-4-002-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-4-001-13	ADD	N/A		Created
04/24/2025	4.0.7	FFS-3-018-15	ADD	N/A		Created
04/24/2025	4.0.7	FFS-3-017-14	ADD	N/A		Created
04/24/2025	4.0.7	FFS-3-016-13	ADD	N/A		Created
04/24/2025	4.0.7	FFS-3-015-12	ADD	N/A		Created
04/24/2025	4.0.7	FFS-3-014-7	ADD	N/A		Created
04/24/2025	4.0.7	FFS-3-013-8	ADD	N/A		Created
04/24/2025	4.0.7	FFS-3-012-6	ADD	N/A		Created
04/24/2025	4.0.7	FFS-3-011-2	ADD	N/A		Created
04/24/2025	4.0.7	FFS-3-010-5	ADD	N/A		Created
04/24/2025	4.0.7	FFS-3-009-4	ADD	N/A		Created
04/24/2025	4.0.7	FFS-3-008-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-3-007-17	ADD	N/A		Created
11/20/2025	4.0.22	FFS-3-006-11	UPDATE	Annotation	Percentage of S-CHIP FFS: original, non-crossover, paid IP claims with principal procedure code	N/A
11/20/2025	4.0.22	FFS-3-006-11	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Procedure codeOf the claims that meet the criteria from STEP 2, select records where 1. PROCEDURE-CODE-1 is not missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	FFS-3-006-11	ADD	N/A		Created
08/13/2025	4.0.16	FFS-3-005-10	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-TYPE-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 3, select records where:1. There is only one CLAIM-DX-IP (CIP00004) segment where DIAGNOSIS-CODE is not missing STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of header claims from STEP 2.	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 3, select records where:1. There is only one CLAIM-DX-IP (CIP00004) segment where DIAGNOSIS-CODE is not missing STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 2.
04/24/2025	4.0.7	FFS-3-005-10	ADD	N/A		Created
05/27/2025	4.0.9	FFS-3-004-16	UPDATE	Ta max	12	37
05/27/2025	4.0.9	FFS-3-004-16	UPDATE	Threshold maximum	12	37
04/24/2025	4.0.7	FFS-3-004-16	ADD	N/A		Created
08/13/2025	4.0.16	FFS-3-003-9	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-TYPE-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 2, select records where 1. There is at least one CLAIM-DX-IP (CIP00004) segment where DIAGNOSIS-CODE is not missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 2	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 2, select records where 1. There is at least one CLAIM-DX-IP (CIP00004) segment where DIAGNOSIS-CODE is not missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 2
04/24/2025	4.0.7	FFS-3-003-9	ADD	N/A		Created
04/24/2025	4.0.7	FFS-3-002-3	ADD	N/A		Created
11/20/2025	4.0.22	FFS-3-001-18	UPDATE	Annotation	Total number of S-CHIP FFS: original, non-crossover, paid IP claims	N/A
11/20/2025	4.0.22	FFS-3-001-18	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Count ClaimsCount the number of unique records that satisfy the constraints of STEP 2	N/A
04/24/2025	4.0.7	FFS-3-001-18	ADD	N/A		Created
04/24/2025	4.0.7	FFS-23-002-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-23-001-2	ADD	N/A		Created
04/24/2025	4.0.7	FFS-22-003-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-22-002-2	ADD	N/A		Created
04/24/2025	4.0.7	FFS-22-001-3	ADD	N/A		Created
04/24/2025	4.0.7	FFS-21-003-3	ADD	N/A		Created
04/24/2025	4.0.7	FFS-21-002-2	ADD	N/A		Created
04/24/2025	4.0.7	FFS-21-001-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-2-013-4	ADD	N/A		Created
04/24/2025	4.0.7	FFS-2-012-3	ADD	N/A		Created
04/24/2025	4.0.7	FFS-2-011-2	ADD	N/A		Created
04/24/2025	4.0.7	FFS-2-010-12	ADD	N/A		Created
04/24/2025	4.0.7	FFS-2-009-11	ADD	N/A		Created
04/24/2025	4.0.7	FFS-2-008-10	ADD	N/A		Created
04/24/2025	4.0.7	FFS-2-007-9	ADD	N/A		Created
04/24/2025	4.0.7	FFS-2-006-8	ADD	N/A		Created
04/24/2025	4.0.7	FFS-2-005-7	ADD	N/A		Created
04/24/2025	4.0.7	FFS-2-004-6	ADD	N/A		Created
04/24/2025	4.0.7	FFS-2-003-5	ADD	N/A		Created
08/13/2025	4.0.16	FFS-2-002-1	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "1"STEP 3: Inpatient hospital servicesOf the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "001"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count from STEP 2	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "1"STEP 3: Inpatient hospital servicesOf the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "001"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count from STEP 2
04/24/2025	4.0.7	FFS-2-002-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-2-001-13	ADD	N/A		Created
04/24/2025	4.0.7	FFS-20-009-7	ADD	N/A		Created
04/24/2025	4.0.7	FFS-20-008-9	ADD	N/A		Created
04/24/2025	4.0.7	FFS-20-007-8	ADD	N/A		Created
04/24/2025	4.0.7	FFS-20-006-6	ADD	N/A		Created
04/24/2025	4.0.7	FFS-20-005-5	ADD	N/A		Created
04/24/2025	4.0.7	FFS-20-004-4	ADD	N/A		Created
04/24/2025	4.0.7	FFS-20-003-3	ADD	N/A		Created
04/24/2025	4.0.7	FFS-20-002-2	ADD	N/A		Created
04/24/2025	4.0.7	FFS-20-001-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-19-009-9	ADD	N/A		Created
04/24/2025	4.0.7	FFS-19-008-8	ADD	N/A		Created
04/24/2025	4.0.7	FFS-19-007-7	ADD	N/A		Created
04/24/2025	4.0.7	FFS-19-006-6	ADD	N/A		Created
04/24/2025	4.0.7	FFS-19-005-4	ADD	N/A		Created
04/24/2025	4.0.7	FFS-19-004-5	ADD	N/A		Created
04/24/2025	4.0.7	FFS-19-003-3	ADD	N/A		Created
08/13/2025	4.0.16	FFS-19-002-1	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "1"STEP 3: Type of Service Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. TYPE-OF-SERVICE = (“012” or “029” or “015” or “002” or “061” or “028” or “041”STEP 4: Service Provider and Billing ProviderOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. SERVICING-PROV-NUM = BILLING-PROV-NUMSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "1"STEP 3: Type of Service Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. TYPE-OF-SERVICE = (“012” or “029” or “015” or “002” or “061” or “028” or “041”STEP 4: Service Provider and Billing ProviderOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. SERVICING-PROV-NUM = BILLING-PROV-NUMSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3
04/24/2025	4.0.7	FFS-19-002-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-19-001-2	ADD	N/A		Created
04/24/2025	4.0.7	FFS-18-010-10	ADD	N/A		Created
04/24/2025	4.0.7	FFS-18-009-9	ADD	N/A		Created
04/24/2025	4.0.7	FFS-18-008-8	ADD	N/A		Created
04/24/2025	4.0.7	FFS-18-007-7	ADD	N/A		Created
04/24/2025	4.0.7	FFS-18-006-5	ADD	N/A		Created
04/24/2025	4.0.7	FFS-18-005-6	ADD	N/A		Created
04/24/2025	4.0.7	FFS-18-004-4	ADD	N/A		Created
08/13/2025	4.0.16	FFS-18-003-1	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Physician claimsOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. TYPE-OF-SERVICE = "012"STEP 4: SpecialtyOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. SERVICING-PROV-SPECIALTY is not missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Physician claimsOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. TYPE-OF-SERVICE = "012"STEP 4: SpecialtyOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. SERVICING-PROV-SPECIALTY is not missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3
04/24/2025	4.0.7	FFS-18-003-1	ADD	N/A		Created
08/13/2025	4.0.16	FFS-18-002-2	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = "012"or "029" or "015" "002" or "061" or "028" or "041"STEP 4: Same service provider ID and billing provider IDOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. SERVICING-PROV-NUM = BILLING-PROV-NUM2. SERVICING-PROV-NUM is non-missing3. BILLING-PROV-NUM is non-missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = "012"or "029" or "015" "002" or "061" or "028" or "041"STEP 4: Same service provider ID and billing provider IDOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. SERVICING-PROV-NUM = BILLING-PROV-NUM2. SERVICING-PROV-NUM is non-missing3. BILLING-PROV-NUM is non-missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3
04/24/2025	4.0.7	FFS-18-002-2	ADD	N/A		Created
04/24/2025	4.0.7	FFS-18-001-3	ADD	N/A		Created
04/24/2025	4.0.7	FFS-17-008-2	ADD	N/A		Created
04/24/2025	4.0.7	FFS-17-007-8	ADD	N/A		Created
04/24/2025	4.0.7	FFS-17-006-7	ADD	N/A		Created
04/24/2025	4.0.7	FFS-17-005-6	ADD	N/A		Created
04/24/2025	4.0.7	FFS-17-004-5	ADD	N/A		Created
04/24/2025	4.0.7	FFS-17-003-4	ADD	N/A		Created
04/24/2025	4.0.7	FFS-17-002-3	ADD	N/A		Created
04/24/2025	4.0.7	FFS-17-001-1	ADD	N/A		Created
08/13/2025	4.0.16	FFS-16-008-2	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers: 1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Missing Prescription Quantity ActualOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. PRESCRIPTION-QUANTITY-ACTUAL is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers: 1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Missing Prescription Quantity ActualOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. PRESCRIPTION-QUANTITY-ACTUAL is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2
04/24/2025	4.0.7	FFS-16-008-2	ADD	N/A		Created
04/24/2025	4.0.7	FFS-16-007-4	ADD	N/A		Created
08/13/2025	4.0.16	FFS-16-006-3	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers: 1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: National drug codeOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. NATIONAL-DRUG-CODE character is 11 numeric digitsSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers: 1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: National drug codeOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. NATIONAL-DRUG-CODE character is 11 numeric digitsSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2
04/24/2025	4.0.7	FFS-16-006-3	ADD	N/A		Created
08/13/2025	4.0.16	FFS-16-005-1	UPDATE	Specification	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Prescription supply daysOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. DAYS-SUPPLY is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Prescription supply daysOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. DAYS-SUPPLY is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2
04/24/2025	4.0.7	FFS-16-005-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-16-004-5	ADD	N/A		Created
04/24/2025	4.0.7	FFS-16-003-6	ADD	N/A		Created
04/24/2025	4.0.7	FFS-16-002-7	ADD	N/A		Created
11/20/2025	4.0.22	FFS-16-001-8	UPDATE	Annotation	Total number of S-CHIP FFS: original, non-crossover, paid RX claims	N/A
11/20/2025	4.0.22	FFS-16-001-8	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Count ClaimsCount the number of unique records that satisfy the constraints of STEP 2	N/A
04/24/2025	4.0.7	FFS-16-001-8	ADD	N/A		Created
04/24/2025	4.0.7	FFS-15-008-2	ADD	N/A		Created
04/24/2025	4.0.7	FFS-15-007-8	ADD	N/A		Created
04/24/2025	4.0.7	FFS-15-006-7	ADD	N/A		Created
04/24/2025	4.0.7	FFS-15-005-6	ADD	N/A		Created
04/24/2025	4.0.7	FFS-15-004-5	ADD	N/A		Created
04/24/2025	4.0.7	FFS-15-003-4	ADD	N/A		Created
04/24/2025	4.0.7	FFS-15-002-3	ADD	N/A		Created
04/24/2025	4.0.7	FFS-15-001-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-14-015-8	ADD	N/A		Created
04/24/2025	4.0.7	FFS-14-014-14	ADD	N/A		Created
04/24/2025	4.0.7	FFS-14-013-13	ADD	N/A		Created
04/24/2025	4.0.7	FFS-14-012-12	ADD	N/A		Created
04/24/2025	4.0.7	FFS-14-011-11	ADD	N/A		Created
04/24/2025	4.0.7	FFS-14-010-10	ADD	N/A		Created
04/24/2025	4.0.7	FFS-14-009-9	ADD	N/A		Created
08/13/2025	4.0.16	FFS-14-008-2	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers: 1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Missing Prescription Quantity ActualOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. PRESCRIPTION-QUANTITY-ACTUAL is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers: 1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Missing Prescription Quantity ActualOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. PRESCRIPTION-QUANTITY-ACTUAL is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2
04/24/2025	4.0.7	FFS-14-008-2	ADD	N/A		Created
08/13/2025	4.0.16	FFS-14-007-4	UPDATE	Specification	STEP 1: Active non-duplicate paid RX records during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Drugs, services, or products rendered is 1Of the records that meet the criteria from STEP 2, count line records with1. PRESCRIPTION-QUANTITY-ACTUAL = 1STEP 4 : Calculate percentage for measureDivide the count of line records from STEP 3 by the count of line records from STEP 2	STEP 1: Active non-duplicate paid RX records during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Drugs, services, or products rendered is 1Of the records that meet the criteria from STEP 2, count line records with1. PRESCRIPTION-QUANTITY-ACTUAL = 1STEP 4 : Calculate percentage for measureDivide the count of line records from STEP 3 by the count of line records from STEP 2
04/24/2025	4.0.7	FFS-14-007-4	ADD	N/A		Created
08/13/2025	4.0.16	FFS-14-006-3	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers: 1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: National drug codeOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. NATIONAL-DRUG-CODE character is 11 numeric digitsSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers: 1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: National drug codeOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. NATIONAL-DRUG-CODE character is 11 numeric digitsSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2
04/24/2025	4.0.7	FFS-14-006-3	ADD	N/A		Created
08/13/2025	4.0.16	FFS-14-005-1	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers: 1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Prescription supply daysOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. DAYS-SUPPLY is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers: 1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Prescription supply daysOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. DAYS-SUPPLY is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2
04/24/2025	4.0.7	FFS-14-005-1	ADD	N/A		Created
08/13/2025	4.0.16	FFS-14-004-5	UPDATE	Specification	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Days of supplyOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. DAYS-SUPPLY > 30STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Days of supplyOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. DAYS-SUPPLY > 30STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2
04/24/2025	4.0.7	FFS-14-004-5	ADD	N/A		Created
11/20/2025	4.0.22	FFS-14-003-6	UPDATE	Annotation	The percentage of Medicaid FFS: original, non-crossover, paid RX claims where the fill date is equal to the prescribed date	N/A
11/20/2025	4.0.22	FFS-14-003-6	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Fill date equals prescribed dateOf the claims that meet the criteria from STEP 2, select records where 1. PRESCRIPTION-FILL-DATE = DATE-PRESCRIBEDSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	FFS-14-003-6	ADD	N/A		Created
11/20/2025	4.0.22	FFS-14-002-7	UPDATE	Annotation	Percentage of Medicaid FFS: original, non-crossover, paid RX claims with prescription fill date within the past 12 months	N/A
11/20/2025	4.0.22	FFS-14-002-7	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Fill date in past 12 monthsOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. Claims PRESCRIPTION-FILL-DATE >= Measure_Month_End minus 365STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	FFS-14-002-7	ADD	N/A		Created
11/20/2025	4.0.22	FFS-14-001-15	UPDATE	Annotation	Total number of Medicaid FFS: original, non-crossover, paid RX claims	N/A
11/20/2025	4.0.22	FFS-14-001-15	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Count claimsCount the number of unique records that satisfy the constraints of STEP 2	N/A
04/24/2025	4.0.7	FFS-14-001-15	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-079-8	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-078-6	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-077-4	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-076-79	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-075-78	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-074-77	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-073-76	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-072-75	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-071-74	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-070-73	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-069-72	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-068-70	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-067-69	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-066-68	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-065-67	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-064-66	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-063-65	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-062-64	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-061-63	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-060-62	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-059-61	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-058-59	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-057-58	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-056-57	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-055-56	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-054-55	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-053-54	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-052-53	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-051-52	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-050-51	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-049-49	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-048-48	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-047-47	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-046-46	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-045-45	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-044-44	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-043-43	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-042-42	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-041-40	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-040-39	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-039-38	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-038-37	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-037-36	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-036-34	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-035-33	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-034-32	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-033-31	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-032-30	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-031-29	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-030-28	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-029-27	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-028-25	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-027-24	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-026-23	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-025-22	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-024-21	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-023-20	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-022-19	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-021-18	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-020-17	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-019-16	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-018-14	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-017-13	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-016-12	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-015-11	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-014-10	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-013-9	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-012-7	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-011-5	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-010-3	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-009-2	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-008-71	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-007-60	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-006-50	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-005-41	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-004-35	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-003-26	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-002-15	ADD	N/A		Created
04/24/2025	4.0.7	FFS-13-001-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-12-005-3	ADD	N/A		Created
04/24/2025	4.0.7	FFS-12-004-4	ADD	N/A		Created
04/24/2025	4.0.7	FFS-12-003-2	ADD	N/A		Created
04/24/2025	4.0.7	FFS-12-002-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-12-001-5	ADD	N/A		Created
04/24/2025	4.0.7	FFS-11-024-2	ADD	N/A		Created
04/24/2025	4.0.7	FFS-11-023-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-11-022-17	ADD	N/A		Created
04/24/2025	4.0.7	FFS-11-021-5	ADD	N/A		Created
04/24/2025	4.0.7	FFS-11-020-6	ADD	N/A		Created
04/24/2025	4.0.7	FFS-11-019-7	ADD	N/A		Created
04/24/2025	4.0.7	FFS-11-018-16	ADD	N/A		Created
04/24/2025	4.0.7	FFS-11-017-13	ADD	N/A		Created
04/24/2025	4.0.7	FFS-11-016-14	ADD	N/A		Created
04/24/2025	4.0.7	FFS-11-015-15	ADD	N/A		Created
04/24/2025	4.0.7	FFS-11-014-11	ADD	N/A		Created
04/24/2025	4.0.7	FFS-11-013-12	ADD	N/A		Created
04/24/2025	4.0.7	FFS-11-012-10	ADD	N/A		Created
04/24/2025	4.0.7	FFS-11-011-4	ADD	N/A		Created
04/24/2025	4.0.7	FFS-11-010-3	ADD	N/A		Created
04/24/2025	4.0.7	FFS-11-009-18	ADD	N/A		Created
04/24/2025	4.0.7	FFS-11-008-19	ADD	N/A		Created
04/24/2025	4.0.7	FFS-11-007-9	ADD	N/A		Created
04/24/2025	4.0.7	FFS-11-006-22	ADD	N/A		Created
08/13/2025	4.0.16	FFS-11-005-21	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing headers, lines, and DX segments that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.For DX segments:1. DX segments merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-TYPE-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = “012” or “002” or “061” or "028" or "041"STEP 4: Non-missing diagnosis codeOf the DX segments that meet the criteria from STEP 1, select records where 1. DIAGNOSIS-CODE value is not missing.STEP 5: Link claim lines to claim DX recordsMerge the lines from STEP 3 with the DX records from STEP 4 by header.STEP 6: Drop lines without diagnosis codesOf the claim lines from STEP 5, keep only lines linked to a DX record from STEP 4STEP 7: Calculate the percentage for the measureDivide the count of claim lines from STEP 6 by the count of claim lines from STEP 3	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing headers, lines, and DX segments that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.For DX segments:1. DX segments merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = “012” or “002” or “061” or "028" or "041"STEP 4: Non-missing diagnosis codeOf the DX segments that meet the criteria from STEP 1, select records where 1. DIAGNOSIS-CODE value is not missing.STEP 5: Link claim lines to claim DX recordsMerge the lines from STEP 3 with the DX records from STEP 4 by header.STEP 6: Drop lines without diagnosis codesOf the claim lines from STEP 5, keep only lines linked to a DX record from STEP 4STEP 7: Calculate the percentage for the measureDivide the count of claim lines from STEP 6 by the count of claim lines from STEP 3
04/24/2025	4.0.7	FFS-11-005-21	ADD	N/A		Created
04/24/2025	4.0.7	FFS-11-004-20	ADD	N/A		Created
04/24/2025	4.0.7	FFS-11-003-8	ADD	N/A		Created
04/24/2025	4.0.7	FFS-11-002-23	ADD	N/A		Created
08/13/2025	4.0.16	FFS-11-001-24	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Count Claim LinesCount the number of unique line records that satisfy the constraints of STEP 2	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Count claim linesCount the number of unique line records that satisfy the constraints of STEP 2
04/24/2025	4.0.7	FFS-11-001-24	ADD	N/A		Created
04/24/2025	4.0.7	FFS-1-030-8	ADD	N/A		Created
04/24/2025	4.0.7	FFS-1-029-7	ADD	N/A		Created
04/24/2025	4.0.7	FFS-1-028-6	ADD	N/A		Created
04/24/2025	4.0.7	FFS-1-027-16	ADD	N/A		Created
04/24/2025	4.0.7	FFS-1-026-15	ADD	N/A		Created
04/24/2025	4.0.7	FFS-1-025-14	ADD	N/A		Created
04/24/2025	4.0.7	FFS-1-024-13	ADD	N/A		Created
04/24/2025	4.0.7	FFS-1-023-12	ADD	N/A		Created
04/24/2025	4.0.7	FFS-1-022-11	ADD	N/A		Created
04/24/2025	4.0.7	FFS-1-021-10	ADD	N/A		Created
04/24/2025	4.0.7	FFS-1-020-9	ADD	N/A		Created
08/13/2025	4.0.16	FFS-1-019-5	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Inpatient hospital servicesOf the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "001"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count from STEP 2	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Inpatient hospital servicesOf the claims that meet the criteria from STEP 2, select records where 1. TYPE-OF-SERVICE = "001"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count from STEP 2
04/24/2025	4.0.7	FFS-1-019-5	ADD	N/A		Created
04/24/2025	4.0.7	FFS-1-018-27	ADD	N/A		Created
04/24/2025	4.0.7	FFS-1-017-26	ADD	N/A		Created
08/13/2025	4.0.16	FFS-1-016-25	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Ancillary revenue codesOf the claims that meet the criteria from STEP 2, select records where 1. REVENUE-CODE = "0229" through "0998"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate paid IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Ancillary revenue codesOf the claims that meet the criteria from STEP 2, select records where 1. REVENUE-CODE = "0229" through "0998"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2
04/24/2025	4.0.7	FFS-1-016-25	ADD	N/A		Created
08/13/2025	4.0.16	FFS-1-015-24	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Accommodation revenue codesOf the claims that meet the criteria from STEP 2, select records where: 1. REVENUE-CODE = "0100" through "0219"STEP 4: Calculate the percentage for the measureDivide the count of header claims from STEP 3 by the count of header claims from STEP 2	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Accommodation revenue codesOf the claims that meet the criteria from STEP 2, select records where: 1. REVENUE-CODE = "0100" through "0219"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2
04/24/2025	4.0.7	FFS-1-015-24	ADD	N/A		Created
04/24/2025	4.0.7	FFS-1-014-19	ADD	N/A		Created
04/24/2025	4.0.7	FFS-1-013-20	ADD	N/A		Created
11/20/2025	4.0.22	FFS-1-012-18	UPDATE	Annotation	Calculate the percentage of Medicaid FFS: original, non-crossover, paid IP claims with 'still patient' patient status	N/A
11/20/2025	4.0.22	FFS-1-012-18	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Patient status is 'still patient'Of the claims that meet the criteria from STEP 2, count records with1. PATIENT-STATUS = '30'STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	FFS-1-012-18	ADD	N/A		Created
11/20/2025	4.0.22	FFS-1-011-2	UPDATE	Annotation	The percentage of Medicaid FFS: original, non-crossover, paid IP claims where the patient died	N/A
11/20/2025	4.0.22	FFS-1-011-2	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Patient status codeOf the records that meet the criteria from STEP 2, select records with PATIENT-STATUS = ("20" or “40” or “41” or “42”)STEP 4 : Calculate percentage for measureDivide the count of records from STEP 3 by the count of records from STEP 2	N/A
04/24/2025	4.0.7	FFS-1-011-2	ADD	N/A		Created
11/20/2025	4.0.22	FFS-1-010-17	UPDATE	Annotation	Calculate the percentage of Medicaid FFS: original, non-crossover, paid IP claims with patient status of discharged to other institution	N/A
11/20/2025	4.0.22	FFS-1-010-17	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Patient status of discharged to other institutionOf the claims that meet the criteria from STEP 2, select claims with patient status of other institution:1. PATIENT-STATUS = “02” or “03” or “04” or “05” or “43” or “51” or “61” or “62” or “63” or “64” or “65” or “66” or “70” or “82” or “83” or “84” or “85” or “88” or “89” or “90” or “91” or “92” or “93” or “94” or “95”STEP 4 : Calculate percentage for measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	FFS-1-010-17	ADD	N/A		Created
11/20/2025	4.0.22	FFS-1-009-4	UPDATE	Annotation	Calculate the percentage of Medicaid FFS: original, non-crossover, paid IP claims with patient status discharged to home	N/A
11/20/2025	4.0.22	FFS-1-009-4	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Patient status of discharged to homeOf the claims that meet the criteria from STEP 2, select claims with home patient status:1. PATIENT-STATUS = “01” or “06” or “08” or “50” or “81” or “86”STEP 4 : Calculate percentage for measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	FFS-1-009-4	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-085-12	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-084-10	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-083-8	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-082-83	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-081-82	ADD	N/A		Created
11/20/2025	4.0.22	FFS-1-008-1	UPDATE	Annotation	Percentage of Medicaid FFS: original, non-crossover, paid IP claims with admit date within the past year	N/A
11/20/2025	4.0.22	FFS-1-008-1	UPDATE	Specification	STEP 1: Active non-duplicate IP paid claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Service end date in past yearOf the claims that meet the criteria from STEP 2, select records where 1. ADMISSION-DATE >-= Measure_Month_End minus 365STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	FFS-1-008-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-080-81	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-079-80	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-078-79	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-077-78	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-076-77	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-075-76	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-074-74	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-073-73	ADD	N/A		Created
11/20/2025	4.0.22	FFS-1-007-29	UPDATE	Annotation	Average number of procedures codes for Medicaid FFS: original, non-crossover, paid IP claims	N/A
11/20/2025	4.0.22	FFS-1-007-29	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Non-missing procedure codesOf the claims that meet the criteria from STEP 2, set Count_Elements equal to the total number of non-missing data elements IN PROCEDURE-CODE-1, PROCEDURE-CODE-2 ... PROCEDURE-CODE-6STEP 4: Total number of diagnosesSum Count_Elements for all claims in STEP 3 STEP 5: Calculate the average for measureDivide the sum from STEP 4 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	FFS-1-007-29	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-072-72	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-071-71	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-070-70	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-069-69	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-068-68	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-067-67	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-066-66	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-065-65	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-064-63	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-063-62	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-062-61	ADD	N/A		Created
11/20/2025	4.0.22	FFS-1-006-23	UPDATE	Annotation	Percentage of Medicaid FFS: original, non-crossover, paid IP claims with principal procedure code	N/A
11/20/2025	4.0.22	FFS-1-006-23	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Procedure codeOf the claims that meet the criteria from STEP 2, select records where 1. PROCEDURE-CODE-1 is not missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	FFS-1-006-23	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-061-60	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-060-59	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-059-58	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-058-57	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-057-56	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-056-55	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-055-53	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-054-52	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-053-51	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-052-50	ADD	N/A		Created
08/13/2025	4.0.16	FFS-1-005-22	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-TYPE-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 3, select records where:1. There is only one CLAIM-DX-IP (CIP00004) segment where DIAGNOSIS-CODE is not missing STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 2.	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 3, select records where:1. There is only one CLAIM-DX-IP (CIP00004) segment where DIAGNOSIS-CODE is not missing STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 2.
04/24/2025	4.0.7	FFS-1-005-22	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-051-49	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-050-48	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-049-47	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-048-46	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-047-44	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-046-43	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-045-42	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-044-41	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-043-40	ADD	N/A		Created
05/27/2025	4.0.9	FFS-1-004-28	UPDATE	Ta max	12	37
05/27/2025	4.0.9	FFS-1-004-28	UPDATE	Threshold maximum	12	37
04/24/2025	4.0.7	FFS-1-004-28	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-042-38	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-041-37	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-040-36	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-039-35	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-038-34	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-037-33	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-036-32	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-035-31	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-034-29	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-033-28	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-032-27	ADD	N/A		Created
08/13/2025	4.0.16	FFS-1-003-21	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-TYPE-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 2, select records where 1. There is at least one CLAIM-DX-IP (CIP00004) segment where DIAGNOSIS-CODE is not missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 2	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Diagnosis codeOf the claims that meet the criteria from STEP 2, select records where 1. There is at least one CLAIM-DX-IP (CIP00004) segment where DIAGNOSIS-CODE is not missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 2
04/24/2025	4.0.7	FFS-1-003-21	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-031-26	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-030-25	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-029-24	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-028-23	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-027-22	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-026-21	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-025-20	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-024-18	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-023-17	ADD	N/A		Created
08/13/2025	4.0.16	FFS-1-002-3	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Service end date in past yearOf the claims that meet the criteria from STEP 2, select records where 1. ENDING-DATE-OF-SERVICE >-= Measure_Month_End minus 365STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Service end date in past yearOf the claims that meet the criteria from STEP 2, select records where 1. ENDING-DATE-OF-SERVICE >-= Measure_Month_End minus 365STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2
04/24/2025	4.0.7	FFS-1-002-3	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-022-16	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-021-15	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-020-14	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-019-13	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-018-11	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-017-9	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-016-7	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-015-6	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-014-75	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-013-64	ADD	N/A		Created
11/20/2025	4.0.22	FFS-1-001-30	UPDATE	Annotation	Total number of IP Medicaid FFS: Original, Non-Crossover, Paid IP Claims	N/A
11/20/2025	4.0.22	FFS-1-001-30	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claim lines that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Count claimsCount the number of unique records that satisfy the constraints of STEP 2	N/A
04/24/2025	4.0.7	FFS-1-001-30	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-012-54	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-011-45	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-010-39	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-009-30	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-008-19	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-007-5	ADD	N/A		Created
08/13/2025	4.0.16	FFS-10-006-2	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "1"STEP 3: Medicaid Paid Amount > 0Of the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria:1. MEDICAID-PAID-AMT > 0STEP 4: Procedure Code or Revenue CodeOf the claim lines that meet the criteria from STEP 3, further restrict them by the following criteria:1a. PROCEDURE-CODE is not missingOR1b. REVENUE-CODE is not missingSTEP 5: Calculate the percentageDivide the count of claim lines from STEP 4 by the count of claim lines for STEP 3	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "1"STEP 3: Medicaid Paid Amount > 0Of the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria:1. MEDICAID-PAID-AMT > 0STEP 4: Procedure Code or Revenue CodeOf the claim lines that meet the criteria from STEP 3, further restrict them by the following criteria:1a. PROCEDURE-CODE is not missingOR1b. REVENUE-CODE is not missingSTEP 5: Calculate the percentageDivide the count of claim lines from STEP 4 by the count of claim lines for STEP 3
04/24/2025	4.0.7	FFS-10-006-2	ADD	N/A		Created
08/13/2025	4.0.16	FFS-10-005-1	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "1"STEP 3: Medicaid paid amountOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. MEDICAID-PAID-AMT > 0STEP 4: Procedure code flagOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. PROCEDURE-CODE-FLAG is not missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "1"STEP 3: Medicaid paid amountOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. MEDICAID-PAID-AMT > 0STEP 4: Procedure code flagOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. PROCEDURE-CODE-FLAG is not missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3
04/24/2025	4.0.7	FFS-10-005-1	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-004-4	ADD	N/A		Created
08/13/2025	4.0.16	FFS-10-003-84	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "1"STEP 3: Medicaid paid amountOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. MEDICAID-PAID-AMT > 0STEP 4: Place of serviceOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. PLACE-OF-SERVICE = 11STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "1"STEP 3: Medicaid paid amountOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. MEDICAID-PAID-AMT > 0STEP 4: Place of serviceOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. PLACE-OF-SERVICE = 11STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3
04/24/2025	4.0.7	FFS-10-003-84	ADD	N/A		Created
08/13/2025	4.0.16	FFS-10-002-3	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "1"STEP 3: Type of service and Medicaid paid amountOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1.MEDICAID-PAID-AMT > 0 2.TYPE-OF-SERVICE = “012” or “002” or “061”STEP 4: ER place of serviceOf the claims that meet the criteria from STEP 3, select records where 1. PLACE-OF-SERVICE = "23"STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "1"STEP 3: Type of service and Medicaid paid amountOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1.MEDICAID-PAID-AMT > 0 2.TYPE-OF-SERVICE = “012” or “002” or “061”STEP 4: ER place of serviceOf the claims that meet the criteria from STEP 3, select records where 1. PLACE-OF-SERVICE = "23"STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3
04/24/2025	4.0.7	FFS-10-002-3	ADD	N/A		Created
04/24/2025	4.0.7	FFS-10-001-85	ADD	N/A		Created
04/24/2025	4.0.7	EXP-S-008-8	ADD	N/A		Created
04/24/2025	4.0.7	EXP-S-007-4	ADD	N/A		Created
04/24/2025	4.0.7	EXP-S-006-6	ADD	N/A		Created
04/24/2025	4.0.7	EXP-S-005-2	ADD	N/A		Created
04/24/2025	4.0.7	EXP-S-004-7	ADD	N/A		Created
04/24/2025	4.0.7	EXP-S-003-3	ADD	N/A		Created
04/24/2025	4.0.7	EXP-S-002-5	ADD	N/A		Created
04/24/2025	4.0.7	EXP-S-001-1	ADD	N/A		Created
11/20/2025	4.0.22	EXP-9-002-2	UPDATE	Annotation	Calculate the percentage of S-CHIP FFS: original, crossover, paid LT claims where total Medicaid paid amount is equal to $0 or missing	N/A
11/20/2025	4.0.22	EXP-9-002-2	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "1"STEP 3: Total Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 2, restrict to claims that meet the following criteria:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 4: Calculate percentageDivide the number of claims from STEP 3 by the number of claims from STEP 2	N/A
04/24/2025	4.0.7	EXP-9-002-2	ADD	N/A		Created
04/24/2025	4.0.7	EXP-9-001-1	ADD	N/A		Created
11/20/2025	4.0.22	EXP-8-004-1	UPDATE	Annotation	Calculate the percentage of S-CHIP FFS: original, non-crossover, paid LT claims where total Medicaid paid amount is equal to $0 or missing	N/A
11/20/2025	4.0.22	EXP-8-004-1	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Total Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 2, restrict to claims that meet the following criteria:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 4: Calculate percentageDivide the number of claims from STEP 3 by the number of claims from STEP 2	N/A
04/24/2025	4.0.7	EXP-8-004-1	ADD	N/A		Created
04/24/2025	4.0.7	EXP-8-003-2	ADD	N/A		Created
04/24/2025	4.0.7	EXP-8-002-3	ADD	N/A		Created
11/20/2025	4.0.22	EXP-8-001-4	UPDATE	Annotation	Calculate the sum of the total Medicaid amount paid for S-CHIP FFS: original, non-crossover, paid LT claims	N/A
11/20/2025	4.0.22	EXP-8-001-4	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Sum the total Medicaid paid amountSum the TOT-MEDICAID-PAID-AMT of the records which meet the criteria from STEP 2	N/A
04/24/2025	4.0.7	EXP-8-001-4	ADD	N/A		Created
11/20/2025	4.0.22	EXP-7-027-2	UPDATE	Annotation	The percentage of Medicaid FFS: original, crossover, paid LT claims that have total Medicaid paid amount equal to $0 or missing	N/A
11/20/2025	4.0.22	EXP-7-027-2	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "1"STEP 3: Total Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 2, select records with 1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	EXP-7-027-2	ADD	N/A		Created
04/24/2025	4.0.7	EXP-7-026-3	ADD	N/A		Created
04/24/2025	4.0.7	EXP-7-025-10	ADD	N/A		Created
04/24/2025	4.0.7	EXP-7-024-9	ADD	N/A		Created
04/24/2025	4.0.7	EXP-7-023-8	ADD	N/A		Created
04/24/2025	4.0.7	EXP-7-022-7	ADD	N/A		Created
04/24/2025	4.0.7	EXP-7-021-6	ADD	N/A		Created
04/24/2025	4.0.7	EXP-7-020-5	ADD	N/A		Created
04/24/2025	4.0.7	EXP-7-019-4	ADD	N/A		Created
04/24/2025	4.0.7	EXP-7-018-11	ADD	N/A		Created
04/24/2025	4.0.7	EXP-7-017-18	ADD	N/A		Created
04/24/2025	4.0.7	EXP-7-016-17	ADD	N/A		Created
04/24/2025	4.0.7	EXP-7-015-16	ADD	N/A		Created
04/24/2025	4.0.7	EXP-7-014-15	ADD	N/A		Created
04/24/2025	4.0.7	EXP-7-013-14	ADD	N/A		Created
04/24/2025	4.0.7	EXP-7-012-13	ADD	N/A		Created
04/24/2025	4.0.7	EXP-7-011-12	ADD	N/A		Created
04/24/2025	4.0.7	EXP-7-010-19	ADD	N/A		Created
04/24/2025	4.0.7	EXP-7-009-1	ADD	N/A		Created
04/24/2025	4.0.7	EXP-7-008-26	ADD	N/A		Created
04/24/2025	4.0.7	EXP-7-007-25	ADD	N/A		Created
04/24/2025	4.0.7	EXP-7-006-24	ADD	N/A		Created
04/24/2025	4.0.7	EXP-7-005-23	ADD	N/A		Created
04/24/2025	4.0.7	EXP-7-004-22	ADD	N/A		Created
04/24/2025	4.0.7	EXP-7-003-21	ADD	N/A		Created
04/24/2025	4.0.7	EXP-7-002-20	ADD	N/A		Created
04/24/2025	4.0.7	EXP-7-001-27	ADD	N/A		Created
11/20/2025	4.0.22	EXP-6-029-1	UPDATE	Annotation	The percentage of Medicaid FFS: original, non-crossover, paid LT claims that have total Medicaid paid amount equal to $0 or missing	N/A
11/20/2025	4.0.22	EXP-6-029-1	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Total Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 2, select records with 1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	EXP-6-029-1	ADD	N/A		Created
11/20/2025	4.0.22	EXP-6-028-2	UPDATE	Annotation	Calculate the percentage of Medicaid FFS: original, non-crossover, paid LT claims where the total amount billed is $0	N/A
11/20/2025	4.0.22	EXP-6-028-2	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Medicaid billed $0Of the claims that meet the criteria from STEP 2, count records with1. TOT-BILLED-AMT = "0"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	EXP-6-028-2	ADD	N/A		Created
04/24/2025	4.0.7	EXP-6-027-4	ADD	N/A		Created
04/24/2025	4.0.7	EXP-6-026-11	ADD	N/A		Created
04/24/2025	4.0.7	EXP-6-025-10	ADD	N/A		Created
04/24/2025	4.0.7	EXP-6-024-9	ADD	N/A		Created
04/24/2025	4.0.7	EXP-6-023-8	ADD	N/A		Created
04/24/2025	4.0.7	EXP-6-022-7	ADD	N/A		Created
04/24/2025	4.0.7	EXP-6-021-6	ADD	N/A		Created
04/24/2025	4.0.7	EXP-6-020-5	ADD	N/A		Created
04/24/2025	4.0.7	EXP-6-019-12	ADD	N/A		Created
04/24/2025	4.0.7	EXP-6-018-19	ADD	N/A		Created
04/24/2025	4.0.7	EXP-6-017-18	ADD	N/A		Created
04/24/2025	4.0.7	EXP-6-016-17	ADD	N/A		Created
04/24/2025	4.0.7	EXP-6-015-16	ADD	N/A		Created
04/24/2025	4.0.7	EXP-6-014-15	ADD	N/A		Created
04/24/2025	4.0.7	EXP-6-013-14	ADD	N/A		Created
04/24/2025	4.0.7	EXP-6-012-13	ADD	N/A		Created
04/24/2025	4.0.7	EXP-6-011-20	ADD	N/A		Created
04/24/2025	4.0.7	EXP-6-010-3	ADD	N/A		Created
04/24/2025	4.0.7	EXP-6-009-28	ADD	N/A		Created
04/24/2025	4.0.7	EXP-6-008-27	ADD	N/A		Created
04/24/2025	4.0.7	EXP-6-007-26	ADD	N/A		Created
04/24/2025	4.0.7	EXP-6-006-25	ADD	N/A		Created
04/24/2025	4.0.7	EXP-6-005-24	ADD	N/A		Created
04/24/2025	4.0.7	EXP-6-004-23	ADD	N/A		Created
04/24/2025	4.0.7	EXP-6-003-22	ADD	N/A		Created
04/24/2025	4.0.7	EXP-6-002-29	ADD	N/A		Created
11/20/2025	4.0.22	EXP-6-001-21	UPDATE	Annotation	Calculate the sum of the total Medicaid amount paid for Medicaid FFS: original, non-crossover, paid LT claims	N/A
11/20/2025	4.0.22	EXP-6-001-21	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claim lines that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Sum the total Medicaid paid amountSum the TOT-MEDICAID-PAID-AMT of the records which meet the criteria from STEP 2	N/A
04/24/2025	4.0.7	EXP-6-001-21	ADD	N/A		Created
04/24/2025	4.0.7	EXP-5-019-9	ADD	N/A		Created
04/24/2025	4.0.7	EXP-5-018-8	ADD	N/A		Created
04/24/2025	4.0.7	EXP-5-017-7	ADD	N/A		Created
04/24/2025	4.0.7	EXP-5-016-6	ADD	N/A		Created
04/24/2025	4.0.7	EXP-5-015-5	ADD	N/A		Created
04/24/2025	4.0.7	EXP-5-014-4	ADD	N/A		Created
04/24/2025	4.0.7	EXP-5-013-3	ADD	N/A		Created
04/24/2025	4.0.7	EXP-5-012-2	ADD	N/A		Created
04/24/2025	4.0.7	EXP-5-011-1	ADD	N/A		Created
04/24/2025	4.0.7	EXP-5-010-11	ADD	N/A		Created
04/24/2025	4.0.7	EXP-5-009-19	ADD	N/A		Created
04/24/2025	4.0.7	EXP-5-008-18	ADD	N/A		Created
04/24/2025	4.0.7	EXP-5-007-17	ADD	N/A		Created
04/24/2025	4.0.7	EXP-5-006-16	ADD	N/A		Created
04/24/2025	4.0.7	EXP-5-005-15	ADD	N/A		Created
04/24/2025	4.0.7	EXP-5-004-14	ADD	N/A		Created
04/24/2025	4.0.7	EXP-5-003-13	ADD	N/A		Created
04/24/2025	4.0.7	EXP-5-002-12	ADD	N/A		Created
04/24/2025	4.0.7	EXP-5-001-10	ADD	N/A		Created
11/20/2025	4.0.22	EXP-4-002-2	UPDATE	Annotation	Calculate the percentage of S-CHIP FFS: original, crossover, paid IP claims where total Medicaid paid amount is equal to $0 or missing	N/A
11/20/2025	4.0.22	EXP-4-002-2	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "1"STEP 3: Total Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 2, restrict to claims that meet the following criteria:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 4: Calculate percentageDivide the number of claims from STEP 3 by the number of claims from STEP 2	N/A
04/24/2025	4.0.7	EXP-4-002-2	ADD	N/A		Created
04/24/2025	4.0.7	EXP-4-001-1	ADD	N/A		Created
11/20/2025	4.0.22	EXP-3-005-2	UPDATE	Annotation	Calculate the percentage of S-CHIP FFS: original, non-crossover, paid IP claims where total Medicaid paid amount is equal to $0 or missing	N/A
11/20/2025	4.0.22	EXP-3-005-2	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Total Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 2, restrict to claims that meet the following criteria:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 4: Calculate percentageDivide the number of claims from STEP 3 by the number of claims from STEP 2.	N/A
04/24/2025	4.0.7	EXP-3-005-2	ADD	N/A		Created
04/24/2025	4.0.7	EXP-3-004-1	ADD	N/A		Created
04/24/2025	4.0.7	EXP-3-003-4	ADD	N/A		Created
04/24/2025	4.0.7	EXP-3-002-3	ADD	N/A		Created
11/20/2025	4.0.22	EXP-3-001-5	UPDATE	Annotation	Calculate the sum of the total Medicaid amount paid for S-CHIP FFS: original, non-crossover, paid IP claims	N/A
11/20/2025	4.0.22	EXP-3-001-5	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Sum the total Medicaid paid amountSum the TOT-MEDICAID-PAID-AMT of the records which meet the criteria from STEP 2	N/A
04/24/2025	4.0.7	EXP-3-001-5	ADD	N/A		Created
04/24/2025	4.0.7	EXP-26-003-3	ADD	N/A		Created
04/24/2025	4.0.7	EXP-26-002-2	ADD	N/A		Created
04/24/2025	4.0.7	EXP-26-001-1	ADD	N/A		Created
04/24/2025	4.0.7	EXP-25-002-1	ADD	N/A		Created
04/24/2025	4.0.7	EXP-25-001-2	ADD	N/A		Created
04/24/2025	4.0.7	EXP-24-008-7	ADD	N/A		Created
04/24/2025	4.0.7	EXP-24-007-5	ADD	N/A		Created
04/24/2025	4.0.7	EXP-24-006-3	ADD	N/A		Created
04/24/2025	4.0.7	EXP-24-005-1	ADD	N/A		Created
04/24/2025	4.0.7	EXP-24-004-6	ADD	N/A		Created
04/24/2025	4.0.7	EXP-24-003-4	ADD	N/A		Created
04/24/2025	4.0.7	EXP-24-002-2	ADD	N/A		Created
04/24/2025	4.0.7	EXP-24-001-8	ADD	N/A		Created
04/24/2025	4.0.7	EXP-23-002-1	ADD	N/A		Created
04/24/2025	4.0.7	EXP-23-001-2	ADD	N/A		Created
04/24/2025	4.0.7	EXP-22-008-7	ADD	N/A		Created
04/24/2025	4.0.7	EXP-22-007-5	ADD	N/A		Created
04/24/2025	4.0.7	EXP-22-006-3	ADD	N/A		Created
04/24/2025	4.0.7	EXP-22-005-1	ADD	N/A		Created
04/24/2025	4.0.7	EXP-22-004-6	ADD	N/A		Created
04/24/2025	4.0.7	EXP-22-003-4	ADD	N/A		Created
04/24/2025	4.0.7	EXP-22-001-8	ADD	N/A		Created
04/24/2025	4.0.7	EXP-22-001-2	ADD	N/A		Created
04/24/2025	4.0.7	EXP-21-002-2	ADD	N/A		Created
04/24/2025	4.0.7	EXP-21-001-1	ADD	N/A		Created
11/20/2025	4.0.22	EXP-2-020-2	UPDATE	Annotation	The percentage of Medicaid FFS: original, crossover, paid IP claims that have total Medicaid paid amount equal to $0 or missing	N/A
11/20/2025	4.0.22	EXP-2-020-2	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND. STEP 2: Medicaid FFS: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "1"STEP 3: Total Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 2, count records with1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	EXP-2-020-2	ADD	N/A		Created
04/24/2025	4.0.7	EXP-2-019-11	ADD	N/A		Created
04/24/2025	4.0.7	EXP-2-018-10	ADD	N/A		Created
04/24/2025	4.0.7	EXP-2-017-9	ADD	N/A		Created
04/24/2025	4.0.7	EXP-2-016-8	ADD	N/A		Created
04/24/2025	4.0.7	EXP-2-015-7	ADD	N/A		Created
04/24/2025	4.0.7	EXP-2-014-6	ADD	N/A		Created
04/24/2025	4.0.7	EXP-2-013-5	ADD	N/A		Created
04/24/2025	4.0.7	EXP-2-012-4	ADD	N/A		Created
04/24/2025	4.0.7	EXP-2-011-3	ADD	N/A		Created
04/24/2025	4.0.7	EXP-2-010-13	ADD	N/A		Created
04/24/2025	4.0.7	EXP-2-009-21	ADD	N/A		Created
04/24/2025	4.0.7	EXP-2-008-20	ADD	N/A		Created
04/24/2025	4.0.7	EXP-2-007-19	ADD	N/A		Created
04/24/2025	4.0.7	EXP-2-006-18	ADD	N/A		Created
04/24/2025	4.0.7	EXP-2-005-17	ADD	N/A		Created
04/24/2025	4.0.7	EXP-2-004-16	ADD	N/A		Created
04/24/2025	4.0.7	EXP-2-003-15	ADD	N/A		Created
04/24/2025	4.0.7	EXP-2-002-14	ADD	N/A		Created
04/24/2025	4.0.7	EXP-2-001-12	ADD	N/A		Created
11/20/2025	4.0.22	EXP-2-001-1	UPDATE	Annotation	Calculate the percentage of Medicaid FFS: original, crossover, paid IP claims that have Total Medicaid Paid Amount greater than $2,000,000	N/A
11/20/2025	4.0.22	EXP-2-001-1	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "1"STEP 3: Medicaid % Paid > $2,000,000Of the claims that meet the criteria from STEP 2, count records with1. TOT-MEDICAID-PAID-AMT > 2,000,000STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	EXP-2-001-1	ADD	N/A		Created
04/24/2025	4.0.7	EXP-20-002-2	ADD	N/A		Created
04/24/2025	4.0.7	EXP-20-001-1	ADD	N/A		Created
04/24/2025	4.0.7	EXP-19-016-2	ADD	N/A		Created
04/24/2025	4.0.7	EXP-19-015-8	ADD	N/A		Created
04/24/2025	4.0.7	EXP-19-014-7	ADD	N/A		Created
04/24/2025	4.0.7	EXP-19-013-6	ADD	N/A		Created
04/24/2025	4.0.7	EXP-19-012-5	ADD	N/A		Created
04/24/2025	4.0.7	EXP-19-011-4	ADD	N/A		Created
04/24/2025	4.0.7	EXP-19-010-3	ADD	N/A		Created
04/24/2025	4.0.7	EXP-19-009-1	ADD	N/A		Created
04/24/2025	4.0.7	EXP-19-008-10	ADD	N/A		Created
04/24/2025	4.0.7	EXP-19-007-16	ADD	N/A		Created
04/24/2025	4.0.7	EXP-19-006-15	ADD	N/A		Created
04/24/2025	4.0.7	EXP-19-005-14	ADD	N/A		Created
04/24/2025	4.0.7	EXP-19-004-13	ADD	N/A		Created
04/24/2025	4.0.7	EXP-19-003-12	ADD	N/A		Created
04/24/2025	4.0.7	EXP-19-002-11	ADD	N/A		Created
04/24/2025	4.0.7	EXP-19-001-9	ADD	N/A		Created
11/20/2025	4.0.22	EXP-18-005-3	UPDATE	Annotation	Calculate the percentage of S-CHIP FFS: original, non-crossover, paid RX claims where total Medicaid paid amount is equal to $0 or missing	N/A
11/20/2025	4.0.22	EXP-18-005-3	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Total Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 2, restrict to claims that meet the following criteria:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 4: Calculate percentageDivide the number of claims from STEP 3 by the number of claims from STEP 2.	N/A
04/24/2025	4.0.7	EXP-18-005-3	ADD	N/A		Created
04/24/2025	4.0.7	EXP-18-004-2	ADD	N/A		Created
04/24/2025	4.0.7	EXP-18-003-4	ADD	N/A		Created
04/24/2025	4.0.7	EXP-18-002-1	ADD	N/A		Created
11/20/2025	4.0.22	EXP-18-001-5	UPDATE	Annotation	Calculate the sum of the total Medicaid paid amount for S-CHIP FFS: original, non-crossover, paid RX claims	N/A
11/20/2025	4.0.22	EXP-18-001-5	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Sum the total Medicaid paid amountSum the TOT-MEDICAID-PAID-AMT of the records which meet the criteria from STEP 2	N/A
04/24/2025	4.0.7	EXP-18-001-5	ADD	N/A		Created
04/24/2025	4.0.7	EXP-17-016-2	ADD	N/A		Created
04/24/2025	4.0.7	EXP-17-015-8	ADD	N/A		Created
04/24/2025	4.0.7	EXP-17-014-7	ADD	N/A		Created
04/24/2025	4.0.7	EXP-17-013-6	ADD	N/A		Created
04/24/2025	4.0.7	EXP-17-012-5	ADD	N/A		Created
04/24/2025	4.0.7	EXP-17-011-4	ADD	N/A		Created
04/24/2025	4.0.7	EXP-17-010-3	ADD	N/A		Created
04/24/2025	4.0.7	EXP-17-009-1	ADD	N/A		Created
04/24/2025	4.0.7	EXP-17-008-10	ADD	N/A		Created
04/24/2025	4.0.7	EXP-17-007-16	ADD	N/A		Created
04/24/2025	4.0.7	EXP-17-006-15	ADD	N/A		Created
04/24/2025	4.0.7	EXP-17-005-14	ADD	N/A		Created
04/24/2025	4.0.7	EXP-17-004-13	ADD	N/A		Created
04/24/2025	4.0.7	EXP-17-003-12	ADD	N/A		Created
04/24/2025	4.0.7	EXP-17-002-11	ADD	N/A		Created
04/24/2025	4.0.7	EXP-17-001-9	ADD	N/A		Created
11/20/2025	4.0.22	EXP-16-021-3	UPDATE	Annotation	The percentage of Medicaid FFS: original, non-crossover, paid RX claims that have total Medicaid paid amount equal to $0 or missing	N/A
11/20/2025	4.0.22	EXP-16-021-3	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Total Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 2, select records with 1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	EXP-16-021-3	ADD	N/A		Created
11/20/2025	4.0.22	EXP-16-020-2	UPDATE	Annotation	Calculate the percentage of Medicaid FFS: original, non-crossover, paid RX claims where the total amount billed is $0	N/A
11/20/2025	4.0.22	EXP-16-020-2	UPDATE	Specification	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Medicaid billed $0Of the claims that meet the criteria from STEP 2, count records with1. TOT-BILLED-AMT = "0"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	EXP-16-020-2	ADD	N/A		Created
04/24/2025	4.0.7	EXP-16-019-6	ADD	N/A		Created
04/24/2025	4.0.7	EXP-16-018-12	ADD	N/A		Created
04/24/2025	4.0.7	EXP-16-017-11	ADD	N/A		Created
04/24/2025	4.0.7	EXP-16-016-10	ADD	N/A		Created
04/24/2025	4.0.7	EXP-16-015-9	ADD	N/A		Created
04/24/2025	4.0.7	EXP-16-014-8	ADD	N/A		Created
04/24/2025	4.0.7	EXP-16-013-7	ADD	N/A		Created
04/24/2025	4.0.7	EXP-16-012-5	ADD	N/A		Created
11/20/2025	4.0.22	EXP-16-011-4	UPDATE	Annotation	Calculate the average amount paid (excluding outliers with Medicaid Amount Paid > $2 million) for Medicaid FFS: original, non-crossover, paid RX claims	N/A
11/20/2025	4.0.22	EXP-16-011-4	UPDATE	Specification	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS Payment: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Paid amounts less than $300,000Of the records that meet the criteria from STEP 2, further restrict them to those with:1. TOT-MEDICAID-PAID-AMT< 300,000STEP 4: Average1. Of the records that meet the criteria in STEP 3, take the average of TOT-MEDICAID-PAID-AMT	N/A
04/24/2025	4.0.7	EXP-16-011-4	ADD	N/A		Created
11/20/2025	4.0.22	EXP-16-010-1	UPDATE	Annotation	Calculate the percentage of Medicaid FFS: original, non-crossover, paid RX claims where the total amount billed is greater than $300,000	N/A
11/20/2025	4.0.22	EXP-16-010-1	UPDATE	Specification	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Medicaid % Paid > $300,000Of the claims that meet the criteria from STEP 2, count records with1. TOT-MEDICAID-PAID-AMT > 300,000STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	EXP-16-010-1	ADD	N/A		Created
04/24/2025	4.0.7	EXP-16-009-15	ADD	N/A		Created
04/24/2025	4.0.7	EXP-16-008-21	ADD	N/A		Created
04/24/2025	4.0.7	EXP-16-007-20	ADD	N/A		Created
04/24/2025	4.0.7	EXP-16-006-19	ADD	N/A		Created
04/24/2025	4.0.7	EXP-16-005-18	ADD	N/A		Created
04/24/2025	4.0.7	EXP-16-004-17	ADD	N/A		Created
04/24/2025	4.0.7	EXP-16-003-16	ADD	N/A		Created
04/24/2025	4.0.7	EXP-16-002-14	ADD	N/A		Created
11/20/2025	4.0.22	EXP-16-001-13	UPDATE	Annotation	Calculate the sum of the total Medicaid amount paid for Medicaid FFS: original, non-crossover, paid RX claims	N/A
11/20/2025	4.0.22	EXP-16-001-13	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Sum the total Medicaid paid amountSum the TOT-MEDICAID-PAID-AMT of the records which meet the criteria from STEP 2	N/A
04/24/2025	4.0.7	EXP-16-001-13	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-154-5	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-153-3	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-151-77	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-151-76	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-150-75	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-149-74	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-148-73	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-147-72	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-146-71	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-145-70	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-144-68	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-143-67	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-142-66	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-141-65	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-140-64	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-139-63	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-138-62	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-137-61	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-136-60	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-135-59	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-134-57	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-133-56	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-132-55	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-131-54	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-130-53	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-129-52	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-128-51	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-127-50	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-126-49	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-125-47	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-124-46	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-123-45	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-122-44	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-121-43	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-120-42	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-119-41	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-118-40	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-117-38	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-116-37	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-115-36	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-114-35	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-113-34	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-112-32	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-111-31	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-110-30	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-109-29	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-108-28	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-107-27	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-106-26	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-105-25	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-104-23	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-103-22	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-102-21	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-101-20	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-100-19	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-099-18	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-098-17	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-097-16	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-096-15	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-095-14	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-094-12	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-093-11	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-092-10	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-091-9	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-090-8	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-089-7	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-088-6	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-087-4	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-086-2	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-085-1	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-084-69	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-083-58	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-082-48	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-081-39	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-080-33	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-079-24	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-078-13	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-077-82	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-076-80	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-075-154	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-074-153	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-073-152	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-072-151	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-071-150	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-070-149	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-069-148	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-068-147	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-067-145	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-066-144	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-065-143	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-064-142	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-063-141	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-062-140	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-061-139	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-060-138	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-059-137	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-058-136	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-057-134	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-056-133	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-055-132	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-054-131	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-053-130	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-052-129	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-051-128	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-050-127	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-049-126	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-048-124	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-047-123	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-046-122	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-045-121	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-044-120	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-043-119	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-042-118	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-041-117	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-040-115	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-039-114	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-038-113	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-037-112	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-036-111	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-035-109	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-034-108	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-033-107	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-032-106	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-031-105	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-030-104	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-029-103	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-028-102	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-027-100	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-026-99	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-025-98	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-024-97	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-023-96	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-022-95	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-021-94	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-020-93	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-019-92	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-018-91	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-017-89	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-016-88	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-015-87	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-014-86	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-013-85	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-012-84	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-011-83	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-010-81	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-009-79	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-008-78	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-007-146	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-006-135	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-005-125	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-004-116	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-003-110	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-002-101	ADD	N/A		Created
04/24/2025	4.0.7	EXP-15-001-90	ADD	N/A		Created
04/24/2025	4.0.7	EXP-14-004-2	ADD	N/A		Created
04/24/2025	4.0.7	EXP-14-003-3	ADD	N/A		Created
04/24/2025	4.0.7	EXP-14-002-1	ADD	N/A		Created
04/24/2025	4.0.7	EXP-14-001-4	ADD	N/A		Created
04/24/2025	4.0.7	EXP-13-005-4	ADD	N/A		Created
04/24/2025	4.0.7	EXP-13-004-2	ADD	N/A		Created
04/24/2025	4.0.7	EXP-13-003-1	ADD	N/A		Created
04/24/2025	4.0.7	EXP-13-002-3	ADD	N/A		Created
08/13/2025	4.0.16	EXP-13-001-5	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Sum the Medicaid paid amountSum the MEDICAID-PAID-AMT of the records which meet the criteria from STEP 2	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Sum the Medicaid paid amountSum the MEDICAID-PAID-AMT of the records which meet the criteria from STEP 2
04/24/2025	4.0.7	EXP-13-001-5	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-158-2	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-157-8	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-156-6	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-155-80	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-154-79	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-153-78	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-152-77	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-151-76	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-150-75	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-149-74	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-148-73	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-147-71	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-146-70	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-145-69	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-144-68	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-143-67	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-142-66	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-141-65	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-140-64	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-139-63	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-138-62	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-137-60	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-136-59	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-135-58	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-134-57	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-133-56	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-132-55	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-131-54	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-130-53	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-129-52	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-128-50	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-127-49	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-126-48	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-125-47	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-124-46	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-123-45	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-122-44	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-121-43	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-120-41	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-119-40	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-118-39	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-117-38	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-116-37	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-115-35	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-114-34	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-113-33	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-112-32	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-111-31	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-110-30	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-109-29	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-108-28	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-107-26	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-106-25	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-105-24	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-104-23	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-103-22	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-102-21	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-101-20	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-100-19	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-099-18	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-098-17	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-097-15	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-096-14	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-095-13	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-094-12	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-093-11	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-092-10	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-091-9	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-090-7	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-089-5	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-088-4	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-087-72	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-086-61	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-085-51	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-084-42	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-083-36	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-082-27	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-081-16	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-080-3	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-079-1	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-078-86	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-077-84	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-076-158	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-075-157	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-074-156	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-073-155	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-072-154	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-071-153	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-070-152	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-069-151	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-068-149	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-067-148	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-066-147	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-065-146	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-064-145	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-063-144	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-062-143	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-061-142	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-060-141	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-059-140	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-058-138	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-057-137	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-056-136	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-055-135	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-054-134	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-053-133	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-052-132	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-051-131	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-050-130	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-049-128	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-048-127	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-047-126	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-046-125	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-045-124	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-044-123	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-043-122	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-042-121	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-041-119	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-040-118	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-039-117	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-038-116	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-037-115	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-036-113	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-035-112	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-034-111	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-033-110	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-032-109	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-031-108	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-030-107	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-029-106	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-028-104	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-027-103	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-026-102	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-025-101	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-024-100	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-023-99	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-022-98	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-021-97	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-020-96	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-019-95	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-018-93	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-017-92	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-016-91	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-015-90	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-014-89	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-013-88	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-012-87	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-011-85	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-010-83	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-009-82	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-008-150	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-007-139	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-006-129	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-005-120	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-004-114	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-003-105	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-002-94	ADD	N/A		Created
04/24/2025	4.0.7	EXP-12-001-81	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-162-4	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-161-2	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-160-1	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-159-10	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-158-8	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-157-82	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-156-81	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-155-80	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-154-79	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-153-78	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-152-77	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-151-76	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-150-75	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-149-73	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-148-72	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-147-71	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-146-70	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-145-69	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-144-68	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-143-67	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-142-66	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-141-65	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-140-64	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-139-62	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-138-61	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-137-60	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-136-59	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-135-58	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-134-57	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-133-56	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-132-55	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-131-54	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-130-52	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-129-51	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-128-50	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-127-49	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-126-48	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-125-47	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-124-46	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-123-45	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-122-43	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-121-42	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-120-41	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-119-40	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-118-39	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-117-37	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-116-36	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-115-35	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-114-34	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-113-33	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-112-32	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-111-31	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-110-30	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-109-28	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-108-27	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-107-26	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-106-25	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-105-24	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-104-23	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-103-22	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-102-21	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-101-20	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-100-19	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-099-17	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-098-16	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-097-15	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-096-14	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-095-13	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-094-12	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-093-11	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-092-9	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-091-7	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-090-6	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-089-74	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-088-63	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-087-53	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-086-44	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-085-38	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-084-29	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-083-18	ADD	N/A		Created
08/13/2025	4.0.16	EXP-11-082-5	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS Payment: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: HCBS service codeOf the records that meet the criteria from STEP 2, select records with HCBS-SERVICE-CODE is not missingSTEP 4: Restrict claims with paid amounts less than $200,000Of the records that meet the criteria from STEP 3, further restrict them to those with MEDICAID-PAID-AMT > 0 and MEDICAID-PAID-AMT < $200,000STEP 5: Average1. Of the line records that meet the criteria in STEP 4, take the average of MEDICAID-PAID-AMT	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS Payment: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: HCBS service codeOf the records that meet the criteria from STEP 2, select records with HCBS-SERVICE-CODE is not missingSTEP 4: Restrict claims with paid amounts less than $200,000Of the records that meet the criteria from STEP 3, further restrict them to those with MEDICAID-PAID-AMT > 0 and MEDICAID-PAID-AMT < $200,000STEP 5: Average1. Of the line records that meet the criteria in STEP 4, take the average of MEDICAID-PAID-AMT
04/24/2025	4.0.7	EXP-11-082-5	ADD	N/A		Created
08/13/2025	4.0.16	EXP-11-081-3	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS Payment: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Medicaid amount paid > $100,000Of the claims that meet the criteria from STEP 2, count records with MEDICAID-PAID-AMT > 100,000STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS Payment: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Medicaid amount paid > $100,000Of the claims that meet the criteria from STEP 2, count records with MEDICAID-PAID-AMT > 100,000STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2
04/24/2025	4.0.7	EXP-11-081-3	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-080-90	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-079-88	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-078-162	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-077-161	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-076-160	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-075-159	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-074-158	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-073-157	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-072-156	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-071-155	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-070-153	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-069-152	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-068-151	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-067-150	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-066-149	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-065-148	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-064-147	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-063-146	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-062-145	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-061-144	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-060-142	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-059-141	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-058-140	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-057-139	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-056-138	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-055-137	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-054-136	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-053-135	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-052-134	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-051-132	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-050-131	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-049-130	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-048-129	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-047-128	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-046-127	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-045-126	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-044-125	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-043-123	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-042-122	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-041-121	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-040-120	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-039-119	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-038-117	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-037-116	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-036-115	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-035-114	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-034-113	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-033-112	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-032-111	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-031-110	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-030-108	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-029-107	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-028-106	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-027-105	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-026-104	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-025-103	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-024-102	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-023-101	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-022-100	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-021-99	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-020-97	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-019-96	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-018-95	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-017-94	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-016-93	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-015-92	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-014-91	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-013-89	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-012-87	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-011-86	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-010-154	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-009-143	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-008-133	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-007-124	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-006-118	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-005-109	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-004-98	ADD	N/A		Created
08/13/2025	4.0.16	EXP-11-003-83	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the line records that meet the criteria from STEP 2, further restrict them by the following criteria:1. HCBS-TAXONOMY starts with "02", "04", or "08"2. MEDICAID-PAID-AMT is not missingSTEP 4: Amount paid1. Of the line records that meet the criteria from STEP 3, sum MEDICAID-PAID-AMT(this will be the numerator)STEP 5: All servicesOf the line records that meet the criteria from STEP 2, further restrict them by the following criteria:1. HCBS-TAXONOMY is not missing2. MEDICAID-PAID-AMT is not missingSTEP 6: Amount paidOf the line records that meet the criteria from STEP 5, sum MEDICAID-PAID-AMT(this will be the denominator)STEP 7: Calculate percentageDivide the numerator by the denominator	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Type of serviceOf the line records that meet the criteria from STEP 2, further restrict them by the following criteria:1. HCBS-TAXONOMY starts with "02", "04", or "08"2. MEDICAID-PAID-AMT is not missingSTEP 4: Amount paid1. Of the line records that meet the criteria from STEP 3, sum MEDICAID-PAID-AMT(this will be the numerator)STEP 5: All servicesOf the line records that meet the criteria from STEP 2, further restrict them by the following criteria:1. HCBS-TAXONOMY is not missing2. MEDICAID-PAID-AMT is not missingSTEP 6: Amount paidOf the line records that meet the criteria from STEP 5, sum MEDICAID-PAID-AMT(this will be the denominator)STEP 7: Calculate percentageDivide the numerator by the denominator
04/24/2025	4.0.7	EXP-11-003-83	ADD	N/A		Created
04/24/2025	4.0.7	EXP-11-002-84	ADD	N/A		Created
08/13/2025	4.0.16	EXP-11-001-85	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claim lines that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Sum the Medicaid paid amountSum the MEDICAID-PAID-AMT of the records which meet the criteria from STEP 2	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claim lines that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Sum the Medicaid paid amountSum the MEDICAID-PAID-AMT of the records which meet the criteria from STEP 2
04/24/2025	4.0.7	EXP-11-001-85	ADD	N/A		Created
11/20/2025	4.0.22	EXP-1-024-2	UPDATE	Annotation	The percentage of Medicaid FFS: original, non-crossover, paid IP claims that have total Medicaid paid amount equal to $0 or missing	N/A
11/20/2025	4.0.22	EXP-1-024-2	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND. STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Total Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 2, count records with1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	EXP-1-024-2	ADD	N/A		Created
11/20/2025	4.0.22	EXP-1-023-1	UPDATE	Annotation	Calculate the percentage of Medicaid FFS: original, non-crossover, paid IP claims where the total amount billed is $0	N/A
11/20/2025	4.0.22	EXP-1-023-1	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Medicaid billed $0Of the claims that meet the criteria from STEP 2, count records with1. TOT-BILLED-AMT = "0"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	EXP-1-023-1	ADD	N/A		Created
04/24/2025	4.0.7	EXP-1-022-13	ADD	N/A		Created
04/24/2025	4.0.7	EXP-1-021-12	ADD	N/A		Created
04/24/2025	4.0.7	EXP-1-020-11	ADD	N/A		Created
04/24/2025	4.0.7	EXP-1-019-10	ADD	N/A		Created
04/24/2025	4.0.7	EXP-1-018-9	ADD	N/A		Created
04/24/2025	4.0.7	EXP-1-017-8	ADD	N/A		Created
04/24/2025	4.0.7	EXP-1-016-7	ADD	N/A		Created
04/24/2025	4.0.7	EXP-1-015-6	ADD	N/A		Created
04/24/2025	4.0.7	EXP-1-014-5	ADD	N/A		Created
11/20/2025	4.0.22	EXP-1-013-4	UPDATE	Annotation	Calculate the average amount paid (excluding outliers with Medicaid Amount Paid > $2 million) for Medicaid FFS: original, non-crossover, paid IP claims	N/A
11/20/2025	4.0.22	EXP-1-013-4	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS Payment: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Restrict claims with paid amounts less than $2,000,000Of the records that meet the criteria from STEP 2, further restrict them to those with:1. TOT-MEDICAID-PAID-AMT< 2,000,000STEP 4: AverageOf the records that meet the criteria in STEP 3, take the average of TOT-MEDICAID-PAID-AMT	N/A
04/24/2025	4.0.7	EXP-1-013-4	ADD	N/A		Created
11/20/2025	4.0.22	EXP-1-012-3	UPDATE	Annotation	Calculate the percentage of Medicaid FFS: original, non-crossover, paid IP claims where the total amount paid to Medicaid is > $2,000,000.00	N/A
11/20/2025	4.0.22	EXP-1-012-3	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Medicaid Paid Amount > $2,000,000Of the claims that meet the criteria from STEP 2, select records with 1. TOT-MEDICAID-PAID-AMT > $2,000,000STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	EXP-1-012-3	ADD	N/A		Created
04/24/2025	4.0.7	EXP-1-011-16	ADD	N/A		Created
04/24/2025	4.0.7	EXP-1-010-24	ADD	N/A		Created
04/24/2025	4.0.7	EXP-1-009-23	ADD	N/A		Created
04/24/2025	4.0.7	EXP-1-008-22	ADD	N/A		Created
04/24/2025	4.0.7	EXP-1-007-21	ADD	N/A		Created
04/24/2025	4.0.7	EXP-1-006-20	ADD	N/A		Created
04/24/2025	4.0.7	EXP-1-005-19	ADD	N/A		Created
04/24/2025	4.0.7	EXP-1-004-18	ADD	N/A		Created
04/24/2025	4.0.7	EXP-1-003-17	ADD	N/A		Created
04/24/2025	4.0.7	EXP-10-025-1	ADD	N/A		Created
04/24/2025	4.0.7	EXP-10-024-8	ADD	N/A		Created
04/24/2025	4.0.7	EXP-10-023-7	ADD	N/A		Created
04/24/2025	4.0.7	EXP-10-022-6	ADD	N/A		Created
04/24/2025	4.0.7	EXP-1-002-15	ADD	N/A		Created
04/24/2025	4.0.7	EXP-10-021-5	ADD	N/A		Created
04/24/2025	4.0.7	EXP-10-020-4	ADD	N/A		Created
04/24/2025	4.0.7	EXP-10-019-3	ADD	N/A		Created
04/24/2025	4.0.7	EXP-10-018-2	ADD	N/A		Created
04/24/2025	4.0.7	EXP-10-017-9	ADD	N/A		Created
04/24/2025	4.0.7	EXP-10-016-16	ADD	N/A		Created
04/24/2025	4.0.7	EXP-10-015-15	ADD	N/A		Created
04/24/2025	4.0.7	EXP-10-014-14	ADD	N/A		Created
04/24/2025	4.0.7	EXP-10-013-13	ADD	N/A		Created
04/24/2025	4.0.7	EXP-10-012-12	ADD	N/A		Created
11/20/2025	4.0.22	EXP-1-001-14	UPDATE	Annotation	Calculate the sum of the total Medicaid amount paid for Medicaid FFS: original, non-crossover, paid IP claims	N/A
11/20/2025	4.0.22	EXP-1-001-14	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claim lines that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Sum the total Medicaid paid amountSum the TOT-MEDICAID-PAID-AMT of the records which meet the criteria from STEP 2	N/A
04/24/2025	4.0.7	EXP-1-001-14	ADD	N/A		Created
04/24/2025	4.0.7	EXP-10-011-11	ADD	N/A		Created
04/24/2025	4.0.7	EXP-10-010-10	ADD	N/A		Created
04/24/2025	4.0.7	EXP-10-009-17	ADD	N/A		Created
04/24/2025	4.0.7	EXP-10-008-24	ADD	N/A		Created
04/24/2025	4.0.7	EXP-10-007-23	ADD	N/A		Created
04/24/2025	4.0.7	EXP-10-006-22	ADD	N/A		Created
04/24/2025	4.0.7	EXP-10-005-21	ADD	N/A		Created
04/24/2025	4.0.7	EXP-10-004-20	ADD	N/A		Created
04/24/2025	4.0.7	EXP-10-003-19	ADD	N/A		Created
04/24/2025	4.0.7	EXP-10-002-18	ADD	N/A		Created
04/24/2025	4.0.7	EXP-10-001-25	ADD	N/A		Created
11/20/2025	4.0.22	EL-S-002-2	UPDATE	Annotation	Count the number of unique MSIS ID's that have a valid dual code	N/A
11/20/2025	4.0.22	EL-S-002-2	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Count dualsOf the MSIS IDs that meet the criteria from STEP 2, count the number of unique MSIS IDs that satisfy the following criterion: 1. DUAL-ELIGIBLE-CODE = "01" or “02” or "03" or “04” or "05" or “06” or “08” or “09” or “10”	N/A
04/24/2025	4.0.7	EL-S-002-2	ADD	N/A		Created
11/20/2025	4.0.22	EL-S-001-1	UPDATE	Annotation	Count the total number of eligible MSIS IDs	N/A
11/20/2025	4.0.22	EL-S-001-1	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Count MSIS IDsCount the number of unique MSIS IDs that satisfy the criteria from STEP 1	N/A
04/24/2025	4.0.7	EL-S-001-1	ADD	N/A		Created
04/24/2025	4.0.7	EL-9-001-1	ADD	N/A		Created
08/13/2025	4.0.16	EL-8-002-2	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Managed care plans on the last day of DQ report monthDefine the managed care plan population from segment MANAGED-CARE-MAIN-MCR00002 by keeping active records that satisfy the following criteria:1. MANAGED-CARE-MAIN-REC-EFF-DATE <= last day of the reporting month2. MANAGED-CARE-MAIN-REC-END-DATE >= last day of the reporting month OR missingSTEP 4: Active non-duplicate claims records during DQ report monthDefine the claims universe for IP, LT, and RX at the header level and for OT at the line level by importing headers (and lines for OT) that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, and ADJUDICATION-DATE and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 5: Medicaid and S-CHIP Capitation Payment and Encounter: Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = (“2” or "3" or “B” or "C")STEP 6: Capitation payment financial transactions:Define the FTX universe for the FTX0002, FTX0003, and FTX0005 tables respectively by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-DATE or PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 7: Medicaid & S-CHIP Capitation PaymentOf the financial transactions that meet the criteria from STEP 6, further restrict them by the following criteria:1. PAYEE-ID-TYPE = "02"For those in FTX0005 only:1. OFFSET-TRANS-TYPE = "1" or "2"STEP 8: Define Plan_IdDefine Plan_Id as a unique list of: MANAGED-CARE-PLAN-ID from the EL file that meet the constraints in STEP 2, STATE-PLAN-ID-NUM from the MCR file that meet the constraints in STEP 3, PLAN-ID-NUMBER from the claims files that meet the constraints in STEP 5, and PAYEE-ID from records that meet constraints in STEP 7. Also, define a blank Plan_Id for missing.STEP 9: Define Plan_Type_ElIn cases where Plan_Id can be linked to a MANAGED-CARE-PLAN-ID in MANAGED-CARE-PARTICIPATION-ELG00014, and there is only one plan type for that plan, define Plan_Type_El as MANAGED-CARE-PLAN-TYPE. If there are multiple plan types for the Plan_Id, then set Plan_Type_El to the most frequently used plan type, or the lowest plan type if there is a tie. (If there are multiple plan types, also set MultiplePlanTypes_EL = 1.) In all other cases, Plan_Type_El = missing.STEP 10: Define Plan_Type_Mc and LinkedIn cases where Plan_Id can be linked to a STATE-PLAN-ID-NUM in MANAGED-CARE-MAIN-MCR00002, set In_MCR_File = "Yes". If there is only one plan type for that plan, define Plan_Type_Mc as MANAGED-CARE-PLAN-TYPE . If there are multiple plan types for the Plan_Id, then set Plan_Type_Mc to the most frequently used plan type, or the lowest plan type if there is a tie. (If there are multiple plan types, also set MultiplePlanTypes_Mc = 1.) In all other cases, Plan_Type_Mc = missing and In_MCR_File = "No". STEP 11: Count EnrollmentFor each Plan_Id, define Enrollment as the count of unique MSIS-IDENTIFICATION-NUM that satisfy the constraints in STEP 2aSTEP 12: Capitation RecordsFor each record that meets the criteria from STEP 7, further restrict them by the following criteria:1. ADJUSTMENT_IND = 02a. PAYMENT_OR_RECOUPMENT_AMOUNT (FTX00002 and FTX00005) > 0OR2b. PAYMENT_AMOUNT (FTX00003) > 0STEP 13: Set Capitation TypeUsing the records in STEP 12:1a. Set Capitation_Type = “Medicaid and S-CHIP” if at least one record with MBESCBES_FORM_GROUP = "1" OR "2" AND at least one record with MBESCBES_FORM_GROUP = "3" 1b. Set Capitation_Type = “Medicaid” if at least one record with MBESCBES_FORM_GROUP = "1" OR "2" AND no records with MBESCBES_FORM_GROUP = "3"1c. Set Capitation_Type = "S-CHIP" if no records with MBESCBES_FORM_GROUP = "1" OR "2" AND at least one record with MBESCBES_FORM_GROUP = "3" STEP 14: Count Capitation_Hmo_Hio_PaceDefine Capitation_Hmo_Hio_Pace as the count of unique FTX00002 records from STEP 12 that also satisfy the following criteria:1. PAYEE_MCR_PLAN_TYPE = (“01” or “04” or “17”)STEP 15: Count Capitation_PhpDefine Capitation_Php as the count of unique FTX00002 records from STEP 12 that also satisfy the following criteria:1. PAYEE_MCR_PLAN_TYPE = (“05” or “06”or “07”or “08”or “09” or “10” or “11”or “12” or “13”or “14” or “15”or “16” or “18”or “19”)STEP 16: Count Capitation_PccmDefine Capitation_Pccm as the count of unique FTX00002 records from STEP 12 that also satisfy the following criteria:1. PAYEE_MCR_PLAN_TYPE = (“02" or "03")STEP 17: Count Capitation_PhiDefine Capitation_Phi as the count of unique FTX00003 and FTX00005 records from STEP 12 that also satisfy the following criteria:1. For FTX00005 records only, OFFSET_TRANS_TYPE = "2"STEP 18: Count Capitation_OtherDefine Capitation_Other as the count of unique FTX00002 and FTX00005 records from STEP 12 that also satisfy the following criteria:1. PAYEE_MCR_PLAN_TYPE is not equal to (“01”,“02”,“03”,“04”, “05”,“06”,“07”,“08”,“09”,“10”,“11”,“12”,“13”,“14”,“15”,“16”, “17”,“18”,“19”) 2. For FTX00005 records only, OFFSET_TRANS_TYPE = "1"STEP 19: Count Capitation_TotalDefine Capitation_Total as the sum of Capitation_Hmo_Hio_Pace, Capitation_Php, Capitation_Pccm, Capitation_Phi, and Capitation_OtherSTEP 20: Encounter ClaimsSelect encounter claims in the IP, LT, OT, and RX files by the following criteria:1. PLAN-ID-NUMBER = Plan_Id2. TYPE-OF-CLAIM = (“3” or “C”)3. ADJUSTMENT-IND = “0”STEP 21: Set Encounter TypeUsing the records in STEP 20:1a. Set Encounter_Type = “Medicaid and S-CHIP” if at least one record with TYPE-OF-CLAIM = “3” AND at least one record with TYPE-OF-CLAIM = “C” 1b. Set Encounter_Type = “Medicaid” if at least one record with TYPE-OF-CLAIM = “3” AND no records with TYPE-OF-CLAIM = “C” 1c. Set Encounter_Type = "S-CHIP" if no records with TYPE-OF-CLAIM = “3” AND at least one record with TYPE-OF-CLAIM = “C”STEP 22: Count Encounters_IpDefine Encounters_Ip as the count of unique IP header records from STEP 20STEP 23: Count Encounters_LtDefine Encounters_Lt as the count of unique LT header records from STEP 20STEP 24: Count Encounters_OtDefine Encounters_Ot as the count of unique OT line records from STEP 20STEP 25: Count Encounters_RxDefine Encounters_Rx as the count of unique RX header records from STEP 20STEP 26: Count Encounters_TotalDefine Encounters_Total as the sum of Encounters_Ip, Encounters_Lt, Encounters_Ot, and Encounters_RxSTEP 27: Count RatiosSET Capitation_Ratio = Capitation_Total / EnrollmentSET Encounters_Ip_Ratio = Encounters_Ip / EnrollmentSET Encounters_Lt_Ratio = Encounters_Lt / EnrollmentSET Encounters_Ot_Ratio = Encounters_Ot / EnrollmentSET Encounters_Rx_Ratio = Encounters_Rx / EnrollmentSTEP 28: Repeat for each Plan_IdREPEAT STEPS 9-27 for each Plan_Id identified in STEP 8	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Managed care plans on the last day of DQ report monthDefine the managed care plan population from segment MANAGED-CARE-MAIN-MCR00002 by keeping active records that satisfy the following criteria:1. MANAGED-CARE-MAIN-REC-EFF-DATE <= last day of the reporting month2. MANAGED-CARE-MAIN-REC-END-DATE >= last day of the reporting month OR missingSTEP 4: Active non-duplicate claims records during DQ report monthDefine the claims universe for IP, LT, and RX at the header level and for OT at the line level by importing headers (and lines for OT) that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, and ADJUDICATION-DATE and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 5: Medicaid and S-CHIP Encounter: Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = ("3" or "C")STEP 6: Capitation payment financial transactions:Define the FTX universe for the FTX0002, FTX0003, and FTX0005 tables respectively by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-DATE or PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 7: Medicaid & S-CHIP Capitation PaymentOf the financial transactions that meet the criteria from STEP 6, further restrict them by the following criteria:1. PAYEE-ID-TYPE = "02"For those in FTX0005 only:1. OFFSET-TRANS-TYPE = "1" or "2"STEP 8: Define Plan_IdDefine Plan_Id as a unique list of: MANAGED-CARE-PLAN-ID from the EL file that meet the constraints in STEP 2, STATE-PLAN-ID-NUM from the MCR file that meet the constraints in STEP 3, PLAN-ID-NUMBER from the claims files that meet the constraints in STEP 5, and PAYEE-ID from records that meet constraints in STEP 7. Also, define a blank Plan_Id for missing.STEP 9: Define Plan_Type_ElIn cases where Plan_Id can be linked to a MANAGED-CARE-PLAN-ID in MANAGED-CARE-PARTICIPATION-ELG00014, and there is only one plan type for that plan, define Plan_Type_El as MANAGED-CARE-PLAN-TYPE. If there are multiple plan types for the Plan_Id, then set Plan_Type_El to the most frequently used plan type, or the lowest plan type if there is a tie. (If there are multiple plan types, also set MultiplePlanTypes_EL = 1.) In all other cases, Plan_Type_El = missing.STEP 10: Define Plan_Type_Mc and LinkedIn cases where Plan_Id can be linked to a STATE-PLAN-ID-NUM in MANAGED-CARE-MAIN-MCR00002, set In_MCR_File = "Yes". If there is only one plan type for that plan, define Plan_Type_Mc as MANAGED-CARE-PLAN-TYPE . If there are multiple plan types for the Plan_Id, then set Plan_Type_Mc to the most frequently used plan type, or the lowest plan type if there is a tie. (If there are multiple plan types, also set MultiplePlanTypes_Mc = 1.) In all other cases, Plan_Type_Mc = missing and In_MCR_File = "No". STEP 11: Count EnrollmentFor each Plan_Id, define Enrollment as the count of unique MSIS-IDENTIFICATION-NUM that satisfy the constraints in STEP 2aSTEP 12: Capitation RecordsFor each record that meets the criteria from STEP 7, further restrict them by the following criteria:1. ADJUSTMENT_IND = 02a. PAYMENT_OR_RECOUPMENT_AMOUNT (FTX00002 and FTX00005) > 0OR2b. PAYMENT_AMOUNT (FTX00003) > 0STEP 13: Set Capitation TypeUsing the records in STEP 12:1a. Set Capitation_Type = “Medicaid and S-CHIP” if at least one record with MBESCBES_FORM_GROUP = "1" OR "2" AND at least one record with MBESCBES_FORM_GROUP = "3" 1b. Set Capitation_Type = “Medicaid” if at least one record with MBESCBES_FORM_GROUP = "1" OR "2" AND no records with MBESCBES_FORM_GROUP = "3"1c. Set Capitation_Type = "S-CHIP" if no records with MBESCBES_FORM_GROUP = "1" OR "2" AND at least one record with MBESCBES_FORM_GROUP = "3" STEP 14: Count Capitation_Hmo_Hio_PaceDefine Capitation_Hmo_Hio_Pace as the count of unique FTX00002 records from STEP 12 that also satisfy the following criteria:1. PAYEE-MCR-PLAN-TYPE = (“01” or “04” or “17”)STEP 15: Count Capitation_PhpDefine Capitation_Php as the count of unique FTX00002 records from STEP 12 that also satisfy the following criteria:1. PAYEE-MCR-PLAN-TYPE = (“05” or “06”or “07”or “08”or “09” or “10” or “11”or “12” or “13”or “14” or “15”or “16” or “18”or “19”)STEP 16: Count Capitation_PccmDefine Capitation_Pccm as the count of unique FTX00002 records from STEP 12 that also satisfy the following criteria:1. PAYEE-MCR-PLAN-TYPE = (“02" or "03")STEP 17: Count Capitation_PhiDefine Capitation_Phi as the count of unique FTX00003 and FTX00005 records from STEP 12 that also satisfy the following criteria:1. For FTX00005 records only, OFFSET-TRANS-TYPE = "2"STEP 18: Count Capitation_OtherDefine Capitation_Other as the count of unique FTX00002 and FTX00005 records from STEP 12 that also satisfy the following criteria:1. PAYEE-MCR-PLAN-TYPE is not equal to (“01”,“02”,“03”,“04”, “05”,“06”,“07”,“08”,“09”,“10”,“11”,“12”,“13”,“14”,“15”,“16”, “17”,“18”,“19”) 2. For FTX00005 records only, OFFSET-TRANS-TYPE = "1"STEP 19: Count Capitation_TotalDefine Capitation_Total as the sum of Capitation_Hmo_Hio_Pace, Capitation_Php, Capitation_Pccm, Capitation_Phi, and Capitation_OtherSTEP 20: Encounter ClaimsSelect encounter claims in the IP, LT, OT, and RX files by the following criteria:1. PLAN-ID-NUMBER = Plan_Id2. TYPE-OF-CLAIM = (“3” or “C”)3. ADJUSTMENT-IND = “0”STEP 21: Set Encounter TypeUsing the records in STEP 20:1a. Set Encounter_Type = “Medicaid and S-CHIP” if at least one record with TYPE-OF-CLAIM = “3” AND at least one record with TYPE-OF-CLAIM = “C” 1b. Set Encounter_Type = “Medicaid” if at least one record with TYPE-OF-CLAIM = “3” AND no records with TYPE-OF-CLAIM = “C” 1c. Set Encounter_Type = "S-CHIP" if no records with TYPE-OF-CLAIM = “3” AND at least one record with TYPE-OF-CLAIM = “C”STEP 22: Count Encounters_IpDefine Encounters_Ip as the count of unique IP header records from STEP 20STEP 23: Count Encounters_LtDefine Encounters_Lt as the count of unique LT header records from STEP 20STEP 24: Count Encounters_OtDefine Encounters_Ot as the count of unique OT line records from STEP 20STEP 25: Count Encounters_RxDefine Encounters_Rx as the count of unique RX header records from STEP 20STEP 26: Count Encounters_TotalDefine Encounters_Total as the sum of Encounters_Ip, Encounters_Lt, Encounters_Ot, and Encounters_RxSTEP 27: Count RatiosSET Capitation_Ratio = Capitation_Total / EnrollmentSET Encounters_Ip_Ratio = Encounters_Ip / EnrollmentSET Encounters_Lt_Ratio = Encounters_Lt / EnrollmentSET Encounters_Ot_Ratio = Encounters_Ot / EnrollmentSET Encounters_Rx_Ratio = Encounters_Rx / EnrollmentSTEP 28: Repeat for each Plan_IdREPEAT STEPS 9-27 for each Plan_Id identified in STEP 8
04/24/2025	4.0.7	EL-8-002-2	ADD	N/A		Created
04/24/2025	4.0.7	EL-8-001-1	ADD	N/A		Created
04/24/2025	4.0.7	EL-7-001-1	ADD	N/A		Created
04/24/2025	4.0.7	EL-10-007-7	ADD	N/A		Created
04/24/2025	4.0.7	EL-6-021-21	ADD	N/A		Created
04/24/2025	4.0.7	EL-6-020-20	ADD	N/A		Created
11/20/2025	4.0.22	EL-6-019-19	UPDATE	Annotation	Count the number of 'Other - specific CMS approval duals'	N/A
11/20/2025	4.0.22	EL-6-019-19	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Count of number of 'Other - specific CMS approval duals'Of the MSIS IDs which meet the criteria from STEP 2, count the number with 1. DUAL-ELIGIBLE-CODE = '09'	N/A
04/24/2025	4.0.7	EL-6-019-19	ADD	N/A		Created
11/20/2025	4.0.22	EL-6-018-18	UPDATE	Annotation	Count the number of 'Other Duals'	N/A
11/20/2025	4.0.22	EL-6-018-18	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Count of number of 'Other Duals'Of the MSIS IDs which meet the criteria from STEP 2, count the number with 1. DUAL-ELIGIBLE-CODE = '08'	N/A
04/24/2025	4.0.7	EL-6-018-18	ADD	N/A		Created
11/20/2025	4.0.22	EL-6-017-17	UPDATE	Annotation	Count the number of 'QI-1 Duals'	N/A
11/20/2025	4.0.22	EL-6-017-17	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Count of number of 'QI-1 Duals'Of the MSIS IDs which meet the criteria from STEP 2, count the number with 1. DUAL-ELIGIBLE-CODE = '06'	N/A
04/24/2025	4.0.7	EL-6-017-17	ADD	N/A		Created
11/20/2025	4.0.22	EL-6-016-16	UPDATE	Annotation	Count the number of 'QDWI Duals'	N/A
11/20/2025	4.0.22	EL-6-016-16	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Count of number of 'QDWI Duals'Of the MSIS IDs which meet the criteria from STEP 2, count the number with 1. DUAL-ELIGIBLE-CODE = '05'	N/A
04/24/2025	4.0.7	EL-6-016-16	ADD	N/A		Created
11/20/2025	4.0.22	EL-6-015-15	UPDATE	Annotation	Count the number of 'SLMB Plus Duals'	N/A
11/20/2025	4.0.22	EL-6-015-15	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Count of number of 'SLMB Plus Duals'Of the MSIS IDs which meet the criteria from STEP 2, count the number with 1. DUAL-ELIGIBLE-CODE = '04'	N/A
04/24/2025	4.0.7	EL-6-015-15	ADD	N/A		Created
11/20/2025	4.0.22	EL-6-014-14	UPDATE	Annotation	Count the number of 'SLMB Only Duals'	N/A
11/20/2025	4.0.22	EL-6-014-14	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Count of number of 'SLMB Only Duals'Of the MSIS IDs which meet the criteria from STEP 2, count the number with 1. DUAL-ELIGIBLE-CODE = '03'	N/A
04/24/2025	4.0.7	EL-6-014-14	ADD	N/A		Created
11/20/2025	4.0.22	EL-6-013-13	UPDATE	Annotation	Count the number of 'QMB Plus Duals'	N/A
11/20/2025	4.0.22	EL-6-013-13	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Count of number of 'QMB Plus Duals'Of the MSIS IDs which meet the criteria from STEP 2, count the number with 1. DUAL-ELIGIBLE-CODE = '02'	N/A
04/24/2025	4.0.7	EL-6-013-13	ADD	N/A		Created
11/20/2025	4.0.22	EL-6-012-12	UPDATE	Annotation	Count the number of 'QMB Only Duals'	N/A
11/20/2025	4.0.22	EL-6-012-12	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Count of number of 'QMB Only Duals'Of the MSIS IDs which meet the criteria from STEP 2, count the number with 1. DUAL-ELIGIBLE-CODE = '01'	N/A
04/24/2025	4.0.7	EL-6-012-12	ADD	N/A		Created
04/24/2025	4.0.7	EL-6-011-11	ADD	N/A		Created
04/24/2025	4.0.7	EL-6-010-10	ADD	N/A		Created
04/24/2025	4.0.7	EL-6-009-9	ADD	N/A		Created
04/24/2025	4.0.7	EL-6-008-8	ADD	N/A		Created
04/24/2025	4.0.7	EL-6-007-7	ADD	N/A		Created
04/24/2025	4.0.7	EL-6-006-6	ADD	N/A		Created
04/24/2025	4.0.7	EL-6-005-5	ADD	N/A		Created
04/24/2025	4.0.7	EL-6-004-4	ADD	N/A		Created
04/24/2025	4.0.7	EL-6-003-3	ADD	N/A		Created
04/24/2025	4.0.7	EL-6-002-2	ADD	N/A		Created
04/24/2025	4.0.7	EL-6-001-1	ADD	N/A		Created
11/20/2025	4.0.22	EL-5-003-2	UPDATE	Annotation	Count the number of unique MSIS IDs that are classified as S-CHIP	N/A
11/20/2025	4.0.22	EL-5-003-2	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: S-CHIPOf the MSIS IDs which meet the criteria from STEP 2, restrict to:1. CHIP-CODE = "3"STEP 4: Count unique MSIS IDsCount the number of unique MSIS IDs from STEP 3	N/A
04/24/2025	4.0.7	EL-5-003-2	ADD	N/A		Created
11/20/2025	4.0.22	EL-5-002-1	UPDATE	Annotation	Count the number of unique MSIS IDs that are classified as M-CHIP	N/A
11/20/2025	4.0.22	EL-5-002-1	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: M-CHIPOf the MSIS IDs which meet the criteria from STEP 2, restrict to:1. CHIP-CODE = "2"STEP 4: Count unique MSIS IDsCount the number of unique MSIS IDs from STEP 3	N/A
04/24/2025	4.0.7	EL-5-002-1	ADD	N/A		Created
11/20/2025	4.0.22	EL-5-001-3	UPDATE	Annotation	The age groups for the measure are defined. Each age group should be run as its own frequency.Where the denominator is the records with CHIP code = 2, run a frequency for the defined age groups. For CHIP code = 2, the frequencies across the age groups should sum to 100.(continued on the row below)Where the denominator is the records with CHIP code = 3, run a frequency for the defined age groups. For CHIP code = 3, the frequencies across the age groups should sum to 100. For each chip code, run the frequency of age groups for the previous month.Calculate the change in value from the previous month to the current month for each frequency percent.Sum the changes across all frequencies.	N/A
11/20/2025	4.0.22	EL-5-001-3	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Primary demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment PRIMARY-DEMOGRAPHICS-ELG00002 by keeping records that satisfy the following criteria:1a. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month 2a. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: Calculate AgeUsing the PRIMARY-DEMOGRAPHICS-ELG00002 segment.1a. If DATE-OF-DEATH is non-missing and occurs before the last day of the DQ report month, Age is equal to the years between DATE-OF-DEATH and DATE-OF-BIRTH.1b. Otherwise, Age is equal to the years between the last day of the DQ report month and DATE-OF-BIRTH. STEP 4: Create age categoriesCreate age group using the following categories:Age <11 <= Age <= 56 <= Age <= 1415 <= Age <= 1819 <= Age <= 2021 <= Age <= 4445 <= Age <= 6465 <= Age <= 7475 <= Age <= 84Age >= 85STEP 5: Variable demographics on the last day of report monthUsing the MSIS IDs that meet the criteria from STEP 2, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month 2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 6: Merge CHIP-CODEUsing the dataset from STEP 4, merge on CHIP-CODE from the dataset in STEP 5STEP 7: Restrict to a specific CHIP-CODE valueFrom STEP 6, select those where CHIP-CODE = “2” or “3”STEP 8: Calculate frequencyFrom STEP 7, count the total number of MSIS IDS in each age group, separately for each selected CHIP-CODE (“2” or “3”)STEP 9: Calculate percentageDivide the count of MSIS IDs in each age group and CHIP-CODE combination (e.g., CHIP-CODE = 2, Ages 1 - 5) from STEP 8 by the total number of MSIS IDs from STEP 7STEP 10: Repeat for prior monthRepeat STEPS 1 through 9 for the prior month.STEP 11: Calculate change for each age categoryCalculate one-half of the absolute difference of the percentage for each age group and CHIP-CODE combination between the current and prior monthSTEP 12: SUM to calculate index of dissimilarity statisticSum the values from STEP 11 across all age group CHIP-CODE categories	N/A
04/24/2025	4.0.7	EL-5-001-3	ADD	N/A		Created
11/20/2025	4.0.22	EL-4-001-1	UPDATE	Annotation	Calculate a frequency of enrollment type for M-CHIP enrollees	N/A
11/20/2025	4.0.22	EL-4-001-1	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping active records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: M-CHIPOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:1. CHIP-CODE = "2"STEP 4: FrequencyCount the number of unique MSIS IDs from STEP 3 for:1. (1,2,9) Each valid value: ENROLLMENT-TYPE = ("1", "2", "9", respectively)2. (A) Any valid value: ENROLLMENT-TYPE = ("1" or "2" or "9")3. (N) No valid value: ENROLLMENT-TYPE (NOT ("1" or "2" or "9") or missing4. (T) total: ENROLLMENT-TYPE = (any missing or non-missing value)	N/A
04/24/2025	4.0.7	EL-4-001-1	ADD	N/A		Created
11/20/2025	4.0.22	EL-3-011-10	UPDATE	Annotation	Calculate the percentage of eligibles in BCCP eligibility group that are female	N/A
11/20/2025	4.0.22	EL-3-011-10	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month 3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: BCCP eligibility groupOf the MSIS IDs that meet the criteria from STEP 2, further refine the population using ELIGIBILITY-GROUP=“34”STEP 4: Primary demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment PRIMARY-DEMOGRAPHICS-ELG00002 by keeping records that satisfy the following criteria:1a. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 5: FemaleOf the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping records with SEX = "F"STEP 6: Calculate percentage for measureDIVIDE the count of MSIS IDs from STEP 5 by the count of MSIS IDs from STEP 3	N/A
04/24/2025	4.0.7	EL-3-011-10	ADD	N/A		Created
11/20/2025	4.0.22	EL-3-010-9	UPDATE	Annotation	Calculate the percentage of eligibles in BCCP eligibility group that are aged 16-65	N/A
11/20/2025	4.0.22	EL-3-010-9	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month 3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: BCCP eligibility groupOf the MSIS IDs that meet the criteria from STEP 2, further refine the population using ELIGIBILITY-GROUP=“34”STEP 4: Primary demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment PRIMARY-DEMOGRAPHICS-ELG00002 by keeping records that satisfy the following criteria:1a. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 5: Calculate AgeOf the MSIS IDs that meet the criteria from STEP 4, calculate age:1a. If DATE-OF-DEATH is non-missing and occurs before the last day of the DQ report month, Age is equal to the years between DATE-OF-DEATH and DATE-OF-BIRTH.1b. Otherwise, Age is equal to the years between the last day of the DQ report month and DATE-OF-BIRTH. Note: Perform calculations to count full years (e.g., 5/1/2015 - 8/1/1950 = 64)STEP 6: Age between 16 and 65Refine the MSIS IDs from STEP 5 by keeping records with:1. Age >= 16 and Age < 65STEP 7: Calculate percentage for measureDIVIDE the count of MSIS IDs from STEP 6 by the count of MSIS IDs from STEP 3	N/A
04/24/2025	4.0.7	EL-3-010-9	ADD	N/A		Created
11/20/2025	4.0.22	EL-3-009-5	UPDATE	Annotation	Calculate the percentage of foster care enrollees that are less than 26 years old	N/A
11/20/2025	4.0.22	EL-3-009-5	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month 3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Unique foster care enrolleesOf the MSIS IDs that meet the criteria from STEP 2, select foster care enrollees:1. ELIGIBILITY-GROUP = "08" or "09" or "30"2. Remove any duplicates, so each MSIS-ID only appears once.STEP 4: Primary demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment PRIMARY-DEMOGRAPHICS-ELG00002 by keeping records that satisfy the following criteria:1a. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month 2a. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 5: Calculate ageOf the MSIS IDs that meet the criteria from STEP 4, calculate age:1a. If DATE-OF-DEATH is non-missing and occurs before the last day of the DQ report month, Age is equal to the years between DATE-OF-DEATH and DATE-OF-BIRTH.1b. Otherwise, Age is equal to the years between the last day of the DQ report month and DATE-OF-BIRTH. Note: perform calculations to count full years (e.g., 5/1/2015 – 8/1/1950 = 64)STEP 6: Foster care enrollees aged < 26Merge the MSIS IDs from STEP 3 and 5 and only keep the matches and make sure there is still only one observation per MSIS-ID. Then, select foster care enrollees with Age < 26.STEP 7: Calculate percentage for measureDivide the count of MSIS IDs from STEP 6 by the count of MSIS IDs from STEP 3	N/A
04/24/2025	4.0.7	EL-3-009-5	ADD	N/A		Created
04/24/2025	4.0.7	EL-3-008-8	ADD	N/A		Created
11/20/2025	4.0.22	EL-3-007-4	UPDATE	Annotation	Calculate the percentage of pregnant women that are between the ages of 13 and 64	N/A
11/20/2025	4.0.22	EL-3-007-4	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month 3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Unique Pregnant WomenOf the MSIS IDs that meet the criteria from STEP 2, select pregnant women:1. ELIGIBILITY-GROUP = "05" or "53" or "67" or "68"2. Remove any duplicates, so each MSIS ID only appears once.STEP 4: Primary demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment PRIMARY-DEMOGRAPHICS-ELG00002 by keeping records that satisfy the following criteria:1a. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month 2a. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 5: Calculate AgeOf the MSIS IDs that meet the criteria from STEP 4, calculate age:1a. If DATE-OF-DEATH is non-missing and occurs before the last day of the DQ report month, Age is equal to the years between DATE-OF-DEATH and DATE-OF-BIRTH.1b. Otherwise, Age is equal to the years between the last day of the DQ report month and DATE-OF-BIRTH. STEP 6: Pregnant Women Aged 13-64MERGE MSIS IDs from STEP 3 and 5 and only keep the matches and make sure there is still only one observation per MSIS ID. Then, select women with ages between 13 and 64: Age >= 13 and Age <=64.STEP 7: Calculate percentage for measureDIVIDE the count of MSIS IDs from STEP 6 by the count of MSIS IDs from STEP 3	N/A
04/24/2025	4.0.7	EL-3-007-4	ADD	N/A		Created
04/24/2025	4.0.7	EL-3-006-3	ADD	N/A		Created
04/24/2025	4.0.7	EL-3-005-6	ADD	N/A		Created
04/24/2025	4.0.7	EL-3-004-2	ADD	N/A		Created
11/20/2025	4.0.22	EL-3-003-11	UPDATE	Annotation	Calculate the percentage of eligibles 65 and older who are dual eligibles	N/A
11/20/2025	4.0.22	EL-3-003-11	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Primary demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment PRIMARY-DEMOGRAPHICS-ELG00002 by keeping records that satisfy the following criteria:1a. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: Calculate AgeOf the MSIS IDs that meet the criteria from STEP 2, calculate age:1a. If DATE-OF-DEATH is non-missing and occurs before the last day of the DQ report month, Age is equal to the years between DATE-OF-DEATH and DATE-OF-BIRTH.1b. Otherwise, Age is equal to the years between the last day of the DQ report month and DATE-OF-BIRTH. Note: Perform calculations to count full years (e.g., 5/1/2015 – 8/1/1950 = 64)STEP 4: Age 65 and olderOf the MSIS IDs that meet the criteria from STEP 3, further refine the population by keeping records with age >=65STEP 5: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 4, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 6: Dual eligibleOf the MSIS IDs that meet the criteria from STEP 5, further refine the population using DUAL-ELIGIBLE-CODE=“01” or “02” or “03” or “04” or “05” or “06” or “08” or “09” or “10” STEP 7: Calculate percentage for measureDIVIDE the count of MSIS IDs from STEP 6 by the count of MSIS IDs from STEP 4	N/A
04/24/2025	4.0.7	EL-3-003-11	ADD	N/A		Created
04/24/2025	4.0.7	EL-3-002-7	ADD	N/A		Created
11/20/2025	4.0.22	EL-3-001-1	UPDATE	Annotation	Count the total number of eligible MSIS IDs with a valid ELIGIBILITY-GROUP	N/A
11/20/2025	4.0.22	EL-3-001-1	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month2. ENROLLMENT-END-DATE >= last day of the DQ report OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Unique Valid CodesOf the MSIS IDs that meet the criteria from STEP 2, select those with a valid value for ELIGIBILITY-GROUP:1. ELIGIBILITY-GROUP = "01" or "02" or "03" or "04" or "05" or "06" or "07" or "08" or "09" or "72" or "73" or "74" or "75" or "11" or "12" or "13" or "14" or "15" or "16" or "17" or "18" or "19" or "20" or "21" or "22" or "23" or "24" or "25" or "26" or "27" or "28" or "29" or "30" or "31" or "32" or "33" or "34" or "35" or "36" or "37" or "38" or "39" or "40" or "41" or "42" or "43" or "44" or "45" or "46" or "47" or "48" or "49" or "50" or "51" or "52" or "53" or "54" or "55" or "56" or "59" or "60" or "61" or "62" or "63" or "64" or "65" or "66" or "67" or "68" or "69" or "70" or "71" or "76"2. Remove any duplicates, so each MSIS ID only appears once.	N/A
04/24/2025	4.0.7	EL-3-001-1	ADD	N/A		Created
04/24/2025	4.0.7	EL-2-001-1	ADD	N/A		Created
11/20/2025	4.0.22	EL-11-001-1	UPDATE	Annotation	Compute the percentage of full dual-eligibles receiving private insurance	N/A
11/20/2025	4.0.22	EL-11-001-1	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month 3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Unique Full DualsOf the MSIS IDs that meet the criteria from STEP 2, further refine the population using:1. DUAL-ELIGIBLE-CODE = “02” or “04” or “08”STEP 4: TPL eligible person on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment TPL-MEDICAID-ELIGIBLE-PERSON-MAIN-TPL00002 by keeping active records that satisfy the following criteria:1a. ELIG-PRSN-MAIN-EFF-DATE <= last day of the DQ report month2a. ELIG-PRSN-MAIN-END-DATE >= last day of the DQ report month OR missingOR1b. ELIG-PRSN-MAIN-EFF-DATE is missing2b. ELIG-PRSN-MAIN-END-DATE is missingSTEP 5: Private health insuranceOf the MSIS IDs that meet the criteria from STEP 4, select those with private insurance:1. TPL-HEALTH-INSURANCE-COVERAGE-IND = "1"STEP 6: Calculate percentageDivide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 3	N/A
04/24/2025	4.0.7	EL-11-001-1	ADD	N/A		Created
11/20/2025	4.0.22	EL-1-020-15	UPDATE	Annotation	Calculate the percentage of eligibles who died in month	N/A
11/20/2025	4.0.22	EL-1-020-15	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Primary demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment PRIMARY-DEMOGRAPHICS-ELG00002 by keeping records that satisfy the following criteria:1a. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: Died in monthOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:DATE-OF-DEATH >= first day of the DQ report monthANDDATE-OF-DEATH <= last day of the DQ report monthSTEP 4: Calculate percentage for measureDIVIDE the count of MSIS IDs from STEP 3 by the count of MSIS IDs from STEP 1	N/A
04/24/2025	4.0.7	EL-1-020-15	ADD	N/A		Created
11/20/2025	4.0.22	EL-1-019-6	UPDATE	Annotation	Calculate the percentage of eligibles who are female	N/A
11/20/2025	4.0.22	EL-1-019-6	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Primary demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment PRIMARY-DEMOGRAPHICS-ELG00002 by keeping records that satisfy the following criteria:1a. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: FemaleOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with SEX = "F"STEP 4: Calculate percentage for measureDIVIDE the count of MSIS IDs from STEP 3 by the count of MSIS IDs from STEP 1	N/A
04/24/2025	4.0.7	EL-1-019-6	ADD	N/A		Created
11/20/2025	4.0.22	EL-1-018-19	UPDATE	Annotation	Calculate the percentage of individuals age 65 and over	N/A
11/20/2025	4.0.22	EL-1-018-19	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Primary demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment PRIMARY-DEMOGRAPHICS-ELG00002 by keeping records that satisfy the following criteria:1a. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: Calculate Age and Keep Ages at least 65Of the MSIS IDs that meet the criteria from STEP 2, calculate Age:1a. If DATE-OF-DEATH is non-missing and occurs before the last day of the DQ report month, Age is equal to the years between DATE-OF-DEATH and DATE-OF-BIRTH.1b. Otherwise, Age is equal to the years between the last day of the DQ report month and DATE-OF-BIRTH.Note: perform calculations to count full years (e.g., 5/1/2015 – 8/1/1950 = 64)2. Only keep records where Age >= 65.STEP 4: Calculate percentageDivide the count of unique MSIS IDs from STEP 3 by the count of unique MSIS IDs from STEP 1	N/A
04/24/2025	4.0.7	EL-1-018-19	ADD	N/A		Created
11/20/2025	4.0.22	EL-1-017-18	UPDATE	Annotation	Calculate the percentage of individuals with ages 0-20	N/A
11/20/2025	4.0.22	EL-1-017-18	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Primary demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment PRIMARY-DEMOGRAPHICS-ELG00002 by keeping records that satisfy the following criteria:1a. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: Calculate Age and Keep Ages 0-20Of the MSIS IDs that meet the criteria from STEP 2, calculate Age:1a. If DATE-OF-DEATH is non-missing and occurs before the last day of the DQ report month, Age is equal to the years between DATE-OF-DEATH and DATE-OF-BIRTH.1b. Otherwise, Age is equal to the years between the last day of the DQ report month and DATE-OF-BIRTH.Note: perform calculations to count full years (e.g., 5/1/2015 – 8/1/1950 = 64)2. Only keep records where Age >=0 AND Age <=20 STEP 4: Calculate percentageDivide the count of unique MSIS IDs from STEP 3 by the count of unique MSIS IDs from STEP 1	N/A
04/24/2025	4.0.7	EL-1-017-18	ADD	N/A		Created
11/20/2025	4.0.22	EL-1-016-17	UPDATE	Annotation	Calculate the percentage of individuals with age = 0	N/A
11/20/2025	4.0.22	EL-1-016-17	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Primary demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment PRIMARY-DEMOGRAPHICS-ELG00002 by keeping records that satisfy the following criteria:1a. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: Calculate Age and Keep Age=0Of the MSIS IDs that meet the criteria from STEP 2, calculate Age:1a. If DATE-OF-DEATH is non-missing and occurs before the last day of the DQ report month, Age is equal to the years between DATE-OF-DEATH and DATE-OF-BIRTH.1b. Otherwise, Age is equal to the years between the last day of the DQ report month and DATE-OF-BIRTH.Note: perform calculations to count full years (e.g., 5/1/2015 – 8/1/1950 = 64)2. Only keep records where Age = 0.STEP 4: Calculate percentageDivide the count of unique MSIS IDs from STEP 3 by the count of unique MSIS IDs from STEP 1	N/A
04/24/2025	4.0.7	EL-1-016-17	ADD	N/A		Created
11/20/2025	4.0.22	EL-1-015-14	UPDATE	Annotation	Calculate the percentage of eligibles with a non-citizen immigration status whose immigration verification is pending	N/A
11/20/2025	4.0.22	EL-1-015-14	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: Immigration statusOf the MSIS IDs that meet the criteria from STEP 2, restrict to those with an immigration status:1. IMMIGRATION-STATUS = "1" or "2" or "3"STEP 4: Enrollment in Medicaid is pending immigration verificationOf the MSIS IDs that meet the criteria from STEP 3, restrict to those pending immigration verification: 1. IMMIGRATION-VERIFICATION-FLAG = "1"STEP 5: Calculate percentageDivide the count of unique MSIS IDs from STEP 4 by the count of unique MSIS IDs from STEP 3	N/A
04/24/2025	4.0.7	EL-1-015-14	ADD	N/A		Created
04/24/2025	4.0.7	EL-1-014-13	ADD	N/A		Created
04/24/2025	4.0.7	EL-1-013-12	ADD	N/A		Created
04/24/2025	4.0.7	EL-1-012-11	ADD	N/A		Created
11/20/2025	4.0.22	EL-1-011-10	UPDATE	Annotation	Calculate the percentage of eligibles with unspecified, unknown, missing, or invalid race	N/A
11/20/2025	4.0.22	EL-1-011-10	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION-ELG00016 by keeping active records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Unknown raceOf the MSIS IDs that meet the criteria from STEP 2, further restrict them by the following criteria:1. RACE does not equal (“001,” “002,” “003,” “004,” “005,” “006,” “007,” “008,” “009,” “010,” “011,” “012,” “013,” “014,” “015,” “016,” or “018”) or is missingSTEP 4: PercentageDivide the count from STEP 3 by the count in STEP 1*Note: This can include MSIS IDs from STEP 1 that did not join to a race information segment.	N/A
04/24/2025	4.0.7	EL-1-011-10	ADD	N/A		Created
11/20/2025	4.0.22	EL-1-010-9	UPDATE	Annotation	Calculate the percentage of unique MSIS IDs with unspecified or unknown ethnicity of all unique MSIS IDs with ethnicity information	N/A
11/20/2025	4.0.22	EL-1-010-9	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Ethnicity information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ETHNICITY-INFORMATION-ELG00015 by keeping active records that satisfy the following criteria:1a. ETHNICITY-DECLARATION-EFF-DATE <= last day of the DQ report month2a. ETHNICITY-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. ETHNICITY-DECLARATION-EFF-DATE is missing2b. ETHNICITY-DECLARATION-END-DATE is missingSTEP 3: Unknown ethnicityOf the MSIS IDs that meet the criteria from STEP 2, further restrict them by the following criteria:1. ETHNICITY-CODE does not equal ( "0","1","2","3","4", or "5") or is missingSTEP 4: PercentageDivide the count from STEP 3 by the count in STEP 1Note: This can include MSIS IDs from STEP 1 that did not join to an ethnicity information segment.	N/A
04/24/2025	4.0.7	EL-1-010-9	ADD	N/A		Created
11/20/2025	4.0.22	EL-1-009-8	UPDATE	Annotation	Calculate the index of dissimilarity measure - ethnicity	N/A
11/20/2025	4.0.22	EL-1-009-8	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Ethnicity information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ETHNICITY-INFORMATION-ELG00015 by keeping active records that satisfy the following criteria:1a. ETHNICITY-DECLARATION-EFF-DATE <= last day of the DQ report month2a. ETHNICITY-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. ETHNICITY-DECLARATION-EFF-DATE is missing2b. ETHNICITY-DECLARATION-END-DATE is missingSTEP 3: Non-missing ethnicityOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with: 1. ETHNICITY-CODE non-missingSTEP 4: Percent ethnicity for the current month1. For each distinct value of ethnicity code, set the number of unique MSIS IDs as Numerator_Count_By_Value. 2. Sum the total number of unique MSIS IDs within each valid value of ethnicity and set as Denominator_Count. Note that Denominator_Count should also equal to the count of MSIS IDs from STEP 3.3. For each distinct value of ethnicity code, calculate Percent_Current_Month as the ratio of Numerator_Count_By_Value over Denominator_Count. STEP 5: Percent ethnicity for the previous monthRepeat STEP 1 through STEP 4 for the previous month. For each distinct value of ethnicity code, set the percent of ethnicity code for the previous month as Percent_Prior_Month_1.STEP 6: Calculate change between monthsFor each frequency percent, calculate Frequency_Change as the absolute value of (Percent_Current_Month – Percent_Prior_Month_1) / 2. Note that Frequency_Change is a vector of frequencies.STEP 7: Calculate index of dissimilarityCalculate the index of dissimilarity by summing Frequency_Change across all frequencies	N/A
04/24/2025	4.0.7	EL-1-009-8	ADD	N/A		Created
11/20/2025	4.0.22	EL-1-008-7	UPDATE	Annotation	Calculate the index of dissimilarity measure - race codes	N/A
11/20/2025	4.0.22	EL-1-008-7	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION-ELG00016 by keeping active records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Non-missing raceOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with: 1. RACE is non-missingSTEP 4: Percent race for the current month1. For each distinct value of race, set the number of unique MSIS IDs as Numerator_Count_By_Value. 2. Sum the total number of unique MSIS IDs within each valid value of ethnicity and set as Denominator_Count. Note that Denominator_Count should also equal to the count of MSIS IDs from STEP 3.3. For each distinct value of race, calculate Percent_Current_Month as the ratio of Numerator_Count_By_Value over Denominator_Count. STEP 5: Percent race for the previous monthRepeat STEP 1 through STEP 4 for the previous month. For each distinct value of race, set the percent of race for the previous month as Percent_Prior_Month_1.STEP 6: Calculate change between monthsFor each frequency percent, calculate Frequency_Change as the absolute value of (Percent_Current_Month – Percent_Prior_Month_1) / 2. Note that Frequency_Change is a vector of frequencies.STEP 7: Calculate index of dissimilarityCalculate the index of dissimilarity by summing Frequency_Change across all frequencies	N/A
04/24/2025	4.0.7	EL-1-008-7	ADD	N/A		Created
11/20/2025	4.0.22	EL-1-007-5	UPDATE	Annotation	Calculate the index of dissimilarity measure - zip code	N/A
11/20/2025	4.0.22	EL-1-007-5	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligible contact information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBLE_CONTACT_INFORMATION ELG00004 by keeping records that satisfy the following criteria:1a. ELIGIBLE-ADDR-EFF-DATE <= last day of the DQ report month2a. ELIGIBLE-ADDR-END-DATE >= last day of the DQ report month OR missingOR1b. ELIGIBLE-ADDR-EFF-DATE is missing2b. ELIGIBLE-ADDR-END-DATE is missingSTEP 3: Non-missing zip code for primary addressOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with: 1. ELIGIBLE-ZIP-CODE non-missing2. ELIGIBLE_ADDRESS_TYPE = "01"STEP 4: Percent eligible zip code for the current month1. For each distinct value of zip code, set the number of unique MSIS IDs as Numerator_Count_By_Value. 2. Sum the total number of unique MSIS IDs within each valid value of ethnicity and set as Denominator_Count. Note that Denominator_Count should also equal to the count of MSIS IDs from STEP 3.3. For each distinct value of zip code, calculate Percent_Current_Month as the ratio of Numerator_Count_By_Value over Denominator_Count.STEP 5: Percent zip code for the previous monthRepeat STEP 1 through STEP 4 for the previous month. For each distinct value of zip code, set the percent of zip code for the previous month as Percent_Prior_Month_1. STEP 6: Calculate change between monthsFor each frequency percent, calculate Frequency_Change as the absolute value of (Percent_Current_Month – Percent_Prior_Month_1) / 2. Note that Frequency_Change is a vector of frequencies.STEP 7: Calculate index of dissimilarityCalculate the index of dissimilarity by summing Frequency_Change across all frequencies	N/A
04/24/2025	4.0.7	EL-1-007-5	ADD	N/A		Created
11/20/2025	4.0.22	EL-1-006-4	UPDATE	Annotation	Calculate the index of dissimilarity measure - county	N/A
11/20/2025	4.0.22	EL-1-006-4	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligible contact information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBLE_CONTACT_INFORMATION ELG00004 by keeping records that satisfy the following criteria:1a. ELIGIBLE-ADDR-EFF-DATE <= last day of the DQ report month2a. ELIGIBLE-ADDR-END-DATE >= last day of the DQ report month OR missingOR1b. ELIGIBLE-ADDR-EFF-DATE is missing2b. ELIGIBLE-ADDR-END-DATE is missingSTEP 3: Non-missing county code for primary addressOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with: 1. ELIGIBLE-COUNTY-CODE non-missing2. ELIGIBLE_ADDRESS_TYPE = "01"STEP 4: Percent eligible county code for the current month1. For each distinct value of county code, set the number of unique MSIS IDs as Numerator_Count_By_Value. 2. Sum the total number of unique MSIS IDs within each valid value of ethnicity and set as Denominator_Count. Note that Denominator_Count should also equal to the count of MSIS IDs from STEP 3.3. For each distinct value of county code, calculate Percent_Current_Month as the ratio of Numerator_Count_By_Value over Denominator_Count.STEP 5: Percent eligible county code for the previous monthRepeat STEP 1 through STEP 4 for the previous month. For each distinct value of county code, set the percent of county code for the previous month as Percent_Prior_Month_1. STEP 6: Calculate change between monthsFor each frequency percent, calculate Frequency_Change as the absolute value of (Percent_Current_Month – Percent_Prior_Month_1) / 2. Note that Frequency_Change is a vector of frequencies.STEP 7: Calculate index of dissimilarityCalculate the index of dissimilarity by summing Frequency_Change across all frequencies	N/A
04/24/2025	4.0.7	EL-1-006-4	ADD	N/A		Created
11/20/2025	4.0.22	EL-1-005-16	UPDATE	Annotation	Calculate the percentage of unique MSIS ID's that a MSIS Case Number	N/A
11/20/2025	4.0.22	EL-1-005-16	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: MSIS Case Number is not missingOf the MSIS IDs that meet the criteria from STEP 2, restrict to those with a non-missing case number:1. MSIS_CASE_NUM is not missingSTEP 4: Calculate the percentageDivide the count of unique MSIS IDs from STEP 3 by the count from STEP 1	N/A
04/24/2025	4.0.7	EL-1-005-16	ADD	N/A		Created
11/20/2025	4.0.22	EL-1-004-3	UPDATE	Annotation	Count the number of unique SSNs that have more than one unique MSIS ID.	N/A
11/20/2025	4.0.22	EL-1-004-3	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment VARIABLE-DEMOGRAPHICS-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: SSN's with multiple MSIS IDsUse segment VARIABLE-DEMOGRAPHIC-ELG00003 and count unique SSN's associated with more than one MSIS-IDENTIFICATION-NUM	N/A
04/24/2025	4.0.7	EL-1-004-3	ADD	N/A		Created
04/24/2025	4.0.7	EL-1-002-2	ADD	N/A		Created
11/20/2025	4.0.22	EL-1-001-1	UPDATE	Annotation	Calculate the percentage of eligibles with SSN and MSIS ID	N/A
11/20/2025	4.0.22	EL-1-001-1	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment VARIABLE-DEMOGRAPHICS-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: Non-missing SSNOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with non-missing SSNSTEP 4: Non-missing MSIS IDOf the MSIS IDs that meet the criteria from STEP 3, further refine the population by keeping records with non-missing MSIS-IDENTIFICATION-NUMSTEP 5: Calculate percentage for measureDIVIDE the count of MSIS IDs from STEP 4 by the count of MSIS IDs from STEP 1	N/A
04/24/2025	4.0.7	EL-1-001-1	ADD	N/A		Created
04/24/2025	4.0.7	EL-10-006-3	ADD	N/A		Created
04/24/2025	4.0.7	EL-10-005-6	ADD	N/A		Created
11/20/2025	4.0.22	EL-10-004-5	UPDATE	Annotation	Calculate the percentage of restricted benefit eligibles enrolled in comprehensive managed care	N/A
11/20/2025	4.0.22	EL-10-004-5	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Restricted benefit eligiblesOf the MSIS IDs that meet the criteria from STEP 2, further refine the population using RESTRICTED-BENEFITS-CODE = (“2” or “3” or “6”)STEP 4: Managed care enrollment on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 5: Identify individuals in a comprehensive managed care planSelect MSIS IDs from STEP 4 where MANAGED-CARE-PLAN-TYPE = "01"STEP 6: Calculate percentageDivide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 3	N/A
04/24/2025	4.0.7	EL-10-004-5	ADD	N/A		Created
11/20/2025	4.0.22	EL-10-003-2	UPDATE	Annotation	Count the total number of MSIS ID's that are enrolled in at least one managed care plan with a valid plan type	N/A
11/20/2025	4.0.22	EL-10-003-2	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Unique Valid ValuesOf the MSIS IDs which meet the criteria from STEP 2, restrict to those with a valid MANAGED-CARE-PLAN-TYPE:1. MANAGED-CARE-PLAN-TYPE = "01", "02", "03", "04", "05", "06", "07", "08", "09", "10", "11", "12", "13", "14", "15", "16", "17", "18", "19", "20", "60", "70", "80"STEP 4: Count unique MSIS IDsCount the number of unique MSIS IDs from STEP 3	N/A
04/24/2025	4.0.7	EL-10-003-2	ADD	N/A		Created
11/20/2025	4.0.22	EL-10-002-4	UPDATE	Annotation	For each unique MSIS id, count the unique number of non-missing plan ids that have a valid or unknown plan type. Calculate the average count by dividing the number of plan ids from above by the number of unique MSIS ids that have a non-missing plan id with a valid or unknown plan type.	N/A
11/20/2025	4.0.22	EL-10-002-4	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Non-missing Plan ID and valid plan typeOf the MSIS IDs which meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:1. MANAGED-CARE-PLAN-ID is not missing2. MANAGED-CARE-PLAN-TYPE is not equal to "00"STEP 4: Count plan ID's For each MSIS ID that meets the criteria from STEP 3, create Count_Plans and set it equal to the number of unique MANAGED-CARE-PLAN-ID values associated with that MSIS-ID. STEP 5: Calculate average number of managed care plans Divide the sum of Count_Plans from STEP 4 by the count of unique MSIS IDs from STEP 3	N/A
04/24/2025	4.0.7	EL-10-002-4	ADD	N/A		Created
11/20/2025	4.0.22	EL-10-001-1	UPDATE	Annotation	Calculate the index of dissimilarity measure - plan type	N/A
11/20/2025	4.0.22	EL-10-001-1	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Non-missing plan typeOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with: 1. MANAGED-CARE-PLAN-TYPE non-missingSTEP 4: Percent plan type for the current month1. For each distinct value of plan type, set the number of unique MSIS IDs as Numerator_Count_By_Value. 2. Sum the total number of unique MSIS IDs within each valid value of plan type and set as Denominator_Count. Note that Denominator_Count should also equal to the count of MSIS IDs from STEP 3.3. For each distinct value of plan type, calculate Percent_Current_Month as the ratio of Numerator_Count_By_Value over Denominator_Count. STEP 5: Percent plan type for the previous monthRepeat STEP 1 through STEP 4 for the previous month. For each distinct value of plan type, set the percent of plan type for the previous month as Percent_Prior_Month_1.STEP 6: Calculate change between monthsFor each frequency percent, calculate Frequency_Change as the absolute value of (Percent_Current_Month – Percent_Prior_Month_1) / 2. Note that Frequency_Change is a vector of frequencies.STEP 7: Calculate index of dissimilarityCalculate the index of dissimilarity by summing Frequency_Change across all frequencies	N/A
04/24/2025	4.0.7	EL-10-001-1	ADD	N/A		Created
04/24/2025	4.0.7	ALL-3-002-2	ADD	N/A		Created
04/24/2025	4.0.7	ALL-3-001-1	ADD	N/A		Created
04/24/2025	4.0.7	ALL-2-008-8	ADD	N/A		Created
04/24/2025	4.0.7	ALL-2-007-7	ADD	N/A		Created
08/13/2025	4.0.16	ALL-2-006-6	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: State plan participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment STATE-PLAN-OPTION-PARTICIPATION-ELG00011 by keeping records that satisfy the following criteria:1a. STATE-PLAN-OPTION-EFF-DATE <= last day of the DQ report month2a. STATE-PLAN-OPTION-END-DATE >= last day of the DQ report month OR missingOR1b. STATE-PLAN-OPTION-EFF-DATE is missing2b. STATE-PLAN-OPTION-END-DATE is missingSTEP 3: 1915(j) eligiblesOf the MSIS-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:STATE-PLAN-OPTION-TYPE = '03'STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 5: Medicaid FFS and Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" 2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 6: HCBS under 1915(j)Of the claims from STEP 5, further restrict by the below criteria1. HCBS-SERVICE-CODE = "2"STEP 7: Eligibles with OT claimsOf the MSIS-IDs from STEP 3, count the number which also appear in the claims from STEP 6STEP 8: Calculate percentage for measureDivide the number of MSIS-IDs from STEP 7 by the number of MSIS-IDs from STEP 3	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: State plan participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment STATE-PLAN-OPTION-PARTICIPATION-ELG00011 by keeping records that satisfy the following criteria:1a. STATE-PLAN-OPTION-EFF-DATE <= last day of the DQ report month2a. STATE-PLAN-OPTION-END-DATE >= last day of the DQ report month OR missingOR1b. STATE-PLAN-OPTION-EFF-DATE is missing2b. STATE-PLAN-OPTION-END-DATE is missingSTEP 3: 1915(j) eligiblesOf the MSIS-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:STATE-PLAN-OPTION-TYPE = '03'STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 5: Medicaid FFS and Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" 2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 6: HCBS under 1915(j)Of the claims from STEP 5, further restrict by the below criteria1. HCBS-SERVICE-CODE = "2"STEP 7: Eligibles with OT claimsOf the MSIS-IDs from STEP 3, count the number which also appear in the claims from STEP 6STEP 8: Calculate percentage for measureDivide the number of MSIS-IDs from STEP 7 by the number of MSIS-IDs from STEP 3
04/24/2025	4.0.7	ALL-2-006-6	ADD	N/A		Created
08/13/2025	4.0.16	ALL-2-005-5	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: State plan participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment STATE-PLAN-OPTION-PARTICIPATION-ELG00011 by keeping records that satisfy the following criteria:1a. STATE-PLAN-OPTION-EFF-DATE <= last day of the DQ report month2a. STATE-PLAN-OPTION-END-DATE >= last day of the DQ report month OR missingOR1b. STATE-PLAN-OPTION-EFF-DATE is missing2b. STATE-PLAN-OPTION-END-DATE is missingSTEP 3: 1915(j) eligiblesOf the MSIS-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:STATE-PLAN-OPTION-TYPE = '03'STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 5: Medicaid FFS and Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" 2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 6: Eligibles with OT claimsOf the MSIS-IDs from STEP 3, count the number which also appear in the claims from STEP 5STEP 7: Calculate percentage for measureDivide the number of MSIS-IDs from STEP 6 by the number of MSIS-IDs from STEP 3	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: State plan participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment STATE-PLAN-OPTION-PARTICIPATION-ELG00011 by keeping records that satisfy the following criteria:1a. STATE-PLAN-OPTION-EFF-DATE <= last day of the DQ report month2a. STATE-PLAN-OPTION-END-DATE >= last day of the DQ report month OR missingOR1b. STATE-PLAN-OPTION-EFF-DATE is missing2b. STATE-PLAN-OPTION-END-DATE is missingSTEP 3: 1915(j) eligiblesOf the MSIS-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:STATE-PLAN-OPTION-TYPE = '03'STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 5: Medicaid FFS and Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" 2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 6: Eligibles with OT claimsOf the MSIS-IDs from STEP 3, count the number which also appear in the claims from STEP 5STEP 7: Calculate percentage for measureDivide the number of MSIS-IDs from STEP 6 by the number of MSIS-IDs from STEP 3
04/24/2025	4.0.7	ALL-2-005-5	ADD	N/A		Created
08/13/2025	4.0.16	ALL-2-004-4	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: State plan participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment STATE-PLAN-OPTION-PARTICIPATION-ELG00011 by keeping records that satisfy the following criteria:1a. STATE-PLAN-OPTION-EFF-DATE <= last day of the DQ report month2a. STATE-PLAN-OPTION-END-DATE >= last day of the DQ report month OR missingOR1b. STATE-PLAN-OPTION-EFF-DATE is missing2b. STATE-PLAN-OPTION-END-DATE is missingSTEP 3: 1915(i) eligiblesOf the MSIS-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:STATE-PLAN-OPTION-TYPE = '02'STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 5: Medicaid FFS and Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" 2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 6: HCBS under 1915(i)Of the claims from STEP 5, further restrict by the below criteria1. HCBS-SERVICE-CODE = "1"STEP 7: Eligibles with OT claimsOf the MSIS-IDs from STEP 3, count the number which also appear in the claims from STEP 6STEP 8: Calculate percentage for measureDivide the number of MSIS-IDs from STEP 7 by the number of MSIS-IDs from STEP 3	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: State plan participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment STATE-PLAN-OPTION-PARTICIPATION-ELG00011 by keeping records that satisfy the following criteria:1a. STATE-PLAN-OPTION-EFF-DATE <= last day of the DQ report month2a. STATE-PLAN-OPTION-END-DATE >= last day of the DQ report month OR missingOR1b. STATE-PLAN-OPTION-EFF-DATE is missing2b. STATE-PLAN-OPTION-END-DATE is missingSTEP 3: 1915(i) eligiblesOf the MSIS-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:STATE-PLAN-OPTION-TYPE = '02'STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 5: Medicaid FFS and Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" 2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 6: HCBS under 1915(i)Of the claims from STEP 5, further restrict by the below criteria1. HCBS-SERVICE-CODE = "1"STEP 7: Eligibles with OT claimsOf the MSIS-IDs from STEP 3, count the number which also appear in the claims from STEP 6STEP 8: Calculate percentage for measureDivide the number of MSIS-IDs from STEP 7 by the number of MSIS-IDs from STEP 3
04/24/2025	4.0.7	ALL-2-004-4	ADD	N/A		Created
08/13/2025	4.0.16	ALL-2-003-3	UPDATE	Specification	STEP 1: STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: State plan participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment STATE-PLAN-OPTION-PARTICIPATION-ELG00011 by keeping records that satisfy the following criteria:1a. STATE-PLAN-OPTION-EFF-DATE <= last day of the DQ report month2a. STATE-PLAN-OPTION-END-DATE >= last day of the DQ report month OR missingOR1b. STATE-PLAN-OPTION-EFF-DATE is missing2b. STATE-PLAN-OPTION-END-DATE is missingSTEP 3: 1915(i) eligiblesOf the MSIS-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:STATE-PLAN-OPTION-TYPE = '02'STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 5: Medicaid FFS and Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" 2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 6: Eligibles with OT claimsOf the MSIS-IDs from STEP 3, count the number which also appear in the claims from STEP 5STEP 7: Calculate percentage for measureDivide the number of MSIS-IDs from STEP 6 by the number of MSIS-IDs from STEP 3	STEP 1: STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: State plan participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment STATE-PLAN-OPTION-PARTICIPATION-ELG00011 by keeping records that satisfy the following criteria:1a. STATE-PLAN-OPTION-EFF-DATE <= last day of the DQ report month2a. STATE-PLAN-OPTION-END-DATE >= last day of the DQ report month OR missingOR1b. STATE-PLAN-OPTION-EFF-DATE is missing2b. STATE-PLAN-OPTION-END-DATE is missingSTEP 3: 1915(i) eligiblesOf the MSIS-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:STATE-PLAN-OPTION-TYPE = '02'STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 5: Medicaid FFS and Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" 2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 6: Eligibles with OT claimsOf the MSIS-IDs from STEP 3, count the number which also appear in the claims from STEP 5STEP 7: Calculate percentage for measureDivide the number of MSIS-IDs from STEP 6 by the number of MSIS-IDs from STEP 3
04/24/2025	4.0.7	ALL-2-003-3	ADD	N/A		Created
08/13/2025	4.0.16	ALL-2-002-2	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: State plan participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment STATE-PLAN-OPTION-PARTICIPATION-ELG00011 by keeping records that satisfy the following criteria:1a. STATE-PLAN-OPTION-EFF-DATE <= last day of the DQ report month2a. STATE-PLAN-OPTION-END-DATE >= last day of the DQ report month OR missingOR1b. STATE-PLAN-OPTION-EFF-DATE is missing2b. STATE-PLAN-OPTION-END-DATE is missingSTEP 3: Community First ChoiceOf the MSIS-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:STATE-PLAN-OPTION-TYPE = '01'STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 5: Medicaid FFS and Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" 2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 6: Eligibles with OT claimsOf the MSIS-IDs from STEP 3, count the number which also appear in the claims from STEP 5STEP 7: Calculate percentage for measureDivide the number of MSIS-IDs from STEP 6 by the number of MSIS-IDs from STEP 3	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: State plan participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment STATE-PLAN-OPTION-PARTICIPATION-ELG00011 by keeping records that satisfy the following criteria:1a. STATE-PLAN-OPTION-EFF-DATE <= last day of the DQ report month2a. STATE-PLAN-OPTION-END-DATE >= last day of the DQ report month OR missingOR1b. STATE-PLAN-OPTION-EFF-DATE is missing2b. STATE-PLAN-OPTION-END-DATE is missingSTEP 3: Community First ChoiceOf the MSIS-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:STATE-PLAN-OPTION-TYPE = '01'STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 5: Medicaid FFS and Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" 2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 6: Eligibles with OT claimsOf the MSIS-IDs from STEP 3, count the number which also appear in the claims from STEP 5STEP 7: Calculate percentage for measureDivide the number of MSIS-IDs from STEP 6 by the number of MSIS-IDs from STEP 3
04/24/2025	4.0.7	ALL-2-002-2	ADD	N/A		Created
08/13/2025	4.0.16	ALL-2-001-1	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS and Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" 2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Count the number of unique HCBS taxonomy valid valuesOf the claims that meet the criteria from step 2, count the number of unique HCBS-TAXONOMY valid values.Note: HCBS-TAXONOMY valid values are: "01010", "02011", "02012", "02013", "02021", "02022", "02023", "02031", "02032", "02033", "03010", "03021", "03022", "03030", "04010", "04020", "04030", "04040", "04050", "04060", "04070", "04080", "05010", "05020", "06010", "07010", "08010", "08020", "08030", "08040", "08050", "08060", "09011", "09012", "09020", "10010", "10020", "10030", "10040", "10050", "10060", "10070", "10080", "10090", "11010", "11020", "11030", "11040", "11050", "11060", "11070", "11080", "11090", "11100", "11120", "11130", "12010", "12020", "13010", "14010", "14020", "14031", "14032", "15010", "16010", "17010", "17020", "17030", "17990"	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS and Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" 2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Count the number of unique HCBS taxonomy valid valuesOf the claims that meet the criteria from step 2, count the number of unique HCBS-TAXONOMY valid values.Note: HCBS-TAXONOMY valid values are: "01010", "02011", "02012", "02013", "02021", "02022", "02023", "02031", "02032", "02033", "03010", "03021", "03022", "03030", "04010", "04020", "04030", "04040", "04050", "04060", "04070", "04080", "05010", "05020", "06010", "07010", "08010", "08020", "08030", "08040", "08050", "08060", "09011", "09012", "09020", "10010", "10020", "10030", "10040", "10050", "10060", "10070", "10080", "10090", "11010", "11020", "11030", "11040", "11050", "11060", "11070", "11080", "11090", "11100", "11120", "11130", "12010", "12020", "13010", "14010", "14020", "14031", "14032", "15010", "16010", "17010", "17020", "17030", "17990"
04/24/2025	4.0.7	ALL-2-001-1	ADD	N/A		Created
04/24/2025	4.0.7	ALL-1-014-14	ADD	N/A		Created
04/24/2025	4.0.7	ALL-1-013-13	ADD	N/A		Created
04/24/2025	4.0.7	ALL-1-012-12	ADD	N/A		Created
04/24/2025	4.0.7	ALL-1-011-11	ADD	N/A		Created
04/24/2025	4.0.7	ALL-1-010-10	ADD	N/A		Created
04/24/2025	4.0.7	ALL-1-009-9	ADD	N/A		Created
04/24/2025	4.0.7	ALL-1-008-6	ADD	N/A		Created
04/24/2025	4.0.7	ALL-1-007-5	ADD	N/A		Created
04/24/2025	4.0.7	ALL-1-006-4	ADD	N/A		Created
04/24/2025	4.0.7	ALL-1-005-3	ADD	N/A		Created
04/24/2025	4.0.7	ALL-1-004-2	ADD	N/A		Created
04/24/2025	4.0.7	ALL-1-003-1	ADD	N/A		Created
04/24/2025	4.0.7	ALL-1-002-8	ADD	N/A		Created
05/29/2025	4.0.9	FTX.095.391	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. Mandatory	1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. Mandatory
05/29/2025	4.0.9	FTX.009.343	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. Mandatory	1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. Mandatory
06/19/2025	4.0.11	FTX.008.304	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)	1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Mandatory
05/29/2025	4.0.9	FTX.007.264	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. Mandatory	1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. Mandatory
05/07/2025	4.0.8	FTX.006.219	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. Mandatory
05/29/2025	4.0.9	FTX.005.177	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. Mandatory6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)	1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. Mandatory6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)
05/29/2025	4.0.9	FTX.005.173	UPDATE	Definition	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique â€œkeyâ€ value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique �key� value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/
05/29/2025	4.0.9	FTX.004.135	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. If Policy Owner Code equals "01", then value must be populated6. Conditional7. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated	1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. If Policy Owner Code equals "01", then value must be populated6. Conditional7. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated
05/29/2025	4.0.9	FTX.004.127	UPDATE	Definition	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique â€œkeyâ€ value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ MSIS-IDENTIFICATION-NUM is conditional in the FTX00004 segment because some members of a private group policy may not be eligible for Medicaid or CHIP, though at least one member of the group policy must be eligible for Medicaid or CHIP. There should be one FTX00004 segment for each member of the group policy for which the premium assistance payment is being paid, regardless of whether the member of the group policy was eligible for and enrolled in Medicaid or CHIP.	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique �key� value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ MSIS-IDENTIFICATION-NUM is conditional in the FTX00004 segment because some members of a private group policy may not be eligible for Medicaid or CHIP, though at least one member of the group policy must be eligible for Medicaid or CHIP. There should be one FTX00004 segment for each member of the group policy for which the premium assistance payment is being paid, regardless of whether the member of the group policy was eligible for and enrolled in Medicaid or CHIP.
05/29/2025	4.0.9	FTX.003.091	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. Mandatory	1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. Mandatory
05/29/2025	4.0.9	FTX.003.086	UPDATE	Definition	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique â€œkeyâ€ value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique �key� value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/
05/29/2025	4.0.9	FTX.002.046	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. If Subcapitation Indicator equals "1", then value must be populated6. Conditional7. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated	1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. If Subcapitation Indicator equals "1", then value must be populated6. Conditional7. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated
05/29/2025	4.0.9	CRX.003.180	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated	1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated
05/29/2025	4.0.9	COT.003.256	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated	1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated
05/07/2025	4.0.8	COT.003.254	UPDATE	Coding requirement	1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Conditional5. If TYPE-OF-CLAIM is in [1,3,A,C,U,W] and a CPT-4 code or a CDT code (begins with the letter 'D'), then value must be populated	1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Conditional5. If Type of Claim is in [1,3,A,C,U,W] and a CPT-4 code or a CDT code (begins with the letter 'D'), then value must be populated
05/29/2025	4.0.9	CLT.003.261	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated	1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated
07/10/2025	4.0.13	CLT.002.167	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.167	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier, where Provider Identifier Type (PRV.005.077) equals "2"3. Value must exist in the NPPES NPI data file4. Conditional	1. Value must be 10 digits2. Value must have an associated Provider Identifier, where Provider Identifier Type (PRV.005.077) equals "2"3. Value must exist in the NPPES NPI data file4. Situational
05/29/2025	4.0.9	CIP.003.315	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated	1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated
04/24/2025	4.0.7	ALL-1-001-7	ADD	N/A		Created
05/30/2025	4.0.9	Data Quality Measures	UPDATE	Version text	4.0.0	4.0.9
10/10/2025	4.0.19	FTX.095.373	UPDATE	Definition	This is the identifier that corresponds with the payee's role in relation to the Medicaid/CHIP system. The payee is the individual or entity that is either receiving a payment or having a previous payment recouped. The payee is the object of the transaction, as opposed to the payer who is the subject taking the action of either making a payment or taking a recoupment.	This is the identifier that corresponds with the payee's role in relation to the Medicaid/CHIP system. The payee is the individual or entity that is either receiving a payment or having a previous payment recouped. The payee is the object of the transaction, as opposed to the payer who is the subject taking the action of either making a payment or taking a recoupment. For PCCM financial transactions, states may use Payee ID Type “05”, “06" and MCR Plan Type “02”.
04/24/2025	4.0.7	FTX.002.046	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Value must be populated when Payer ID Type equals "01"11. Conditional12. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated	1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. If Subcapitation Indicator equals "1", then value must be populated6. Conditional7. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated
06/19/2025	4.0.11	FTX.002.047	UPDATE	Coding requirement	1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Value must be populated when Payer ID Type equals "01"6. Conditional7. Value must be populated when Payer ID Type equals "01"	1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Value must be populated when Payer ID Type equals "01"6. Conditional
04/15/2025	4.0.6	FTX.002.047	UPDATE	Coding requirement	1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Value must be populated when Payer ID Type equals "01"6. Conditional	1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Value must be populated when Payer ID Type equals "01"6. Conditional7. Value must be populated when Payer ID Type equals "01"
04/15/2025	4.0.6	FTX.002.046	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Value must be populated when Payer ID Type equals "01"11. Conditional12. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated13. Value must be populated when Payer ID Type equals "01"7. Value must be populated when Payer ID Type equals "01"	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Value must be populated when Payer ID Type equals "01"11. Conditional12. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated
04/15/2025	4.0.6	COT.004.281	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Diagnosis Type Code List (VVL)3. Value must be in [D,E,O,P,R]4. Mandatory	1. Value must be 1 character2. Value must be in Diagnosis Type Code List (VVL)3. Mandatory
04/02/2025	4.0.6	CLAIM-DX-IP	UPDATE	Record segment definition	A record segment to capture data about the diagnosis code(s) associated with a claim. -test	A record segment to capture data about the diagnosis code(s) associated with a claim.
04/02/2025	4.0.6	CLAIM-DX-IP	UPDATE	Record segment definition	A record segment to capture data about the diagnosis code(s) associated with a claim.	A record segment to capture data about the diagnosis code(s) associated with a claim. -test
04/02/2025	4.0.6	CLAIM-DX-IP	UPDATE	Record segment definition	A record segment to capture data about the diagnosis code(s) associated with a claim. -test	A record segment to capture data about the diagnosis code(s) associated with a claim.
04/11/2025	4.0.6	FTX.002.046	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Value must be populated when Payer ID Type equals "01"11. Conditional12. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Value must be populated when Payer ID Type equals "01"11. Conditional12. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated13. Value must be populated when Payer ID Type equals "01"7. Value must be populated when Payer ID Type equals "01"
04/11/2025	4.0.6	FTX.002.047	UPDATE	Coding requirement	Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Value must be populated when Payer ID Type equals "01"6. Conditional 7. Value must be populated when Payer ID Type equals "01"7. Value must be populated when Payer ID Type equals "01"	1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Value must be populated when Payer ID Type equals "01"6. Conditional
03/27/2025	4.0.5	FTX.002.046	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Value must be populated when Payer ID Type equals "01"11. Conditional12. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated13. Value must be populated when Payer ID Type equals "01"	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Value must be populated when Payer ID Type equals "01"11. Conditional12. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated
04/11/2025	4.0.6	COT.004.281	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Diagnosis Type Code List (VVL)3. Mandatory	1. Value must be 1 character2. Value must be in Diagnosis Type Code List (VVL)3. Value must be in [D,E,O,P,R]4. Mandatory
07/10/2025	4.0.13	FTX.004.146	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.004.146	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Conditional	1. Value must be 500 characters or less2. Situational
07/10/2025	4.0.13	FTX.003.102	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.003.102	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Conditional	1. Value must be 500 characters or less2. Situational
03/26/2025	4.0.5	FTX.002.046	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Value must be populated when Payer ID Type equals "01"11. Conditional12. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated13. Value must be populated when Payer ID Type equals "01"7. Value must be populated when Payer ID Type equals "01"	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Value must be populated when Payer ID Type equals "01"11. Conditional12. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated13. Value must be populated when Payer ID Type equals "01"
07/17/2025	4.0.14	ELG.003.273	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	ELG.003.273	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Conditional3. Value must be on or before Enrollment End Date (ELG.021.254)	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Situational3. Value must be on or before Enrollment End Date (ELG.021.254)
07/17/2025	4.0.14	CRX.004.204	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	CRX.004.204	UPDATE	Coding requirement	1. Value must be in [01-24]2. Conditional3. Value must be 2 digits	1. Value must be in [01-24]2. Situational3. Value must be 2 digits
07/10/2025	4.0.13	CRX.003.118	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.003.118	UPDATE	Coding requirement	1. Value must be 12 characters or less2. Conditional	1. Value must be 12 characters or less2. Situaitional
07/10/2025	4.0.13	CRX.002.021	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.021	UPDATE	Coding requirement	1. Value must be 12 characters or less2. Conditional	1. Value must be 12 characters or less2. Situational
07/17/2025	4.0.14	COT.003.289	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.289	UPDATE	Coding requirement	1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Conditional	1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Situational
07/17/2025	4.0.14	COT.003.288	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.288	UPDATE	Coding requirement	1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Conditional	1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Situational
07/17/2025	4.0.14	COT.003.287	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.287	UPDATE	Coding requirement	1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Conditional	1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Situational
07/17/2025	4.0.14	COT.003.271	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.271	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Situational
07/17/2025	4.0.14	COT.003.255	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.255	UPDATE	Coding requirement	1. Value must not be more than 76 characters long2. Conditional	1. Value must not be more than 76 characters long2. Situational
04/24/2025	4.0.7	COT.003.254	UPDATE	Necessity	Mandatory	Conditional
04/24/2025	4.0.7	COT.003.254	UPDATE	Coding requirement	1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Mandatory	1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Conditional5. If TYPE-OF-CLAIM is in [1,3,A,C,U,W] and a CPT-4 code or a CDT code (begins with the letter 'D'), then value must be populated
07/17/2025	4.0.14	PRV.002.031	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	PRV.002.031	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Sex List (VVL)3. Conditional	1. Value must be 1 character2. Value must be in Sex List (VVL)3. Situational
04/15/2025	4.0.6	MCR.010.119	UPDATE	Data element name	MANAGED-CARE-PLAN-ID	MANAGED-CARE-PLAN-OTHER-ID
07/10/2025	4.0.13	FTX.095.388	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.095.388	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Transaction Type List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Transaction Type List (VVL)3. Situational
07/10/2025	4.0.13	FTX.095.382	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.095.382	UPDATE	Coding requirement	1. Value must be 12 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional	1. Value must be 12 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
07/10/2025	4.0.13	FTX.095.381	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.095.381	UPDATE	Coding requirement	1. Value must be 100 characters or less2. Conditional	1. Value must be 100 characters or less2. Situational
10/10/2025	4.0.19	FTX.095.376	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Managed Care Plan Type List (VVL)3. If Payee ID Type is in [02,03], then value must be populated4. If Payee ID Type is not [02,03], then value must not be populated5. Conditional	1. Value must be 2 characters2. Value must be in Managed Care Plan Type List (VVL)3. If Payee ID Type is in [02,03], then value must be populated4. If Payee ID Type is in [05,06], then value must equal '02'5. Conditional
09/25/2025	4.0.18	FTX.009.345	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. Value must be populated when Payer ID Type equals "01"	1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. Value must be populated when Payer ID Type equals "01"5. If Payer ID Type is in [02,03,04] value must not be populated
09/25/2025	4.0.18	FTX.009.344	UPDATE	Coding requirement	1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Conditional6. Value must be populated when Payer ID Type equals "01"	1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Conditional6. Value must be populated when Payer ID Type equals "01"7. If Payer ID Type is in [02,03,04] value must not be populated
04/24/2025	4.0.7	FTX.009.343	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Conditional11. Value must be populated when Payer ID Type equals "01"	1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. Mandatory
09/25/2025	4.0.18	FTX.009.342	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Category for Federal Reimbursement List (VVL)3. Conditional4. Value must be populated when Payer ID Type equals "01"	1. Value must be 2 characters2. Value must be in Category for Federal Reimbursement List (VVL)3. Conditional4. Value must be populated when Payer ID Type equals "01"5. If Payer ID Type is in [02,03,04] value must not be populated
03/14/2025	4.0.4	FTX.008.301	UPDATE	Definition	The date representing the beginning of the cost-settlement period. For example, if the cost-settlement is for the first calendar quarter of the year, then the cost settlement begin date would be March 1 of that year.	The date representing the beginning of the cost settlement period. For example, if the cost settlement is for the first calendar quarter of the year then the Cost Settlement Period Start Date would be January 1 of that year and the Cost Settlement Period End Date would be March 31 of that year. Likewise, if the cost settlement is for the first calendar month of the year then the Cost Settlement Period Start Date would be January 1 of that year and the Cost Settlement Period End Date would be January 31 of that year.
04/24/2025	4.0.7	FTX.007.264	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Conditional11. Value must be populated when Payer ID Type equals "01"	1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. Mandatory
02/27/2025	4.0.3	FTX.007.263	UPDATE	Coding requirement	4. Value must be populated when Payer ID Type equals "01"1. Value must be 2 characters2. Value must be in Category for Federal Reimbursement List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Category for Federal Reimbursement List (VVL)3. Conditional4. Value must be populated when Payer ID Type equals "01"
05/29/2025	4.0.9	FTX.006.229	UPDATE	Definition	This is the type of value-based payment model to which the financial transaction applies. These values come from the â€œAlternative Payment Model (APM) Framework Final White Paperâ€, produced by the Healthcare Learning and Action Network. https://hcp-lan.org/work products/apm-whitepaper.pdf	This is the type of value-based payment model to which the financial transaction applies. These values come from the �Alternative Payment Model (APM) Framework Final White Paper�, produced by the Healthcare Learning and Action Network. https://hcp-lan.org/work products/apm-whitepaper.pdf
04/24/2025	4.0.7	FTX.006.219	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Conditional11. Value must be populated when Payer ID Type equals "01"	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)
05/29/2025	4.0.9	FTX.006.215	UPDATE	Definition	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique â€œkeyâ€ value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique �key� value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/
04/24/2025	4.0.7	FTX.005.173	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.021.019)4. When Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Coverage Period Start Date is equal to or greater than Enrollment Effective Date	1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.002.019)4. When Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Coverage Period Start Date is equal to or greater than Enrollment Effective Date
04/24/2025	4.0.7	FTX.004.127	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Conditional3. When populated, value must match MSIS Identification Number (ELG.021.019)4. When populated and Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Premium Period Start Date is equal to or greater than Enrollment Effective Date	1. Value must be 20 characters or less2. Conditional3. When populated, value must match MSIS Identification Number (ELG.002.019)4. When populated and Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Premium Period Start Date is equal to or greater than Enrollment Effective Date
03/14/2025	4.0.4	FTX.004.112	UPDATE	Definition	The date that the payment or recoupment was executed by the payer.	The date that the payment was executed by the payer.
03/14/2025	4.0.4	FTX.003.071	UPDATE	Definition	The date that the payment or recoupment was executed by the payer.	The date that the payment was executed by the payer.
09/25/2025	4.0.18	FTX.002.048	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Value must be populated when Payer ID Type equals "01"4. Conditional	1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Value must be populated when Payer ID Type equals "01"4. Conditional5. If Subcapitation Indicator equals "2", then value must not be populated6. When not populated, an associated MBESCBES Form Group and MBESCBES Form must not be populated
03/26/2025	4.0.5	FTX.002.047	UPDATE	Coding requirement	1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Value must be populated when Payer ID Type equals "01"6. Conditional	Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Value must be populated when Payer ID Type equals "01"6. Conditional 7. Value must be populated when Payer ID Type equals "01"7. Value must be populated when Payer ID Type equals "01"
03/14/2025	4.0.4	FTX.002.046	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Value must be populated when Payer ID Type equals "01"12. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated13. Value must be populated when Payer ID Type equals "01"7. Value must be populated when Payer ID Type equals "01"	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Value must be populated when Payer ID Type equals "01"11. Conditional12. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated13. Value must be populated when Payer ID Type equals "01"7. Value must be populated when Payer ID Type equals "01"
09/25/2025	4.0.18	FTX.002.045	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Category for Federal Reimbursement List (VVL)3. Conditional4. Value must be populated when Payer ID Type equals "01"	1. Value must be 2 characters2. Value must be in Category for Federal Reimbursement List (VVL)3. Conditional4. Value must be populated when Payer ID Type equals "01"5. If Subcapitation Indicator equals "2", then value must not be populated
11/20/2025	4.0.22	FTX.002.041	UPDATE	Definition	Managed care plan contract ID	The contract identifier associated with the managed care plan. This data element can be populated with a proxy plan ID for traditional PCCM payments.
10/10/2025	4.0.19	ELG.005.278	UPDATE	Coding requirement	1. Value must not be more than 50 characters long2. Conditional3. If Continuous Eligibility Code is "Other", then value must be populated	1. Value must not be more than 50 characters2. Conditional3. If Continuous Eligibility Code is "Other", then value must be populated
07/17/2025	4.0.14	ELG.005.274	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	ELG.005.274	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Conditional3. Value must be greater than the Eligibility Determinant Effective Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Situational3. Value must be greater than the Eligibility Determinant Effective Date
03/14/2025	4.0.4	ELG.003.273	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Conditional3. Value must be less than the Variable Demographic Element End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Conditional3. Value must be on or before Enrollment End Date (ELG.021.254)
07/17/2025	4.0.14	ELG.005.095	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	ELG.005.095	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Eligibility Termination Reason List (VVL)3. Conditional4. If Eligibility Determinant End Date (ELG.005.100) is on or after End of Time Period (ELG.001.010), then value must not be populated.	1. Value must be 2 characters2. Value must be in Eligibility Termination Reason List (VVL)3. Situational4. If Eligibility Determinant End Date (ELG.005.100) is on or after End of Time Period (ELG.001.010), then value must not be populated.
07/17/2025	4.0.14	CRX.004.206	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	CRX.004.206	UPDATE	Coding requirement	1. Value must be a minimum of 3 characters2. If associated Diagnosis Code Flag value equals "1" (ICD-9), then value must be in ICD-9 Diagnosis Code List (VVL)3. If associated Diagnosis Code Flag value equals "2" (ICD-10), then value must be in ICD-10 Diagnosis Code List (VVL)4. Value must not contain a decimal point5. Conditional	1. Value must be a minimum of 3 characters2. If associated Diagnosis Code Flag value equals "1" (ICD-9), then value must be in ICD-9 Diagnosis Code List (VVL)3. If associated Diagnosis Code Flag value equals "2" (ICD-10), then value must be in ICD-10 Diagnosis Code List (VVL)4. Value must not contain a decimal point5. Situational
07/17/2025	4.0.14	CRX.004.205	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	CRX.004.205	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Diagnosis Code Flag List (VVL)3. Conditional	1. Value must be 1 character2. Value must be in Diagnosis Code Flag List (VVL)3. Situational
03/14/2025	4.0.4	CRX.004.204	UPDATE	Coding requirement	1. Value must be in [01-24]2. Conditional	1. Value must be in [01-24]2. Conditional3. Value must be 2 digits
05/29/2025	4.0.9	CRX.003.136	UPDATE	Definition	A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012. To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting. Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as â€œextended state planâ€ services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment. The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a stateâ€™s service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc. Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf"	A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012. To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting. Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as �extended state plan� services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment. The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a state�s service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc. Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf"
07/10/2025	4.0.13	CRX.003.131	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.003.131	UPDATE	Coding requirement	1. Value may include up to 9 digits to the left of the decimal point, and 9 digits to the right e.g. 123456789.1234567892. Conditional	1. Value may include up to 9 digits to the left of the decimal point, and 9 digits to the right e.g. 123456789.1234567892. Situational
07/10/2025	4.0.13	CRX.002.105	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.105	UPDATE	Coding requirement	1. Conditional2. Value must be an 11-character string3. Character 1 must be numeric values 1 thru 94. Character 2 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)5. Character 3 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)6. Character 4 must be numeric values 0 thru 97. Character 5 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)8. Character 6 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)9. Character 7 must be numeric values 0 thru 910. Character 8 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)11. Character 9 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)12. Character 10 must be numeric values 0 thru 913. Character 11 must be numeric values 0 thru 914. Value must not contain a pipe or asterisk symbols	1. Situational2. Value must be an 11-character string3. Character 1 must be numeric values 1 thru 94. Character 2 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)5. Character 3 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)6. Character 4 must be numeric values 0 thru 97. Character 5 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)8. Character 6 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)9. Character 7 must be numeric values 0 thru 910. Character 8 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)11. Character 9 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)12. Character 10 must be numeric values 0 thru 913. Character 11 must be numeric values 0 thru 914. Value must not contain a pipe or asterisk symbols
05/29/2025	4.0.9	CRX.002.075	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Mandatory4. Value must exist in the NPPES NPI data file5. NPPES Entity Type Code associated with this NPI must equal ‘1’ (Individual)	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Mandatory4. Value must exist in the NPPES NPI data file5. NPPES Entity Type Code associated with this NPI must equal �1� (Individual)
05/29/2025	4.0.9	COT.003.264	UPDATE	Definition	A pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claim form (i.e., 837P or 837D - Place of Service is only captured at the line level of the CMS-1500). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than â€œBâ€, then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS-1450 (UB-04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled.	A pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claim form (i.e., 837P or 837D - Place of Service is only captured at the line level of the CMS-1500). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than �B�, then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS-1450 (UB-04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled.
07/17/2025	4.0.14	COT.003.262	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.262	UPDATE	Coding requirement	1. Value must not be more than 2 characters2. Value must be in State Code list (VVL)3. Conditional	1. Value must not be more than 2 characters2. Value must be in State Code list (VVL)3. Situational
07/17/2025	4.0.14	COT.002.245	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.245	UPDATE	Coding requirement	1. Value must not be more than 2 characters2. Value must be in State Code list (VVL)3. Conditional	1. Value must not be more than 2 characters2. Value must be in State Code list (VVL)3. Situational
10/10/2025	4.0.19	COT.002.238	UPDATE	Coding requirement	1. Value must not be more than 28 characters long2. Mandatory	1. Value must not be more than 28 characters2. Mandatory
05/29/2025	4.0.9	COT.003.188	UPDATE	Definition	A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012. To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting. Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as â€œextended state planâ€ services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment. The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a stateâ€™s service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc. Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf"	A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012. To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting. Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as �extended state plan� services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment. The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a state�s service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc. Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf"
07/17/2025	4.0.14	COT.002.147	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.147	UPDATE	Coding requirement	1. Conditional2. Value must be an 11-character string3. Character 1 must be numeric values 1 thru 94. Character 2 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)5. Character 3 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)6. Character 4 must be numeric values 0 thru 97. Character 5 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)8. Character 6 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)9. Character 7 must be numeric values 0 thru 910. Character 8 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)11. Character 9 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)12. Character 10 must be numeric values 0 thru 913. Character 11 must be numeric values 0 thru 914. Value must not contain a pipe or asterisk symbols	1. Situational2. Value must be an 11-character string3. Character 1 must be numeric values 1 thru 94. Character 2 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)5. Character 3 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)6. Character 4 must be numeric values 0 thru 97. Character 5 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)8. Character 6 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)9. Character 7 must be numeric values 0 thru 910. Character 8 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)11. Character 9 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)12. Character 10 must be numeric values 0 thru 913. Character 11 must be numeric values 0 thru 914. Value must not contain a pipe or asterisk symbols
05/29/2025	4.0.9	COT.002.123	UPDATE	Definition	A pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claim form (i.e., 837P or 837D - Place of Service is only captured at the line level of the CMS-1500). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than â€œBâ€, then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS-1450 (UB-04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled.	A pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claim form (i.e., 837P or 837D - Place of Service is only captured at the line level of the CMS-1500). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than �B�, then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS-1450 (UB-04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled.
07/17/2025	4.0.14	COT.002.083	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.083	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational
07/17/2025	4.0.14	COT.002.082	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.082	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational
07/17/2025	4.0.14	COT.002.081	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.081	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational
07/17/2025	4.0.14	COT.002.080	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.080	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational
07/17/2025	4.0.14	COT.002.079	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.079	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational
07/17/2025	4.0.14	COT.002.078	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.078	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational
07/17/2025	4.0.14	COT.002.077	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.077	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational
07/17/2025	4.0.14	COT.002.076	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.076	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational
07/17/2025	4.0.14	COT.002.075	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.075	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational
07/17/2025	4.0.14	COT.002.074	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.074	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational
07/10/2025	4.0.13	CLT.002.253	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.253	UPDATE	Coding requirement	1. Value must not be more than 2 characters2. Value must be in State Code List (VVL)3. Conditional	1. Value must not be more than 2 characters2. Value must be in State Code List (VVL)3. Situational
10/10/2025	4.0.19	CLT.002.246	UPDATE	Coding requirement	1. Value must not be more than 28 characters long2. Mandatory	1. Value must not be more than 28 characters2. Mandatory
07/10/2025	4.0.13	CLT.002.178	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.178	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Provider Type Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Provider Type Code List (VVL)3. Situational
07/10/2025	4.0.13	CLT.002.168	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.168	UPDATE	Coding requirement	1. Conditional2. Value must be an 11-character string3. Character 1 must be numeric values 1 thru 94. Character 2 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)5. Character 3 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)6. Character 4 must be numeric values 0 thru 97. Character 5 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)8. Character 6 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)9. Character 7 must be numeric values 0 thru 910. Character 8 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)11. Character 9 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)12. Character 10 must be numeric values 0 thru 913. Character 11 must be numeric values 0 thru 914. Value must not contain a pipe or asterisk symbols	1. Situational2. Value must be an 11-character string3. Character 1 must be numeric values 1 thru 94. Character 2 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)5. Character 3 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)6. Character 4 must be numeric values 0 thru 97. Character 5 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)8. Character 6 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)9. Character 7 must be numeric values 0 thru 910. Character 8 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)11. Character 9 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)12. Character 10 must be numeric values 0 thru 913. Character 11 must be numeric values 0 thru 914. Value must not contain a pipe or asterisk symbols
07/10/2025	4.0.13	CLT.002.130	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.130	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in [3,C,W] then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in [3,C,W] then value may match (PRV.005.081) Provider Identifier where the Provider Identifier Type (PRV.005.077) equals "1"5. Discharge Date (CLT.002.046) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or6. Discharge Date (CLT.002.046) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080)	1. Value must be 30 characters or less2. Situational3. When Type of Claim not in [3,C,W] then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in [3,C,W] then value may match (PRV.005.081) Provider Identifier where the Provider Identifier Type (PRV.005.077) equals "1"5. Discharge Date (CLT.002.046) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or6. Discharge Date (CLT.002.046) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080)
07/10/2025	4.0.13	CLT.002.101	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.101	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational
07/10/2025	4.0.13	CLT.002.100	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.100	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational
07/10/2025	4.0.13	CLT.002.099	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.099	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational
07/10/2025	4.0.13	CLT.002.098	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.098	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational
07/10/2025	4.0.13	CLT.002.097	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.097	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational
07/10/2025	4.0.13	CLT.002.096	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.096	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational
07/10/2025	4.0.13	CLT.002.095	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.095	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational
07/10/2025	4.0.13	CLT.002.094	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.094	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational
07/10/2025	4.0.13	CLT.002.093	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.093	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational
07/10/2025	4.0.13	CLT.002.092	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.092	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational
06/05/2025	4.0.10	CLT.002.086	UPDATE	Coding requirement	1. Value must be a positive integer2. Value must be between 00000:99999 (inclusive)3. Conditional4. The sum of the value provided here plus the Non Covered Days (CLT.002.084) must be less than or equal to the number of days between Beginning Date of Service (CLT.002.048) and Ending Date of Service (CLT.002.049) plus one day5. Value must be 5 digits or less6. (inpatient mental health/psychiatric services) when associated Type of Service (CLT.003.211) in [044,048,050], this field must be populated	1. Value must be a positive integer2. Value must be between 00000:99999 (inclusive)3. Conditional4. The sum of the value provided here plus the Non Covered Days (CLT.002.084) must be less than or equal to the number of days between Beginning Date of Service (CLT.002.048) and Ending Date of Service (CLT.002.049) plus one day5. Value must be 5 digits or lessValue is required if the associated Type of Service (CLT.003.211) in [044,048,050] (inpatient mental health/psychiatric services)
07/10/2025	4.0.13	CIP.002.307	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.307	UPDATE	Coding requirement	1. Value must not be more than 2 characters2. Value must be in State Code list (VVL)3. Conditional	1. Value must not be more than 2 characters2. Value must be in State Code list (VVL)3. Situational
10/10/2025	4.0.19	CIP.002.300	UPDATE	Coding requirement	1. Value must not be more than 28 characters long2. Mandatory	1. Value must not be more than 28 characters2. Mandatory
07/10/2025	4.0.13	CIP.002.222	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.222	UPDATE	Coding requirement	1. Conditional2. Value must be an 11-character string3. Character 1 must be numeric values 1 thru 94. Character 2 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)5. Character 3 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)6. Character 4 must be numeric values 0 thru 97. Character 5 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)8. Character 6 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)9. Character 7 must be numeric values 0 thru 910. Character 8 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)11. Character 9 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)12. Character 10 must be numeric values 0 thru 913. Character 11 must be numeric values 0 thru 914. Value must not contain a pipe or asterisk symbols	1. Situational2. Value must be an 11-character string3. Character 1 must be numeric values 1 thru 94. Character 2 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)5. Character 3 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)6. Character 4 must be numeric values 0 thru 97. Character 5 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)8. Character 6 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)9. Character 7 must be numeric values 0 thru 910. Character 8 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)11. Character 9 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)12. Character 10 must be numeric values 0 thru 913. Character 11 must be numeric values 0 thru 914. Value must not contain a pipe or asterisk symbols
07/10/2025	4.0.13	CIP.002.188	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.188	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Provider Type Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Provider Type Code List (VVL)3. Situational
07/10/2025	4.0.13	CIP.002.149	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.149	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational
07/10/2025	4.0.13	CIP.002.148	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.148	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational
07/10/2025	4.0.13	CIP.002.147	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.147	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational
07/10/2025	4.0.13	CIP.002.146	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.146	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational
07/10/2025	4.0.13	CIP.002.145	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.145	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational
07/10/2025	4.0.13	CIP.002.144	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.144	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational
07/10/2025	4.0.13	CIP.002.143	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.143	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational
07/10/2025	4.0.13	CIP.002.142	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.142	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational
07/10/2025	4.0.13	CIP.002.141	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.141	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational
07/10/2025	4.0.13	CIP.002.140	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.140	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational
07/10/2025	4.0.13	CIP.002.121	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.121	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Other Insurance Indicator List (VVL)3. Conditional	1. Value must be 1 character2. Value must be in Other Insurance Indicator List (VVL)3. Situational
02/20/2025	4.0.3	SOGI	REMOVE	N/A	Removed
02/20/2025	4.0.3	ELG.023.289	REMOVE	N/A	Removed
02/20/2025	4.0.3	ELG.023.290	REMOVE	N/A	Removed
02/20/2025	4.0.3	ELG.023.288	REMOVE	N/A	Removed
02/20/2025	4.0.3	ELG.023.287	REMOVE	N/A	Removed
02/20/2025	4.0.3	ELG.023.286	REMOVE	N/A	Removed
02/20/2025	4.0.3	ELG.023.285	REMOVE	N/A	Removed
02/20/2025	4.0.3	ELG.023.284	REMOVE	N/A	Removed
02/20/2025	4.0.3	ELG.023.283	REMOVE	N/A	Removed
02/20/2025	4.0.3	ELG.023.291	REMOVE	N/A	Removed
02/20/2025	4.0.3	ELG.023.282	REMOVE	N/A	Removed
02/20/2025	4.0.3	ELG.002.023	ADD	N/A		Created
02/20/2025	4.0.3	ELG.002.023	REMOVE	N/A	Removed
02/20/2025	4.0.3	ELG.023.292	REMOVE	N/A	Removed
02/20/2025	4.0.3	ELG.023.293	REMOVE	N/A	Removed
02/20/2025	4.0.3	ELG.023.294	REMOVE	N/A	Removed
05/29/2025	4.0.9	FTX.095.383	UPDATE	Definition	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique â€œkeyâ€ value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique �key� value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/
05/29/2025	4.0.9	FTX.095.361	UPDATE	Definition	The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.).	A unique claim/transaction number assigned by the state�s payment system that identifies the adjustment claim/transaction for an original item control number.
05/29/2025	4.0.9	FTX.009.322	UPDATE	Definition	A unique claim/transaction number assigned by the stateâ€™s payment system that identifies the adjustment claim/transaction for an original item control number.	A unique claim/transaction number assigned by the state�s payment system that identifies the adjustment claim/transaction for an original item control number.
05/29/2025	4.0.9	FTX.008.283	UPDATE	Definition	A unique claim/transaction number assigned by the stateâ€™s payment system that identifies the adjustment claim/transaction for an original item control number.	A unique claim/transaction number assigned by the state�s payment system that identifies the adjustment claim/transaction for an original item control number.
05/29/2025	4.0.9	FTX.007.240	UPDATE	Definition	A unique claim/transaction number assigned by the stateâ€™s payment system that identifies the adjustment claim/transaction for an original item control number.	A unique claim/transaction number assigned by the state�s payment system that identifies the adjustment claim/transaction for an original item control number.
05/29/2025	4.0.9	FTX.006.196	UPDATE	Definition	A unique claim/transaction number assigned by the stateâ€™s payment system that identifies the adjustment claim/transaction for an original item control number.	A unique claim/transaction number assigned by the state�s payment system that identifies the adjustment claim/transaction for an original item control number.
05/29/2025	4.0.9	FTX.005.153	UPDATE	Definition	A unique claim/transaction number assigned by the stateâ€™s payment system that identifies the adjustment claim/transaction for an original item control number.	A unique claim/transaction number assigned by the state�s payment system that identifies the adjustment claim/transaction for an original item control number.
05/29/2025	4.0.9	FTX.004.109	UPDATE	Definition	A unique claim/transaction number assigned by the stateâ€™s payment system that identifies the adjustment claim/transaction for an original item control number.	A unique claim/transaction number assigned by the state�s payment system that identifies the adjustment claim/transaction for an original item control number.
04/24/2025	4.0.7	FTX.003.086	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.021.019)4. When Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Payment Period Start Date is equal to or greater than Enrollment Effective Date	1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.0002.019)4. When Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Payment Period Start Date is equal to or greater than Enrollment Effective Date
05/29/2025	4.0.9	FTX.003.068	UPDATE	Definition	A unique claim/transaction number assigned by the stateâ€™s payment system that identifies the adjustment claim/transaction for an original item control number.	A unique claim/transaction number assigned by the state�s payment system that identifies the adjustment claim/transaction for an original item control number.
05/29/2025	4.0.9	FTX.002.021	UPDATE	Definition	A unique claim/transaction number assigned by the stateâ€™s payment system that identifies the adjustment claim/transaction for an original item control number.	A unique claim/transaction number assigned by the state�s payment system that identifies the adjustment claim/transaction for an original item control number.
05/29/2025	4.0.9	ELG.005.276	UPDATE	Definition	A free-form text field where a state can identify the â€œotherâ€ authority used to extend eligibility; required when 995 is used.	A free-form text field where a state can identify the �other� authority used to extend eligibility; required when 995 is used.
02/27/2025	4.0.3	CRX.003.136	UPDATE	Definition	"A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012. To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting. Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as â€œextended state planâ€ services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment. The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a stateâ€™s service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc. Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf"	A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012. To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting. Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as â€œextended state planâ€ services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment. The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a stateâ€™s service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc. Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf"
05/29/2025	4.0.9	CRX.002.032	UPDATE	Definition	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = â€œ23â€ to indicate that the sub-capitated network provider provided the service directly to the enrollee.	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = �23� to indicate that the sub-capitated network provider provided the service directly to the enrollee.
05/29/2025	4.0.9	CRX.002.029	UPDATE	Definition	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or â€œCâ€ for an S-CHIP sub-capitated encounter record.	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or �C� for an S-CHIP sub-capitated encounter record.
02/27/2025	4.0.3	COT.003.188	UPDATE	Definition	"A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012. To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting. Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as â€œextended state planâ€ services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment. The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a stateâ€™s service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc. Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf"	A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012. To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting. Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as â€œextended state planâ€ services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment. The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a stateâ€™s service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc. Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf"
05/29/2025	4.0.9	COT.002.041	UPDATE	Definition	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = â€œ23â€ to indicate that the sub-capitated network provider provided the service directly to the enrollee.	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = �23� to indicate that the sub-capitated network provider provided the service directly to the enrollee.
05/29/2025	4.0.9	COT.002.037	UPDATE	Definition	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or â€œCâ€ for an S-CHIP sub-capitated encounter record	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or �C� for an S-CHIP sub-capitated encounter record
05/29/2025	4.0.9	CLT.002.056	UPDATE	Definition	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = â€œ23â€ to indicate that the sub-capitated network provider provided the service directly to the enrollee.	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = �23� to indicate that the sub-capitated network provider provided the service directly to the enrollee.
05/29/2025	4.0.9	CLT.002.052	UPDATE	Definition	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or â€œCâ€ for an S-CHIP sub-capitated encounter record.	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or �C� for an S-CHIP sub-capitated encounter record.
05/29/2025	4.0.9	CIP.002.104	UPDATE	Definition	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = â€œ23â€ to indicate that the sub-capitated network provider provided the service directly to the enrollee.	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = �23� to indicate that the sub-capitated network provider provided the service directly to the enrollee.
05/29/2025	4.0.9	CIP.002.100	UPDATE	Definition	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = "3" for a Medicaid sub-capitated encounter record or â€œCâ€ for an S-CHIP sub-capitated encounter record.	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = "3" for a Medicaid sub-capitated encounter record or �C� for an S-CHIP sub-capitated encounter record.
03/14/2025	4.0.4	TPL.006.085	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]
03/14/2025	4.0.4	TPL.005.069	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]
03/14/2025	4.0.4	PRV.009.122	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]
03/14/2025	4.0.4	PRV.008.112	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]
03/14/2025	4.0.4	PRV.007.099	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]
03/14/2025	4.0.4	PRV.006.091	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]
03/14/2025	4.0.4	PRV.005.080	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]
03/14/2025	4.0.4	PRV.004.066	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]
03/14/2025	4.0.4	PRV.002.021	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]
02/27/2025	4.0.3	MCR.010.119	UPDATE	Definition	A data element to capture the various IDs used to identify a managed care plan. The specific type of identifier is defined in the corresponding value in the Managed Care Plan Identifier Type data element.	A data element to capture the various IDs used to identify a managed care plan, other than the plan ID that is used to link claims, MCR, ELG, and PRV in T-MSIS. The specific type of identifier is defined in the corresponding value in the Managed Care Plan Other Identifier Type data element.
04/24/2025	4.0.7	FTX.095.391	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory	1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. Mandatory
01/16/2025	4.0.2	FTX.095.383	UPDATE	Definition	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique â€śkeyâ€ť value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique â€œkeyâ€ value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/
05/29/2025	4.0.9	FTX.095.369	UPDATE	Definition	The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.).	This is a qualifier that indicates what type of ID the payer ID is. For example, if the payer ID represents the state Medicaid or CHIP agency, then the payer ID type will indicate that the payer ID should be interpreted as a submitting state code.
02/27/2025	4.0.3	FTX.009.343	UPDATE	Necessity	Mandatory	Conditional
02/27/2025	4.0.3	FTX.009.343	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Conditional11. Value must be populated when Payer ID Type equals "01"
01/16/2025	4.0.2	FTX.009.322	UPDATE	Coding requirement	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated
04/24/2025	4.0.7	FTX.008.304	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)
01/16/2025	4.0.2	FTX.008.283	UPDATE	Coding requirement	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated
02/27/2025	4.0.3	FTX.007.264	UPDATE	Necessity	Mandatory	Conditional
02/27/2025	4.0.3	FTX.007.264	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Conditional11. Value must be populated when Payer ID Type equals "01"
01/16/2025	4.0.2	FTX.007.240	UPDATE	Coding requirement	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated
01/16/2025	4.0.2	FTX.006.229	UPDATE	Definition	This is the type of value-based payment model to which the financial transaction applies. These values come from the â€śAlternative Payment Model (APM) Framework Final White Paperâ€ť, produced by the Healthcare Learning and Action Network. https://hcp-lan.org/work products/apm-whitepaper.pdf	This is the type of value-based payment model to which the financial transaction applies. These values come from the â€œAlternative Payment Model (APM) Framework Final White Paperâ€, produced by the Healthcare Learning and Action Network. https://hcp-lan.org/work products/apm-whitepaper.pdf
02/27/2025	4.0.3	FTX.006.219	UPDATE	Necessity	Mandatory	Conditional
02/27/2025	4.0.3	FTX.006.219	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Conditional11. Value must be populated when Payer ID Type equals "01"
01/16/2025	4.0.2	FTX.006.215	UPDATE	Definition	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique â€śkeyâ€ť value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique â€œkeyâ€ value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/
01/16/2025	4.0.2	FTX.006.196	UPDATE	Coding requirement	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated
04/24/2025	4.0.7	FTX.005.177	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory	1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. Mandatory6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)
01/16/2025	4.0.2	FTX.005.173	UPDATE	Definition	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique â€śkeyâ€ť value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique â€œkeyâ€ value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/
01/16/2025	4.0.2	FTX.005.153	UPDATE	Coding requirement	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated
04/24/2025	4.0.7	FTX.004.135	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. If Policy Owner Code equals "01", then value must be populated11. Conditional12. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated	1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. If Policy Owner Code equals "01", then value must be populated6. Conditional7. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated
05/29/2025	4.0.9	FTX.004.128	UPDATE	Definition	The SSN of the member of the group insurance policy. Each FTX00004 segment represents a different member of a given group insurance policy. Typically all members of the group insurance policy will have both an MSIS ID and an SSN. Under some circumstances, itâ€™s possible that or more members of a group insurance policy do not have an MSIS ID, but do have an SSN, if they are included on the group insurance policy but not eligible for Medicaid or CHIP. Itâ€™s also possible that one or more members of a group insurance policy do not have an SSN. If a member of a group insurance policy does not have an SSN, leave this field blank.	The SSN of the member of the group insurance policy. Each FTX00004 segment represents a different member of a given group insurance policy. Typically all members of the group insurance policy will have both an MSIS ID and an SSN. Under some circumstances, it�s possible that or more members of a group insurance policy do not have an MSIS ID, but do have an SSN, if they are included on the group insurance policy but not eligible for Medicaid or CHIP. It�s also possible that one or more members of a group insurance policy do not have an SSN. If a member of a group insurance policy does not have an SSN, leave this field blank.
01/16/2025	4.0.2	FTX.004.127	UPDATE	Definition	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique â€śkeyâ€ť value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ MSIS-IDENTIFICATION-NUM is conditional in the FTX00004 segment because some members of a private group policy may not be eligible for Medicaid or CHIP, though at least one member of the group policy must be eligible for Medicaid or CHIP. There should be one FTX00004 segment for each member of the group policy for which the premium assistance payment is being paid, regardless of whether the member of the group policy was eligible for and enrolled in Medicaid or CHIP.	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique â€œkeyâ€ value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ MSIS-IDENTIFICATION-NUM is conditional in the FTX00004 segment because some members of a private group policy may not be eligible for Medicaid or CHIP, though at least one member of the group policy must be eligible for Medicaid or CHIP. There should be one FTX00004 segment for each member of the group policy for which the premium assistance payment is being paid, regardless of whether the member of the group policy was eligible for and enrolled in Medicaid or CHIP.
01/16/2025	4.0.2	FTX.004.109	UPDATE	Coding requirement	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated
04/24/2025	4.0.7	FTX.003.091	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory	1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. Mandatory
01/16/2025	4.0.2	FTX.003.086	UPDATE	Definition	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique â€śkeyâ€ť value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique â€œkeyâ€ value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/
01/16/2025	4.0.2	FTX.003.068	UPDATE	Coding requirement	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated
02/27/2025	4.0.3	FTX.002.048	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. If Subcapitation Indicator equals "1", then value must be populated4. Conditional	1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Value must be populated when Payer ID Type equals "01"4. Conditional
02/27/2025	4.0.3	FTX.002.047	UPDATE	Coding requirement	1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. If Subcapitation Indicator equals "1", then value must be populated6. Conditional	1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Value must be populated when Payer ID Type equals "01"6. Conditional
02/27/2025	4.0.3	FTX.002.046	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. If Subcapitation Indicator equals "1", then value must be populated12. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Value must be populated when Payer ID Type equals "01"12. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated13. Value must be populated when Payer ID Type equals "01"7. Value must be populated when Payer ID Type equals "01"
04/24/2025	4.0.7	FTX.002.042	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.021.019)4. When Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Capitation Period Start Date is equal to or greater than Enrollment Effective Date	1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.002.019)4. When Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Capitation Period Start Date is equal to or greater than Enrollment Effective Date
01/16/2025	4.0.2	FTX.002.021	UPDATE	Coding requirement	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated
01/16/2025	4.0.2	ELG.005.276	UPDATE	Definition	A free-form text field where a state can identify the â€śotherâ€ť authority used to extend eligibility; required when 995 is used.	A free-form text field where a state can identify the â€œotherâ€ authority used to extend eligibility; required when 995 is used.
05/29/2025	4.0.9	ELG.003.269	UPDATE	Definition	This data element provides the beneficiary's or their household's income as a percentage of the federal poverty level. Used to assign the beneficiary to the eligibility group that covered their Medicaid or CHIP benefits. If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group. A beneficiaryâ€™s income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group.	This data element provides the beneficiary's or their household's income as a percentage of the federal poverty level. Used to assign the beneficiary to the eligibility group that covered their Medicaid or CHIP benefits. If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group. A beneficiary�s income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group.
03/14/2025	4.0.4	ELG.016.217	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]
03/14/2025	4.0.4	ELG.012.175	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]
03/14/2025	4.0.4	ELG.011.165	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]
02/27/2025	4.0.3	ELG.005.095	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Eligibility Termination Reason List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Eligibility Termination Reason List (VVL)3. Conditional4. If Eligibility Determinant End Date (ELG.005.100) is on or after End of Time Period (ELG.001.010), then value must not be populated.
03/14/2025	4.0.4	ELG.003.058	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]
07/17/2025	4.0.14	ELG.003.046	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	ELG.003.046	UPDATE	Coding requirement	1. Value must be 3 characters2. Value must be in Preferred Language Code List (VVL)3. Conditional	1. Value must be 3 characters2. Value must be in Preferred Language Code List (VVL)3. Situational
05/29/2025	4.0.9	ELG.003.038	UPDATE	Definition	A code indicating the federal poverty level range in which the family income falls. If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group. A beneficiaryâ€™s income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group.	A code indicating the federal poverty level range in which the family income falls. If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group. A beneficiary�s income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group.
05/29/2025	4.0.9	ELG.003.034	UPDATE	Definition	A code to classify eligible individual's marital/domestic-relationship status. This element should be reported by the state when the information is material to eligibility (i.e., institutionalization). Because there is no specific statutory or regulatory basis for defining marital status codes, they are being defined in a way that is as flexible for states and data users as possible. States can report at whatever level of granularity is available to them in their system and a data user can choose to use them as-is or roll the values up in broader categories depending on whichever approach best meets their needs. CMS periodically reviews the values reported to MARITAL-STATUS-OTHER-EXPLANATION to determine if states are appropriately using it only when there is no existing MARITAL-STATUS value that reflects the stateâ€™s marital status description for an individual AND to determine whether it is necessary to add additional T-MSIS MARITAL-STATUS values to reflect commonly used state martial status descriptions for which there is no existing T-MSIS MARITAL-STATUS value.	A code to classify eligible individual's marital/domestic-relationship status. This element should be reported by the state when the information is material to eligibility (i.e., institutionalization). Because there is no specific statutory or regulatory basis for defining marital status codes, they are being defined in a way that is as flexible for states and data users as possible. States can report at whatever level of granularity is available to them in their system and a data user can choose to use them as-is or roll the values up in broader categories depending on whichever approach best meets their needs. CMS periodically reviews the values reported to MARITAL-STATUS-OTHER-EXPLANATION to determine if states are appropriately using it only when there is no existing MARITAL-STATUS value that reflects the state�s marital status description for an individual AND to determine whether it is necessary to add additional T-MSIS MARITAL-STATUS values to reflect commonly used state martial status descriptions for which there is no existing T-MSIS MARITAL-STATUS value.
08/29/2025	4.0.17	CRX.003.209	UPDATE	Definition	Indicates group of MBES/CBES forms that this payment applies to (e.g., the CMS-64.9 Base form is for Title XIX-funded Medicaid, the CMS-64.21 form is for Title XXI-funded Medicaid-expansion CHIP (M-CHIP), and the CMS-21 Base form is for Title XXI-funded separate CHIP (S-CHIP)).	Indicates group of MBES/CBES forms that this payment applies to (e.g., the CMS-64.9 Base form is for Title XIX-funded Medicaid, the CMS-64.21 form is for Title XXI-funded Medicaid-expansion CHIP (M-CHIP), and the CMS-21 Base form is for Title XXI-funded separate CHIP (S-CHIP)). States should populate these data elements for claims when Medicaid Paid Amount is 0 or less than 0. For example, these data elements are still expected to be populated on voided or replacement claims. The data elements should align with quarterly MBES/CBES reporting.
08/29/2025	4.0.17	CRX.003.209	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount not equal to $0	1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $0
04/24/2025	4.0.7	CRX.003.180	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Conditional11. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $012. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated	1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated
07/10/2025	4.0.13	CRX.002.162	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.162	UPDATE	Coding requirement	1. Value must be one digit2. Value must be in Prescription Origin Code List (VVL)3. Conditional	1. Value must be one digit2. Value must be in Prescription Origin Code List (VVL)3. Situational
01/16/2025	4.0.2	CRX.003.136	UPDATE	Definition	"A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012. To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting. Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as â€śextended state planâ€ť services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment. The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a stateâ€™s service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc. Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf"	"A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012. To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting. Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as â€œextended state planâ€ services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment. The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a stateâ€™s service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc. Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf"
07/31/2025	4.0.15	CRX.003.132	UPDATE	De size	S9(9)V(9)	S9(9)V9(9)
02/27/2025	4.0.3	CRX.003.125	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional4. Value should not be populated or should be equal to zero, when associated Claim Line Status is in [542,585,654]
07/10/2025	4.0.13	CRX.002.068	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.068	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period (by date of service)4. Value must have a corresponding value in Waiver ID (CRX.002.069)5. Conditional	1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period (by date of service)4. Value must have a corresponding value in Waiver ID (CRX.002.069)5. Situational
05/29/2025	4.0.9	CRX.002.058	UPDATE	Definition	The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim linesâ€™ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.	The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines� associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.
01/16/2025	4.0.2	CRX.002.032	UPDATE	Definition	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = â€ś23â€ť to indicate that the sub-capitated network provider provided the service directly to the enrollee.	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = â€œ23â€ to indicate that the sub-capitated network provider provided the service directly to the enrollee.
01/16/2025	4.0.2	CRX.002.029	UPDATE	Definition	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or â€śCâ€ť for an S-CHIP sub-capitated encounter record.	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or â€œCâ€ for an S-CHIP sub-capitated encounter record.
08/29/2025	4.0.17	COT.003.290	UPDATE	Definition	Indicates group of MBES/CBES forms that this payment applies to (e.g., the CMS-64.9 Base form is for Title XIX-funded Medicaid, the CMS-64.21 form is for Title XXI-funded Medicaid-expansion CHIP (M-CHIP), and the CMS-21 Base form is for Title XXI-funded separate CHIP (S-CHIP)).	Indicates group of MBES/CBES forms that this payment applies to (e.g., the CMS-64.9 Base form is for Title XIX-funded Medicaid, the CMS-64.21 form is for Title XXI-funded Medicaid-expansion CHIP (M-CHIP), and the CMS-21 Base form is for Title XXI-funded separate CHIP (S-CHIP)). States should populate these data elements for claims when Medicaid Paid Amount is 0 or less than 0. For example, these data elements are still expected to be populated on voided or replacement claims. The data elements should align with quarterly MBES/CBES reporting.
08/29/2025	4.0.17	COT.003.290	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount not equal to $0	1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $0
03/25/2025	4.0.5	COT.004.281	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Diagnosis Type Code List (VVL)3. Value must be in [D,E,O,P,R]4. Mandatory	1. Value must be 1 character2. Value must be in Diagnosis Type Code List (VVL)3. Mandatory
01/16/2025	4.0.2	COT.003.264	UPDATE	Definition	A pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claim form (i.e., 837P or 837D - Place of Service is only captured at the line level of the CMS-1500). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than â€śBâ€ť, then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS-1450 (UB-04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled.	A pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claim form (i.e., 837P or 837D - Place of Service is only captured at the line level of the CMS-1500). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than â€œBâ€, then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS-1450 (UB-04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled.
07/17/2025	4.0.14	COT.003.258	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.258	UPDATE	Coding requirement	1.Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.026) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization)	1.Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Situational5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.026) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization)
04/24/2025	4.0.7	COT.003.256	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Conditional11. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $012. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated	1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated
03/14/2025	4.0.4	COT.003.255	UPDATE	Coding requirement		1. Value must not be more than 76 characters long2. Conditional
03/14/2025	4.0.4	COT.003.254	UPDATE	Coding requirement		1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Mandatory
07/17/2025	4.0.14	COT.002.241	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.241	UPDATE	Coding requirement	1.Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.026) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization)	1.Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Situational5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.026) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization)
01/16/2025	4.0.2	COT.003.188	UPDATE	Definition	"A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012. To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting. Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as â€śextended state planâ€ť services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment. The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a stateâ€™s service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc. Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf"	"A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012. To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting. Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as â€œextended state planâ€ services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment. The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a stateâ€™s service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc. Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf"
01/16/2025	4.0.2	COT.002.123	UPDATE	Definition	A pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claim form (i.e., 837P or 837D - Place of Service is only captured at the line level of the CMS-1500). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than â€śBâ€ť, then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS-1450 (UB-04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled.	A pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claim form (i.e., 837P or 837D - Place of Service is only captured at the line level of the CMS-1500). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than â€œBâ€, then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS-1450 (UB-04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled.
07/17/2025	4.0.14	COT.002.103	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.103	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational
07/17/2025	4.0.14	COT.002.102	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.102	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational
07/17/2025	4.0.14	COT.002.101	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.101	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational
07/17/2025	4.0.14	COT.002.100	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.100	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational
07/17/2025	4.0.14	COT.002.099	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.099	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational
07/17/2025	4.0.14	COT.002.098	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.098	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational
07/17/2025	4.0.14	COT.002.097	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.097	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational
07/17/2025	4.0.14	COT.002.096	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.096	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational
07/17/2025	4.0.14	COT.002.095	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.095	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational
07/17/2025	4.0.14	COT.002.094	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.094	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational
07/17/2025	4.0.14	COT.002.093	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.093	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date
07/17/2025	4.0.14	COT.002.092	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.092	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4.Value must be on or before the Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4.Value must be on or before the Occurrence Code End Date
07/17/2025	4.0.14	COT.002.091	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.091	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date
07/17/2025	4.0.14	COT.002.090	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.090	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date
07/17/2025	4.0.14	COT.002.089	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.089	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date
07/17/2025	4.0.14	COT.002.088	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.088	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date
07/17/2025	4.0.14	COT.002.087	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.087	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date
07/17/2025	4.0.14	COT.002.086	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.086	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date
07/17/2025	4.0.14	COT.002.085	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.085	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date
07/17/2025	4.0.14	COT.002.084	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.084	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date
05/29/2025	4.0.9	COT.002.068	UPDATE	Definition	The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim linesâ€™ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.	The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines� associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.
01/16/2025	4.0.2	COT.002.041	UPDATE	Definition	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = â€ś23â€ť to indicate that the sub-capitated network provider provided the service directly to the enrollee.	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = â€œ23â€ to indicate that the sub-capitated network provider provided the service directly to the enrollee.
07/17/2025	4.0.14	COT.002.038	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.038	UPDATE	Coding requirement	1. Value must be 4 characters2. First character value must be a "0"3. Second character value must be in Type of Bill 2 Facility Type List (VVL)4. Third character value must be in Type of Bill 3 Classification Clinics List (VVL)5. Fourth character value must be in Type of Bill 4 Frequency List (VVL)6. Conditional	1. Value must be 4 characters2. First character value must be a "0"3. Second character value must be in Type of Bill 2 Facility Type List (VVL)4. Third character value must be in Type of Bill 3 Classification Clinics List (VVL)5. Fourth character value must be in Type of Bill 4 Frequency List (VVL)6. Situational
01/16/2025	4.0.2	COT.002.037	UPDATE	Definition	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or â€śCâ€ť for an S-CHIP sub-capitated encounter record	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or â€œCâ€ for an S-CHIP sub-capitated encounter record
08/29/2025	4.0.17	CLT.003.282	UPDATE	Definition	Indicates group of MBES/CBES forms that this payment applies to (e.g., the CMS-64.9 Base form is for Title XIX-funded Medicaid, the CMS-64.21 form is for Title XXI-funded Medicaid-expansion CHIP (M-CHIP), and the CMS-21 Base form is for Title XXI-funded separate CHIP (S-CHIP)).	Indicates group of MBES/CBES forms that this payment applies to (e.g., the CMS-64.9 Base form is for Title XIX-funded Medicaid, the CMS-64.21 form is for Title XXI-funded Medicaid-expansion CHIP (M-CHIP), and the CMS-21 Base form is for Title XXI-funded separate CHIP (S-CHIP)). States should populate these data elements for claims when Medicaid Paid Amount is 0 or less than 0. For example, these data elements are still expected to be populated on voided or replacement claims. The data elements should align with quarterly MBES/CBES reporting.
08/29/2025	4.0.17	CLT.003.282	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount not equal to $0	1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $0
04/24/2025	4.0.7	CLT.003.261	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Conditional11. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $012. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated	1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated
07/10/2025	4.0.13	CLT.002.249	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.249	UPDATE	Coding requirement	1.Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.026) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization)	1.Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Situational5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.026) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization)
02/27/2025	4.0.3	CLT.002.178	UPDATE	Coding requirement	1. Value must be 12 characters or less2. Value must be in Provider Type Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Provider Type Code List (VVL)3. Conditional
02/27/2025	4.0.3	CLT.002.130	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in [3,C,W] then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in [3,C,W] then value may match (PRV.005.081) Provider Identifier where the Provider Identifier Type (PRV.005.077) equals "1"5. Ending Date of Service (CLT.002.049) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or6. Ending Date of Service (CLT.002.049) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080)7. Ending Date of Service (CLT.002.049) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or8. Ending Date of Service (CLT.002.049) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080)	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in [3,C,W] then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in [3,C,W] then value may match (PRV.005.081) Provider Identifier where the Provider Identifier Type (PRV.005.077) equals "1"5. Discharge Date (CLT.002.046) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or6. Discharge Date (CLT.002.046) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080)
07/10/2025	4.0.13	CLT.002.121	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.121	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational
07/10/2025	4.0.13	CLT.002.120	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.120	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational
07/10/2025	4.0.13	CLT.002.119	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.119	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational
07/10/2025	4.0.13	CLT.002.118	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.118	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational
07/10/2025	4.0.13	CLT.002.117	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.117	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational
07/10/2025	4.0.13	CLT.002.116	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.116	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational
07/10/2025	4.0.13	CLT.002.115	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.115	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational
07/10/2025	4.0.13	CLT.002.114	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.114	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational
07/10/2025	4.0.13	CLT.002.113	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.113	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational
07/10/2025	4.0.13	CLT.002.112	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.112	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational
07/10/2025	4.0.13	CLT.002.111	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.111	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date
07/10/2025	4.0.13	CLT.002.110	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.110	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date
07/10/2025	4.0.13	CLT.002.109	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.109	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before theOccurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before theOccurrence Code End Date
07/10/2025	4.0.13	CLT.002.108	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.108	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date
07/10/2025	4.0.13	CLT.002.107	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.107	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date
07/10/2025	4.0.13	CLT.002.106	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.106	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date
07/10/2025	4.0.13	CLT.002.105	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.105	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date
07/10/2025	4.0.13	CLT.002.104	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.104	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date
07/10/2025	4.0.13	CLT.002.103	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.103	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date
07/10/2025	4.0.13	CLT.002.102	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.102	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date
05/29/2025	4.0.9	CLT.002.082	UPDATE	Definition	The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim linesâ€™ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.	The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines� associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.
01/16/2025	4.0.2	CLT.002.056	UPDATE	Definition	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = â€ś23â€ť to indicate that the sub-capitated network provider provided the service directly to the enrollee.	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = â€œ23â€ to indicate that the sub-capitated network provider provided the service directly to the enrollee.
01/16/2025	4.0.2	CLT.002.052	UPDATE	Definition	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or â€śCâ€ť for an S-CHIP sub-capitated encounter record.	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or â€œCâ€ for an S-CHIP sub-capitated encounter record.
08/29/2025	4.0.17	CIP.003.340	UPDATE	Definition	Indicates group of MBES/CBES forms that this payment applies to (e.g., the CMS-64.9 Base form is for Title XIX-funded Medicaid, the CMS-64.21 form is for Title XXI-funded Medicaid-expansion CHIP (M-CHIP), and the CMS-21 Base form is for Title XXI-funded separate CHIP (S-CHIP)).	Indicates group of MBES/CBES forms that this payment applies to (e.g., the CMS-64.9 Base form is for Title XIX-funded Medicaid, the CMS-64.21 form is for Title XXI-funded Medicaid-expansion CHIP (M-CHIP), and the CMS-21 Base form is for Title XXI-funded separate CHIP (S-CHIP)). States should populate these data elements for claims when Medicaid Paid Amount is 0 or less than 0. For example, these data elements are still expected to be populated on voided or replacement claims. The data elements should align with quarterly MBES/CBES reporting.
08/29/2025	4.0.17	CIP.003.340	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount not equal to $0	1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $0
04/24/2025	4.0.7	CIP.003.315	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Conditional11. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $012. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated	1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated
07/10/2025	4.0.13	CIP.002.303	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.303	UPDATE	Coding requirement	1.Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.026) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization)	1.Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Situational5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.026) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization)
02/27/2025	4.0.3	CIP.002.188	UPDATE	Coding requirement	1. Value must be 12 characters or less2. Value must be in Provider Type Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Provider Type Code List (VVL)3. Conditional
07/10/2025	4.0.13	CIP.002.169	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.169	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational
07/10/2025	4.0.13	CIP.002.168	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.168	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational
07/10/2025	4.0.13	CIP.002.167	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.167	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational
07/10/2025	4.0.13	CIP.002.166	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.166	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational
07/10/2025	4.0.13	CIP.002.165	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.165	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational
07/10/2025	4.0.13	CIP.002.164	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.164	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational
07/10/2025	4.0.13	CIP.002.163	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.163	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational
07/10/2025	4.0.13	CIP.002.162	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.162	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational
07/10/2025	4.0.13	CIP.002.161	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.161	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational
07/10/2025	4.0.13	CIP.002.160	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.160	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational
07/10/2025	4.0.13	CIP.002.159	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.159	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date
07/10/2025	4.0.13	CIP.002.158	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.158	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date
07/10/2025	4.0.13	CIP.002.157	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.157	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date
07/10/2025	4.0.13	CIP.002.156	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.156	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date
07/10/2025	4.0.13	CIP.002.155	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.155	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date
07/10/2025	4.0.13	CIP.002.153	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.153	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date
07/10/2025	4.0.13	CIP.002.151	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.151	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date
07/10/2025	4.0.13	CIP.002.150	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.150	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date
05/29/2025	4.0.9	CIP.002.132	UPDATE	Definition	The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim linesâ€™ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.	The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines� associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.
01/16/2025	4.0.2	CIP.002.104	UPDATE	Definition	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = â€ś23â€ť to indicate that the sub-capitated network provider provided the service directly to the enrollee.	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = â€œ23â€ to indicate that the sub-capitated network provider provided the service directly to the enrollee.
01/16/2025	4.0.2	CIP.002.100	UPDATE	Definition	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = "3" for a Medicaid sub-capitated encounter record or â€śCâ€ť for an S-CHIP sub-capitated encounter record.	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = "3" for a Medicaid sub-capitated encounter record or â€œCâ€ for an S-CHIP sub-capitated encounter record.
12/10/2024	4.0.1	MANAGED-CARE-ID	UPDATE	Title	MANAGED-CARE-PLAN-ID	MANAGED-CARE-ID
02/27/2025	4.0.3	CRX.004.205	UPDATE	Necessity	Mandatory	Conditional
02/27/2025	4.0.3	CRX.004.205	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Diagnosis Code Flag List (VVL)3. Mandatory	1. Value must be 1 character2. Value must be in Diagnosis Code Flag List (VVL)3. Conditional
05/07/2025	4.0.8	CRX.004.203	UPDATE	Necessity	Mandatory	Conditional
05/07/2025	4.0.8	CRX.004.203	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Diagnosis Type Code List (VVL)3. Value must be "D"4. Mandatory	1. Value must be 1 character2. Value must be in Diagnosis Type Code List (VVL)3. Value must be "D"4. Conditional
10/10/2025	4.0.19	CLT.002.244	UPDATE	Coding requirement	1. Value must not be more than 60 characters long2. Mandatory3. Value must not contain a pipe or asterisk symbols	1. Value must not be more than 60 characters2. Mandatory3. Value must not contain a pipe or asterisk symbols
07/10/2025	4.0.13	CRX.003.192	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.003.192	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Conditional	1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Situational
07/10/2025	4.0.13	CRX.003.191	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.003.191	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Conditional	1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Situational
07/10/2025	4.0.13	CRX.003.190	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.003.190	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Conditional	1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Situational
07/10/2025	4.0.13	CRX.003.189	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.003.189	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Conditional	1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Situational
07/10/2025	4.0.13	CRX.003.188	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.003.188	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Conditional	1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Situational
07/10/2025	4.0.13	CRX.003.187	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.003.187	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Conditional	1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Situational
12/19/2024	4.0.1	FTX.007.240	UPDATE	Definition	A unique claim/transaction number assigned by the state’s payment system that identifies the adjustment claim/transaction for an original item control number.	A unique claim/transaction number assigned by the stateâ€™s payment system that identifies the adjustment claim/transaction for an original item control number.
07/10/2025	4.0.13	CRX.003.186	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.003.186	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Conditional	1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Situational
07/10/2025	4.0.13	CRX.003.185	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.003.185	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Conditional	1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Situational
07/10/2025	4.0.13	CRX.003.184	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.003.184	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Conditional	1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Situational
07/10/2025	4.0.13	CRX.003.183	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.003.183	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Conditional	1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Situational
07/10/2025	4.0.13	CRX.003.182	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.003.182	UPDATE	Coding requirement	1. Value must not be more than 6 characters2. Value must be in Procedure Code List (VVL)3. Conditional	1. Value must not be more than 6 characters2. Value must be in Procedure Code List (VVL)3. Situational
12/19/2024	4.0.1	CRX.003.180	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21.P", value must be in 21.P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Conditional11. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $012. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Conditional11. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $012. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated
12/19/2024	4.0.1	CRX.003.209	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $0	1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount not equal to $0
12/19/2024	4.0.1	FTX.006.219	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21.P", value must be in 21.P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory
02/27/2025	4.0.3	FTX.006.220	UPDATE	Necessity	Mandatory	Conditional
02/27/2025	4.0.3	FTX.006.220	UPDATE	Coding requirement	1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Mandatory	1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Conditional6. Value must be populated when Payer ID Type equals "01"
02/27/2025	4.0.3	FTX.006.221	UPDATE	Necessity	Mandatory	Conditional
02/27/2025	4.0.3	FTX.006.221	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Mandatory	1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. Value must be populated when Payer ID Type equals "01"
02/27/2025	4.0.3	FTX.006.218	UPDATE	Necessity	Mandatory	Conditional
02/27/2025	4.0.3	FTX.006.218	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Category for Federal Reimbursement List (VVL)3. Mandatory	1. Value must be 2 characters2. Value must be in Category for Federal Reimbursement List (VVL)3. Conditional4. Value must be populated when Payer ID Type equals "01"
12/19/2024	4.0.1	FTX.006.215	UPDATE	Definition	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique “key” value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique â€śkeyâ€ť value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/
12/19/2024	4.0.1	FTX.006.215	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Conditional3. When populated, value must match MSIS Identification Number (ELG.002.019)4. When Adjustment Indicator does not equal 1, there must be a valid record of type Enrollment Time Span where the Performance Period Start Date is equal to or greater than Enrollment Effective Date and Performance Period End Date is less than or equal to Enrollment End Date	1. Value must be 20 characters or less2. Conditional3. When populated, value must match MSIS Identification Number (ELG.002.019)4. When populated and Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Performance Period Start Date is equal to or greater than Enrollment Effective Date
12/19/2024	4.0.1	FTX.006.196	UPDATE	Definition	A unique claim/transaction number assigned by the state’s payment system that identifies the adjustment claim/transaction for an original item control number.	A unique claim/transaction number assigned by the stateâ€™s payment system that identifies the adjustment claim/transaction for an original item control number.
12/19/2024	4.0.1	CRX.004.202	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (CRX.001.010)3. Mandatory4. Value should be on or after associated Admission Date value	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (CRX.001.010)3. Mandatory
12/19/2024	4.0.1	TPL.006.085	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99]
12/19/2024	4.0.1	FTX.005.177	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21.P", value must be in 21.P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory
12/19/2024	4.0.1	FTX.005.173	UPDATE	Definition	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique “key” value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique â€śkeyâ€ť value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/
12/19/2024	4.0.1	FTX.005.173	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.021.019)4. When Adjustment Indicator does not equal 1, there must be a valid record of type Enrollment Time Span where the Coverage Period Start Date is equal to or greater than Enrollment Effective Date and Coverage Period End Date is less than or equal to Enrollment End Date	1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.021.019)4. When Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Coverage Period Start Date is equal to or greater than Enrollment Effective Date
12/19/2024	4.0.1	FTX.005.160	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Value must equal Submitting State (FTX.001.007)3. Mandatory	1. Value must be 30 characters or less2. Value must equal Submitting State (FTX.005.150)3. Mandatory
12/19/2024	4.0.1	FTX.005.153	UPDATE	Definition	A unique claim/transaction number assigned by the state’s payment system that identifies the adjustment claim/transaction for an original item control number.	A unique claim/transaction number assigned by the stateâ€™s payment system that identifies the adjustment claim/transaction for an original item control number.
12/19/2024	4.0.1	FTX.004.135	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21.P", value must be in 21.P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. If Policy Owner Code equals "01", then value must be populated11. Conditional12. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. If Policy Owner Code equals "01", then value must be populated11. Conditional12. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated
09/25/2025	4.0.18	FTX.004.136	UPDATE	Necessity	Conditional	Mandatory
09/25/2025	4.0.18	FTX.004.136	UPDATE	Coding requirement	1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. If Policy Owner Code equals "01", then value must be populated6. Conditional	1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Mandatory
09/25/2025	4.0.18	FTX.004.137	UPDATE	Necessity	Conditional	Mandatory
09/25/2025	4.0.18	FTX.004.137	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. If Policy Owner Code equals "01", then value must be populated4. Conditional	1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Mandatory
09/25/2025	4.0.18	FTX.004.134	UPDATE	Necessity	Conditional	Mandatory
09/25/2025	4.0.18	FTX.004.134	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Category for Federal Reimbursement List (VVL)3. If Policy Owner Code equals "01", then value must be populated4. Conditional	1. Value must be 2 characters2. Value must be in Category for Federal Reimbursement List (VVL)3. Mandatory
03/14/2025	4.0.4	FTX.004.133	UPDATE	Definition	The date representing the end of the period covered by the premium payment or recoupment; for example, the last day of the calendar month of beneficiary coverage in the insurance plan that the payment is intended to cover (whether or not the beneficiary actually receives services during that month).	The date representing the end of the period covered by the premium payment; for example, the last day of the calendar month of beneficiary coverage in the insurance plan that the payment is intended to cover (whether or not the beneficiary actually receives services during that month).
03/14/2025	4.0.4	FTX.004.132	UPDATE	Definition	The date representing the beginning of the period covered by the premium payment or recoupment; for example, the first day of the calendar month of beneficiary coverage in the insurance plan that the payment is intended to cover (whether or not the beneficiary actually receives services during that month).	The date representing the beginning of the period covered by the premium payment; for example, the first day of the calendar month of beneficiary coverage in the insurance plan that the payment is intended to cover (whether or not the beneficiary actually receives services during that month).
12/19/2024	4.0.1	FTX.004.128	UPDATE	Definition	The SSN of the member of the group insurance policy. Each FTX00004 segment represents a different member of a given group insurance policy. Typically all members of the group insurance policy will have both an MSIS ID and an SSN. Under some circumstances, it’s possible that or more members of a group insurance policy do not have an MSIS ID, but do have an SSN, if they are included on the group insurance policy but not eligible for Medicaid or CHIP. It’s also possible that one or more members of a group insurance policy do not have an SSN. If a member of a group insurance policy does not have an SSN, leave this field blank.	The SSN of the member of the group insurance policy. Each FTX00004 segment represents a different member of a given group insurance policy. Typically all members of the group insurance policy will have both an MSIS ID and an SSN. Under some circumstances, itâ€™s possible that or more members of a group insurance policy do not have an MSIS ID, but do have an SSN, if they are included on the group insurance policy but not eligible for Medicaid or CHIP. Itâ€™s also possible that one or more members of a group insurance policy do not have an SSN. If a member of a group insurance policy does not have an SSN, leave this field blank.
12/19/2024	4.0.1	FTX.004.127	UPDATE	Definition	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique “key” value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ MSIS-IDENTIFICATION-NUM is conditional in the FTX00004 segment because some members of a private group policy may not be eligible for Medicaid or CHIP, though at least one member of the group policy must be eligible for Medicaid or CHIP. There should be one FTX00004 segment for each member of the group policy for which the premium assistance payment is being paid, regardless of whether the member of the group policy was eligible for and enrolled in Medicaid or CHIP.	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique â€śkeyâ€ť value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ MSIS-IDENTIFICATION-NUM is conditional in the FTX00004 segment because some members of a private group policy may not be eligible for Medicaid or CHIP, though at least one member of the group policy must be eligible for Medicaid or CHIP. There should be one FTX00004 segment for each member of the group policy for which the premium assistance payment is being paid, regardless of whether the member of the group policy was eligible for and enrolled in Medicaid or CHIP.
12/19/2024	4.0.1	FTX.004.127	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Conditional3. Value must match MSIS Identification Number (ELG.021.019)4. When Adjustment Indicator does not equal 1, there must be a valid record of type Enrollment Time Span where the Premium Period Start Date is equal to or greater than Enrollment Effective Date and Premium Period End Date is less than or equal to Enrollment End Date	1. Value must be 20 characters or less2. Conditional3. When populated, value must match MSIS Identification Number (ELG.021.019)4. When populated and Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Premium Period Start Date is equal to or greater than Enrollment Effective Date
03/14/2025	4.0.4	FTX.004.119	UPDATE	Definition	This is the identifier that corresponds with the payee's role in relation to the Medicaid/CHIP system. The payee is the individual or entity that is either receiving a payment or having a previous payment recouped. The payee is the object of the transaction, as opposed to the payer who is the subject taking the action of either making a payment or taking a recoupment. This will typically correspond to the X12 820 Premium Receiver.	This is the identifier that corresponds with the payee's role in relation to the Medicaid/CHIP system. The payee is the individual or entity that is receiving a payment. The payee is the object of the transaction, as opposed to the payer who is the subject taking the action of making a payment. This will typically correspond to the X12 820 Premium Receiver.
03/14/2025	4.0.4	FTX.004.116	UPDATE	Definition	This is the identifier that corresponds with the payer's role in relation to the Medicaid/CHIP system. The payer is the subject taking the action of either making a payment or taking a recoupment, as opposed to the payee who is the object of the transaction. The payer is the entity that is either making a payment or recouping a payment from another entity or individual. The payee is the individual or entity that is either receiving a payment or having a previous payment recouped. This will typically correspond to the X12 820 Premium Payer.	This is the identifier that corresponds with the payer's role in relation to the Medicaid/CHIP system. The payer is the subject taking the action of making a payment, as opposed to the payee who is the object of the transaction. The payer is the entity that is making a payment. The payee is the individual or entity that is either receiving a payment or having a previous payment recouped. This will typically correspond to the X12 820 Premium Payer.
06/19/2025	4.0.11	FTX.004.113	UPDATE	Definition	The dollar amount being paid to the payee.	The dollar amount being paid to the payee. When a single payment covers multiple people, the full Medicaid Group Insurance payment amount should be reported on the FTX00004 transaction representing the policy subscriber, regardless of whether this person is a Medicaid enrollee. The FTX00004 transactions for the other covered people under the policy should have payment amount values of zero ($0.00).
12/19/2024	4.0.1	FTX.004.109	UPDATE	Definition	A unique claim/transaction number assigned by the state’s payment system that identifies the adjustment claim/transaction for an original item control number.	A unique claim/transaction number assigned by the stateâ€™s payment system that identifies the adjustment claim/transaction for an original item control number.
03/14/2025	4.0.4	CIP.004.330	UPDATE	Coding requirement	1. Value must be in [01-24]2. Mandatory	1. Value must be in [01-24]2. Mandatory3. Value must be 2 digits
07/17/2025	4.0.14	CIP.004.333	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	CIP.004.333	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Diagnosis POA Flag List (VVL)3. Conditional	1. Value must be 1 character2. Value must be in Diagnosis POA Flag List (VVL)3. Situational
11/20/2025	4.0.22	CIP.004.332	UPDATE	Definition	ICD-9 or ICD-10 diagnosis codes used as a tool to group and identify diseases, disorders, symptoms, poisonings, adverse effects of drugs and chemicals, injuries and other reasons for patient encounters. Diagnosis codes should be passed through to T-MSIS exactly as they were submitted by the provider on their claim (with the exception of removing the decimal). For example: 210.5 is coded as '21051'.	ICD-9 or ICD-10 diagnosis codes used as a tool to group and identify diseases, disorders, symptoms, poisonings, adverse effects of drugs and chemicals, injuries and other reasons for patient encounters. Diagnosis codes should be passed through to T-MSIS exactly as they were submitted by the provider on their claim (with the exception of removing the decimal). For example: 210.5 is coded as '2105'.
12/19/2024	4.0.1	CIP.004.329	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Diagnosis Type Code List (VVL)3. Value must be in [P,A,E,O]4. Mandatory	1. Value must be 1 character2. Value must be in Diagnosis Type Code List (VVL)3. Value must be in [A,E,O,P]4. Mandatory
12/19/2024	4.0.1	FTX.003.091	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21.P", value must be in 21.P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory
03/14/2025	4.0.4	FTX.003.089	UPDATE	Definition	The date representing the end of the period covered by the premium payment or recoupment; for example, the last day of the calendar month of beneficiary coverage in the insurance plan that the payment is intended to cover (whether or not the beneficiary actually receives services during that month).	The date representing the end of the period covered by the premium payment; for example, the last day of the calendar month of beneficiary coverage in the insurance plan that the payment is intended to cover (whether or not the beneficiary actually receives services during that month).
03/14/2025	4.0.4	FTX.003.088	UPDATE	Definition	The date representing the beginning of the period covered by the premium payment or recoupment; for example, the first day of the calendar month of beneficiary coverage in the insurance plan that the payment is intended to cover (whether or not the beneficiary actually receives services during that month).	The date representing the beginning of the period covered by the premium payment; for example, the first day of the calendar month of beneficiary coverage in the insurance plan that the payment is intended to cover (whether or not the beneficiary actually receives services during that month).
12/19/2024	4.0.1	FTX.003.086	UPDATE	Definition	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique “key” value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique â€śkeyâ€ť value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/
12/19/2024	4.0.1	FTX.003.086	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.021.019)4. When Adjustment Indicator does not equal 1, there must be a valid record of type Enrollment Time Span where the Payment Period Start Date is equal to or greater than Enrollment Effective Date and Payment Period End Date is less than or equal to Enrollment End Date.	1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.021.019)4. When Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Payment Period Start Date is equal to or greater than Enrollment Effective Date
12/19/2024	4.0.1	CIP.003.340	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $0	1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount not equal to $0
12/19/2024	4.0.1	CIP.003.315	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21.P", value must be in 21.P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Conditional11. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $012. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Conditional11. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $012. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated
03/14/2025	4.0.4	FTX.003.078	UPDATE	Definition	This is the identifier that corresponds with the payee's role in relation to the Medicaid/CHIP system. The payee is the individual or entity that is either receiving a payment or having a previous payment recouped. The payee is the object of the transaction, as opposed to the payer who is the subject taking the action of either making a payment or taking a recoupment. This will typically correspond to the X12 820 Premium Receiver.	This is the identifier that corresponds with the payee's role in relation to the Medicaid/CHIP system. The payee is the individual or entity that is receiving a payment. The payee is the object of the transaction, as opposed to the payer who is the subject taking the action of making a payment. This will typically correspond to the X12 820 Premium Receiver.
03/14/2025	4.0.4	FTX.003.075	UPDATE	Definition	This is the identifier that corresponds with the payer's role in relation to the Medicaid/CHIP system. The payer is the subject taking the action of either making a payment or taking a recoupment, as opposed to the payee who is the object of the transaction. The payer is the entity that is either making a payment or recouping a payment from another entity or individual. The payee is the individual or entity that is either receiving a payment or having a previous payment recouped. This will typically correspond to the X12 820 Premium Payer.	This is the identifier that corresponds with the payer's role in relation to the Medicaid/CHIP system. The payer is the subject taking the action of making a payment, as opposed to the payee who is the object of the transaction. The payer is the entity that is making a payment. The payee is the individual or entity that is receiving a payment. This will typically correspond to the X12 820 Premium Payer.
12/19/2024	4.0.1	FTX.003.068	UPDATE	Definition	A unique claim/transaction number assigned by the state’s payment system that identifies the adjustment claim/transaction for an original item control number.	A unique claim/transaction number assigned by the stateâ€™s payment system that identifies the adjustment claim/transaction for an original item control number.
03/14/2025	4.0.4	COT.004.282	UPDATE	Coding requirement	1. Value must be in [01-24]2. Mandatory	1. Value must be in [01-24]2. Mandatory3. Value must be 2 digits
12/19/2024	4.0.1	COT.004.281	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Diagnosis Type Code List (VVL)3. Value must be in [P,A,E,O]4. Mandatory	1. Value must be 1 character2. Value must be in Diagnosis Type Code List (VVL)3. Value must be in [D,E,O,P,R]4. Mandatory
02/27/2025	4.0.3	COT.004.280	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (COT.001.010)3. Mandatory4. Value should be on or after associated Admission Date value	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (COT.001.010)3. Mandatory4. Value should be on or after the associated Beginning Date of Service
12/19/2024	4.0.1	PRV.005.080	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99]
12/19/2024	4.0.1	FTX.002.046	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21.P", value must be in 21.P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. If Subcapitation Indicator equals "01", then value must be populated12. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. If Subcapitation Indicator equals "1", then value must be populated12. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated
12/19/2024	4.0.1	FTX.002.047	UPDATE	Coding requirement	1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. If Subcapitation Indicator equals "01", then value must be populated6. Conditional	1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. If Subcapitation Indicator equals "1", then value must be populated6. Conditional
12/19/2024	4.0.1	FTX.002.048	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. If Subcapitation Indicator equals "01", then value must be populated4. Conditional	1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. If Subcapitation Indicator equals "1", then value must be populated4. Conditional
02/27/2025	4.0.3	FTX.002.045	UPDATE	Necessity	Mandatory	Conditional
02/27/2025	4.0.3	FTX.002.045	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Category for Federal Reimbursement List (VVL)3. Mandatory	1. Value must be 2 characters2. Value must be in Category for Federal Reimbursement List (VVL)3. Conditional4. Value must be populated when Payer ID Type equals "01"
12/19/2024	4.0.1	FTX.002.042	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.021.019)4. When Adjustment Indicator does not equal 1, there must be a valid record of type Enrollment Time Span where the Capitation Period Start Date is equal to or greater than Enrollment Effective Date and Capitation Period End Date is less than or equal to Enrollment End Date	1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.021.019)4. When Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Capitation Period Start Date is equal to or greater than Enrollment Effective Date
12/19/2024	4.0.1	COT.003.264	UPDATE	Definition	PLACE-OF-SERVICE is a pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claims form (i.e., 837P, CMS-1500, or 837D). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than “B”, then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS 1450 (UB04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled.	A pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claim form (i.e., 837P or 837D - Place of Service is only captured at the line level of the CMS-1500). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than â€śBâ€ť, then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS-1450 (UB-04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled.
07/17/2025	4.0.14	COT.003.263	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.263	UPDATE	Coding requirement	1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Value must be in ZIP Code List (VVL)3. Conditional	1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Value must be in ZIP Code List (VVL)3. Situational
12/19/2024	4.0.1	COT.003.254	UPDATE	Coding requirement	1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Mandatory
12/19/2024	4.0.1	COT.003.256	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21.P", value must be in 21.P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Conditional11. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $012. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Conditional11. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $012. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated
12/19/2024	4.0.1	COT.003.290	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $0	1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount not equal to $0
07/10/2025	4.0.13	CIP.002.308	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.308	UPDATE	Coding requirement	1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Value must be in ZIP Code List (VVL)3. Conditional	1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Value must be in ZIP Code List (VVL)3. Situational
12/19/2024	4.0.1	FTX.002.021	UPDATE	Definition	A unique claim/transaction number assigned by the state’s payment system that identifies the adjustment claim/transaction for an original item control number.	A unique claim/transaction number assigned by the stateâ€™s payment system that identifies the adjustment claim/transaction for an original item control number.
12/19/2024	4.0.1	FTX.002.020	UPDATE	Necessity	Conditional	Mandatory
12/19/2024	4.0.1	FTX.002.020	UPDATE	Coding requirement	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. Mandatory
10/10/2025	4.0.19	CIP.002.298	UPDATE	Coding requirement	1. Value must not be more than 60 characters long2. Mandatory3. Value must not contain a pipe or asterisk symbols	1. Value must not be more than 60 characters2. Mandatory3. Value must not contain a pipe or asterisk symbols
12/19/2024	4.0.1	PRV.002.021	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99]
12/19/2024	4.0.1	ELG.021.254	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]
12/19/2024	4.0.1	ELG.021.253	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]
07/17/2025	4.0.14	COT.002.246	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.246	UPDATE	Coding requirement	1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Value must be in ZIP Code List (VVL)3. Conditional	1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Value must be in ZIP Code List (VVL)3. Situational
10/10/2025	4.0.19	COT.002.236	UPDATE	Coding requirement	1. Value must not be more than 60 characters long2. Mandatory3. Value must not contain a pipe or asterisk symbols	1. Value must not be more than 60 characters2. Mandatory3. Value must not contain a pipe or asterisk symbols
12/19/2024	4.0.1	FTX.095.391	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21.P", value must be in 21.P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory
09/25/2025	4.0.18	FTX.095.392	UPDATE	Necessity	Mandatory	Conditional
09/25/2025	4.0.18	FTX.095.392	UPDATE	Coding requirement	1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Mandatory	1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Conditional6. Value must be populated when Payer ID Type equals "01"7. When not populated, an associated MBESCBES Form Group and MBESCBES Category of Service must not be populated
09/25/2025	4.0.18	FTX.095.393	UPDATE	Necessity	Mandatory	Conditional
09/25/2025	4.0.18	FTX.095.393	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Mandatory	1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. Value must be populated when Payer ID Type equals "01"
09/25/2025	4.0.18	FTX.095.390	UPDATE	Necessity	Mandatory	Conditional
09/25/2025	4.0.18	FTX.095.390	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Category for Federal Reimbursement List (VVL)3. Mandatory	1. Value must be 2 characters2. Value must be in Category for Federal Reimbursement List (VVL)3. Conditional4. Value must be populated when Payer ID Type equals "01"
12/19/2024	4.0.1	FTX.095.383	UPDATE	Definition	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique “key” value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique â€śkeyâ€ť value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/
12/19/2024	4.0.1	FTX.095.383	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Conditional3. When populated, value must match MSIS Identification Number (ELG.002.019)4. When Adjustment Indicator does not equal 1, there must be a valid record of type Enrollment Time Span where the Payment Period Start Date is equal to or greater than Enrollment Effective Date and Period Period End Date is less than or equal to Enrollment End Date	1. Value must be 20 characters or less2. Conditional3. When populated, value must match MSIS Identification Number (ELG.002.019)4. When populated and Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Payment Period Start Date is equal to or greater than Enrollment Effective Date
04/15/2025	4.0.6	FTX.095.373	UPDATE	Definition	The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.).	This is the identifier that corresponds with the payee's role in relation to the Medicaid/CHIP system. The payee is the individual or entity that is either receiving a payment or having a previous payment recouped. The payee is the object of the transaction, as opposed to the payer who is the subject taking the action of either making a payment or taking a recoupment.
12/19/2024	4.0.1	ELG.005.276	UPDATE	Definition	A free-form text field where a state can identify the “other” authority used to extend eligibility; required when 995 is used.	A free-form text field where a state can identify the â€śotherâ€ť authority used to extend eligibility; required when 995 is used.
07/17/2025	4.0.14	ELG.005.279	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	ELG.005.279	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Income Standard Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Income Standard Code List (VVL)3. Situational
05/29/2025	4.0.9	FTX.095.368	UPDATE	Definition	The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.).	This is the identifier that corresponds with the payer's role in relation to the Medicaid/CHIP system. The payer is the subject taking the action of either making a payment or taking a recoupment, as opposed to the payee who is the object of the transaction. The payer is the entity that is either making a payment or recouping a payment from another entity or individual. The payee is the individual or entity that is either receiving a payment or having a previous payment recouped.
07/17/2025	4.0.14	ELG.005.277	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	ELG.005.277	UPDATE	Coding requirement	1. Value must be 3 characters2. Value must be in Continuous Eligibility Code List (VVL)3. Conditional	1. Value must be 3 characters2. Value must be in Continuous Eligibility Code List (VVL)3. Situational
07/17/2025	4.0.14	ELG.005.275	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	ELG.005.275	UPDATE	Coding requirement	1. Value must be 3 characters or less2. Value must be in Eligibility Extension Code List (VVL)3. Conditional	1. Value must be 3 characters or less2. Value must be in Eligibility Extension Code List (VVL)3. Situational
05/29/2025	4.0.9	FTX.095.365	UPDATE	Definition	The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.).	The dollar amount being paid to the payee or recouped from the payee for a previous payment. A recoupment should be reported as a negative amount.
05/29/2025	4.0.9	FTX.095.364	UPDATE	Definition	The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.).	The date that the payment or recoupment was executed by the payer.
05/29/2025	4.0.9	FTX.095.363	UPDATE	Definition	The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.).	Indicates the type of adjustment record.
01/16/2025	4.0.2	FTX.095.361	UPDATE	Coding requirement	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated
05/29/2025	4.0.9	FTX.095.360	UPDATE	Definition	The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.).	A unique item control number assigned by the states payment system that identifies an original or adjustment claim/transaction.
05/29/2025	4.0.9	FTX.095.358	UPDATE	Definition	The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.).	A code that uniquely identifies the U.S. State or Territory from which T-MSIS system data resources were received.
12/19/2024	4.0.1	FTX.009.343	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21.P", value must be in 21.P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory
02/27/2025	4.0.3	FTX.009.344	UPDATE	Necessity	Mandatory	Conditional
02/27/2025	4.0.3	FTX.009.344	UPDATE	Coding requirement	1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Mandatory	1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Conditional6. Value must be populated when Payer ID Type equals "01"
02/27/2025	4.0.3	FTX.009.345	UPDATE	Necessity	Mandatory	Conditional
02/27/2025	4.0.3	FTX.009.345	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Mandatory	1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. Value must be populated when Payer ID Type equals "01"
02/27/2025	4.0.3	FTX.009.342	UPDATE	Necessity	Mandatory	Conditional
02/27/2025	4.0.3	FTX.009.342	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Category for Federal Reimbursement List (VVL)3. Mandatory	1. Value must be 2 characters2. Value must be in Category for Federal Reimbursement List (VVL)3. Conditional4. Value must be populated when Payer ID Type equals "01"
03/14/2025	4.0.4	FTX.009.340	UPDATE	Definition	The date representing the beginning of the FQHC wrap payment or recoupment period. For example, if the FQHC wrap payment is for the first calendar quarter of the year, then the FQHC wrap payment begin date would be March 1 of that year.	The date representing the beginning of the FQHC wrap payment or recoupment period. For example, if the FQHC wrap payment is for the first calendar quarter of the year then the Wrap Period Start Date would be January 1 of that year and the Wrap Period End Date would be March 31 of that year. Likewise, if the FQHC wrap payment is for the first calendar month of the year then the Wrap Period Start Date would be January 1 of that year and the Wrap Period End Date would be January 31 of that year.
03/14/2025	4.0.4	CLT.004.276	UPDATE	Coding requirement	1. Value must be in [01-24]2. Mandatory	1. Value must be in [01-24]2. Mandatory3. Value must be 2 digits
07/17/2025	4.0.14	CLT.004.279	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	CLT.004.279	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Diagnosis POA Flag List (VVL)3. Conditional	1. Value must be 1 character2. Value must be in Diagnosis POA Flag List (VVL)3. Situational
12/19/2024	4.0.1	CLT.004.275	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Diagnosis Type Code List (VVL)3. Value must be in [P,A,E,O]4. Mandatory	1. Value must be 1 character2. Value must be in Diagnosis Type Code List (VVL)3. Value must be in [A,E,O,P]4. Mandatory
12/19/2024	4.0.1	FTX.009.322	UPDATE	Definition	A unique claim/transaction number assigned by the state’s payment system that identifies the adjustment claim/transaction for an original item control number.	A unique claim/transaction number assigned by the stateâ€™s payment system that identifies the adjustment claim/transaction for an original item control number.
12/19/2024	4.0.1	CLT.003.261	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21.P", value must be in 21.P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Conditional11. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $012. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Conditional11. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $012. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated
12/19/2024	4.0.1	CLT.003.282	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $0	1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount not equal to $0
12/19/2024	4.0.1	FTX.008.304	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21.P", value must be in 21.P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory
12/19/2024	4.0.1	ELG.002.027	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]
12/19/2024	4.0.1	ELG.002.026	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]
12/19/2024	4.0.1	FTX.008.283	UPDATE	Definition	A unique claim/transaction number assigned by the state’s payment system that identifies the adjustment claim/transaction for an original item control number.	A unique claim/transaction number assigned by the stateâ€™s payment system that identifies the adjustment claim/transaction for an original item control number.
02/27/2025	4.0.3	CRX.004.206	UPDATE	Necessity	Mandatory	Conditional
02/27/2025	4.0.3	CRX.004.206	UPDATE	Coding requirement	1. Value must be a minimum of 3 characters2. If associated Diagnosis Code Flag value equals "1" (ICD-9), then value must be in ICD-9 Diagnosis Code List (VVL)3. If associated Diagnosis Code Flag value equals "2" (ICD-10), then value must be in ICD-10 Diagnosis Code List (VVL)4. Value must not contain a decimal point5. Mandatory	1. Value must be a minimum of 3 characters2. If associated Diagnosis Code Flag value equals "1" (ICD-9), then value must be in ICD-9 Diagnosis Code List (VVL)3. If associated Diagnosis Code Flag value equals "2" (ICD-10), then value must be in ICD-10 Diagnosis Code List (VVL)4. Value must not contain a decimal point5. Conditional
02/27/2025	4.0.3	CRX.004.204	UPDATE	Necessity	Mandatory	Conditional
02/27/2025	4.0.3	CRX.004.204	UPDATE	Coding requirement	1. Value must be in [01-24]2. Mandatory	1. Value must be in [01-24]2. Conditional
07/10/2025	4.0.13	CLT.002.254	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.254	UPDATE	Coding requirement	1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Value must be in ZIP Code List (VVL)3. Conditional	1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Value must be in ZIP Code List (VVL)3. Situational
12/19/2024	4.0.1	FTX.007.264	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21.P", value must be in 21.P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory
02/27/2025	4.0.3	FTX.007.265	UPDATE	Necessity	Mandatory	Conditional
02/27/2025	4.0.3	FTX.007.265	UPDATE	Coding requirement	1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Mandatory	1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Conditional6. Value must be populated when Payer ID Type equals "01"
02/27/2025	4.0.3	FTX.007.266	UPDATE	Necessity	Mandatory	Conditional
02/27/2025	4.0.3	FTX.007.266	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Mandatory	1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. Value must be populated when Payer ID Type equals "01"
02/27/2025	4.0.3	FTX.007.263	UPDATE	Necessity	Mandatory	Conditional
02/27/2025	4.0.3	FTX.007.263	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Category for Federal Reimbursement List (VVL)3. Mandatory	4. Value must be populated when Payer ID Type equals "01"1. Value must be 2 characters2. Value must be in Category for Federal Reimbursement List (VVL)3. Conditional
12/19/2024	4.0.1	CLT.002.249	UPDATE	Coding requirement	1.Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization)	1.Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.026) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization)
07/10/2025	4.0.13	CLT.002.245	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.245	UPDATE	Coding requirement	1. Value must not be more than 60 characters long2. Conditional3. Value must not be equal to associated Address Line 14. Value must not contain a pipe or asterisk symbols5. There must be an Address Line 1 in order to have an Address Line 2	1. Value must not be more than 60 characters long2. Situational3. Value must not be equal to associated Address Line 14. Value must not contain a pipe or asterisk symbols5. There must be an Address Line 1 in order to have an Address Line 2
01/16/2025	4.0.2	CRX.004.200	UPDATE	Coding requirement	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated
07/10/2025	4.0.13	CRX.003.195	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.003.195	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CRX.003.194	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.003.194	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CRX.003.193	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.003.193	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CRX.003.179	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.003.179	UPDATE	Coding requirement	1. Value must not be more than 76 characters long2. Conditional	1. Value must not be more than 76 characters long2. Situational
07/10/2025	4.0.13	CRX.002.178	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.178	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CRX.002.177	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.177	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CRX.002.176	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.176	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
10/10/2025	4.0.19	CRX.002.175	UPDATE	Coding requirement	1. Value must not be more than 50 characters long2. Conditional3. Value must be provided when corresponding Provider Claim Form Code is "Other"	1. Value must not be more than 50 characters2. Conditional3. Value must be provided when corresponding Provider Claim Form Code is "Other"
07/10/2025	4.0.13	CRX.002.173	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.173	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
01/16/2025	4.0.2	CIP.004.326	UPDATE	Coding requirement	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated
07/10/2025	4.0.13	CIP.003.337	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.003.337	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CIP.003.336	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.003.336	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CIP.003.319	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.003.319	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Situational
07/10/2025	4.0.13	CIP.003.318	UPDATE	Necessity	Conditional	SItuational
07/10/2025	4.0.13	CIP.003.318	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Conditional	1. Value must be 30 characters or less2. Situational
07/10/2025	4.0.13	CIP.003.317	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.003.317	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CIP.003.314	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.003.314	UPDATE	Coding requirement	1. Value must not be more than 76 characters long2. Conditional	1. Value must not be more than 76 characters long2. Situational
01/16/2025	4.0.2	COT.004.278	UPDATE	Coding requirement	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated
07/17/2025	4.0.14	COT.003.273	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.273	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/17/2025	4.0.14	COT.003.272	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.272	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
03/14/2025	4.0.4	COT.003.271	UPDATE	Data element name text	order Provider NPI Number	Ordering Provider NPI Number
07/17/2025	4.0.14	COT.003.270	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.270	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Conditional	1. Value must be 30 characters or less2. Situational
07/17/2025	4.0.14	COT.003.269	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.269	UPDATE	Coding requirement	1. Value must be 10 digits2. Conditional3. Value must have an associated Provider Identifier Type equal to "2"4. Value must exist in the NPPES NPI File5. Value must not be populated when Referring Provider NPI Number is not populated.6. Value must not equal Referring Provider NPI Number	1. Value must be 10 digits2. Situational3. Value must have an associated Provider Identifier Type equal to "2"4. Value must exist in the NPPES NPI File5. Value must not be populated when Referring Provider NPI Number is not populated.6. Value must not equal Referring Provider NPI Number
07/17/2025	4.0.14	COT.003.268	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.268	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Conditional	1. Value must be 30 characters or less2. Situational
07/17/2025	4.0.14	COT.003.267	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.267	UPDATE	Coding requirement	1. Value must be 10 digits2. Conditional3. Value must have an associated Provider Identifier Type equal to "2"4. Value must exist in the NPPES NPI File	1. Value must be 10 digits2. Situational3. Value must have an associated Provider Identifier Type equal to "2"4. Value must exist in the NPPES NPI File
07/17/2025	4.0.14	COT.003.266	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.266	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Conditional	1. Value must be 30 characters or less2. Situational
07/17/2025	4.0.14	COT.003.265	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.265	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/17/2025	4.0.14	COT.003.261	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.261	UPDATE	Coding requirement	1. Value must not be more than 28 characters long2. Conditional	1. Value must not be more than 28 characters long2. Situational
07/17/2025	4.0.14	COT.003.260	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.260	UPDATE	Coding requirement	1. Value must not be more than 60 characters long2. Conditional3. Value must not be equal to associated Address Line 14. There must be an Address Line 1 in order to have an Address Line 25. Value must not contain a pipe or asterisk symbols	1. Value must not be more than 60 characters long2. SItuational3. Value must not be equal to associated Address Line 14. There must be an Address Line 1 in order to have an Address Line 25. Value must not contain a pipe or asterisk symbols
07/17/2025	4.0.14	COT.003.259	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.259	UPDATE	Coding requirement	1. Value must not be more than 60 characters long2. Conditional3. Value must not contain a pipe or asterisk symbols	1. Value must not be more than 60 characters long2. Situational3. Value must not contain a pipe or asterisk symbols
12/19/2024	4.0.1	COT.003.258	UPDATE	Coding requirement	1.Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization)	1.Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.026) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization)
12/19/2024	4.0.1	COT.003.255	UPDATE	Coding requirement	1. Value must not be more than 76 characters long2. Conditional
07/10/2025	4.0.13	CIP.002.339	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.339	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CIP.002.338	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.338	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CIP.002.311	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.311	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
10/10/2025	4.0.19	CIP.002.310	UPDATE	Coding requirement	1. Value must not be more than 50 characters long2. Conditional3. Value must be provided when corresponding Provider Claim Form Code is "Other"	1. Value must not be more than 50 characters2. Conditional3. Value must be provided when corresponding Provider Claim Form Code is "Other"
07/10/2025	4.0.13	CIP.002.306	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.306	UPDATE	Coding requirement	1. Value must not be more than 28 characters long2. Conditional	1. Value must not be more than 28 characters long2. Situational
07/10/2025	4.0.13	CIP.002.305	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.305	UPDATE	Coding requirement	1. Value must not be more than 60 characters long2. Conditional3. Value must not be equal to associated Address Line 14. There must be an Address Line 1 in order to have an Address Line 25. Value must not contain a pipe or asterisk symbols	1. Value must not be more than 60 characters long2. Situational3. Value must not be equal to associated Address Line 14. There must be an Address Line 1 in order to have an Address Line 25. Value must not contain a pipe or asterisk symbols
07/10/2025	4.0.13	CIP.002.304	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.304	UPDATE	Coding requirement	1. Value must not be more than 60 characters long2. Conditional3. Value must not contain a pipe or asterisk symbols	1. Value must not be more than 60 characters long2. Situational3. Value must not contain a pipe or asterisk symbols
12/19/2024	4.0.1	CIP.002.303	UPDATE	Coding requirement	1.Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization)	1.Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.026) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization)
07/10/2025	4.0.13	CIP.002.299	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.299	UPDATE	Coding requirement	1. Value must not be more than 60 characters long2. Conditional3. Value must not be equal to associated Address Line 14. Value must not contain a pipe or asterisk symbols5. There must be an Address Line 1 in order to have an Address Line 2	1. Value must not be more than 60 characters long2. Situational3. Value must not be equal to associated Address Line 14. Value must not contain a pipe or asterisk symbols5. There must be an Address Line 1 in order to have an Address Line 2
07/10/2025	4.0.13	CIP.002.297	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.297	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/17/2025	4.0.14	COT.002.253	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.253	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/17/2025	4.0.14	COT.002.252	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.252	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/17/2025	4.0.14	COT.002.251	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.251	UPDATE	Coding requirement	1. Value must be 10 digits2. Conditional3. Value must have an associated Provider Identifier Type equal to "2"4. Value must exist in the NPPES NPI File5. Value must not be populated when Referring Provider NPI Number is not populated6. Value must not equal Referring Provider NPI Number	1. Value must be 10 digits2. Situational3. Value must have an associated Provider Identifier Type equal to "2"4. Value must exist in the NPPES NPI File5. Value must not be populated when Referring Provider NPI Number is not populated6. Value must not equal Referring Provider NPI Number
07/17/2025	4.0.14	COT.002.250	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.250	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Conditional3. Value must not be populated when Referring Provider Number is not populated.4. Value must not equal Referring Provider Number	1. Value must be 30 characters or less2. Situational3. Value must not be populated when Referring Provider Number is not populated.4. Value must not equal Referring Provider Number
07/17/2025	4.0.14	COT.002.249	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.249	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
10/10/2025	4.0.19	COT.002.248	UPDATE	Coding requirement	1. Value must not be more than 50 characters long2. Conditional3. Value must be provided when corresponding Provider Claim Form Code is "Other"	1. Value must not be more than 50 characters2. Conditional3. Value must be provided when corresponding Provider Claim Form Code is "Other"
07/17/2025	4.0.14	COT.002.244	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.244	UPDATE	Coding requirement	1. Value must not be more than 28 characters long2. Conditional	1. Value must not be more than 28 characters long2. Situational
07/17/2025	4.0.14	COT.002.243	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.243	UPDATE	Coding requirement	1. Value must not be more than 60 characters long2. Conditional3. Value must not be equal to associated Address Line 14. There must be an Address Line 1 in order to have an Address Line 25. Value must not contain a pipe or asterisk symbols	1. Value must not be more than 60 characters long2. Situational3. Value must not be equal to associated Address Line 14. There must be an Address Line 1 in order to have an Address Line 25. Value must not contain a pipe or asterisk symbols
07/17/2025	4.0.14	COT.002.242	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.242	UPDATE	Coding requirement	1. Value must not be more than 60 characters long2. Conditional3. Value must not contain a pipe or asterisk symbols	1. Value must not be more than 60 characters long2. Situational3. Value must not contain a pipe or asterisk symbols
12/19/2024	4.0.1	COT.002.241	UPDATE	Coding requirement	1.Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization)	1.Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.026) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization)
07/17/2025	4.0.14	COT.002.237	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.237	UPDATE	Coding requirement	1. Value must not be more than 60 characters long2. Conditional3. Value must not be equal to associated Address Line 14. Value must not contain a pipe or asterisk symbols5. There must be an Address Line 1 in order to have an Address Line 2	1. Value must not be more than 60 characters long2. Situational3. Value must not be equal to associated Address Line 14. Value must not contain a pipe or asterisk symbols5. There must be an Address Line 1 in order to have an Address Line 2
07/17/2025	4.0.14	COT.002.235	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.235	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
12/19/2024	4.0.1	ELG.005.095	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Eligibility Change Reason List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Eligibility Termination Reason List (VVL)3. Conditional
01/16/2025	4.0.2	CLT.004.272	UPDATE	Coding requirement	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated
07/10/2025	4.0.13	CLT.003.267	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.003.267	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CLT.003.266	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.003.266	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CLT.003.265	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.003.265	UPDATE	Coding requirement	1. Value must be 10 digits2. Conditional3. Value must have an associated Provider Identifier Type equal to "2"4. Value must exist in the NPPES NPI File	1. Value must be 10 digits2. Situational3. Value must have an associated Provider Identifier Type equal to "2"4. Value must exist in the NPPES NPI File
07/10/2025	4.0.13	CLT.003.264	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.003.264	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Conditional	1. Value must be 30 characters or less2. Situational
07/10/2025	4.0.13	CLT.003.263	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.003.263	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CLT.003.260	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.003.260	UPDATE	Coding requirement	1. Value must not be more than 76 characters long2. Conditional	1. Value must not be more than 76 characters long2. Situational
12/19/2024	4.0.1	ELG.003.046	UPDATE	Coding requirement	1. Value must be 3 characters2. Value must be in Primary Language Code List (VVL)3. Conditional	1. Value must be 3 characters2. Value must be in Preferred Language Code List (VVL)3. Conditional
07/10/2025	4.0.13	CLT.002.259	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.259	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CLT.002.258	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.258	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CLT.002.257	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.257	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
10/10/2025	4.0.19	CLT.002.256	UPDATE	Coding requirement	1. Value must not be more than 50 characters long2. Conditional3. Value must be provided when corresponding Provider Claim Form Code is "Other"	1. Value must not be more than 50 characters2. Conditional3. Value must be provided when corresponding Provider Claim Form Code is "Other"
07/10/2025	4.0.13	CLT.002.252	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.252	UPDATE	Coding requirement	1. Value must not be more than 28 characters long2. Conditional	1. Value must not be more than 28 characters long2. Situational
07/10/2025	4.0.13	CLT.002.251	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.251	UPDATE	Coding requirement	1. Value must not be more than 60 characters long2. Conditional3. Value must not be equal to associated Address Line 14. There must be an Address Line 1 in order to have an Address Line 25. Value must not contain a pipe or asterisk symbols	1. Value must not be more than 60 characters long2. Situational3. Value must not be equal to associated Address Line 14. There must be an Address Line 1 in order to have an Address Line 25. Value must not contain a pipe or asterisk symbols
07/10/2025	4.0.13	CLT.002.250	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.250	UPDATE	Coding requirement	1. Value must not be more than 60 characters long2. Conditional3. Value must not contain a pipe or asterisk symbols	1. Value must not be more than 60 characters long2. Situational3. Value must not contain a pipe or asterisk symbols
04/24/2025	4.0.7	Data Quality Measures	UPDATE	Show	False	True
04/24/2025	4.0.7	Data Quality Measures	UPDATE	Version text		4.0.0
04/24/2025	4.0.7	Data Quality Measures	UPDATE	Thresholds document	None	319
04/24/2025	4.0.7	Data Quality Measures	UPDATE	Measures specification	None	320
04/24/2025	4.0.7	Data Quality Measures	UPDATE	Threshold and measures combined	None	321
11/26/2024	4.0.0	Data Quality Measures	UPDATE	Show	True	False
12/19/2024	4.0.1	ELG.003.044	UPDATE	Definition	The date the five-year bar for an individual ends. Section 403 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) provides that certain immigrants who enter the United States on or after August 22, 1996 are not eligible to receive federally-funded benefits, including Medicaid and the State Children's Health Insurance Program (Separate CHIP), for five years from the date they enter the country with a status as a "qualified alien."	The date the five-year bar for an individual ends. Section 403 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) provides that certain immigrants who enter the United States on or after August 22, 1996 are not eligible to receive federally-funded benefits, including Medicaid and the State Children's Health Insurance Program (Separate CHIP), for five years from the date they enter the country with a status as a "qualified noncitizen."
07/17/2025	4.0.14	COT.003.208	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.208	UPDATE	Coding requirement	1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Value must be in ZIP Code List (VVL)3. Conditional	1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Value must be in ZIP Code List (VVL)3. Situational
10/08/2024	4.0.0	ELG.003.044	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD" 2. Conditional3. If Immigration Status (ELG.003.042) equals "8" (U.S. Citizen), then value should not be populated	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Conditional3. If Immigration Status (ELG.003.042) equals "8" (U.S. Citizen), then value should not be populated
10/01/2024	4.0.0	ELG.003.044	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Conditional3. If Immigration Status (ELG.003.042) equals "8" (U.S. Citizen), then value should not be populated	1. The date must be a valid calendar date in the form "CCYYMMDD" 2. Conditional3. If Immigration Status (ELG.003.042) equals "8" (U.S. Citizen), then value should not be populated
07/17/2025	4.0.14	TPL.006.079	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	TPL.006.079	UPDATE	Coding requirement	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 2 value(s)3. If Address Line 2 is not populated, then value should not be populated4. Value must not contain a pipe or asterisk symbols5. Conditional	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 2 value(s)3. If Address Line 2 is not populated, then value should not be populated4. Value must not contain a pipe or asterisk symbols5. Situational
07/17/2025	4.0.14	TPL.006.078	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	TPL.006.078	UPDATE	Coding requirement	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 3 value(s)3. There must be an Address Line 1 in order to have an Address Line 24. Value must not contain a pipe or asterisk symbols5. Conditional	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 3 value(s)3. There must be an Address Line 1 in order to have an Address Line 24. Value must not contain a pipe or asterisk symbols5. Situational
12/19/2024	4.0.1	TPL.005.069	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99]
07/17/2025	4.0.14	TPL.003.047	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	TPL.003.047	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Policy Owner Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Policy Owner Code List (VVL)3. Situational
07/17/2025	4.0.14	TPL.003.046	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	TPL.003.046	UPDATE	Coding requirement	1. Value must be 9-digit number2. For any individual, the value must be the same over all segment effective and end dates3. Conditional	1. Value must be 9-digit number2. For any individual, the value must be the same over all segment effective and end dates3. Situational
07/17/2025	4.0.14	TPL.003.038	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	TPL.003.038	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/17/2025	4.0.14	TPL.003.037	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	TPL.003.037	UPDATE	Coding requirement	1. Value must be 2 characters or less2. Value must be in Insurance Plan Type List (VVL)3. Conditional4. Value must have an associated Insurance Plan ID	1. Value must be 2 characters or less2. Value must be in Insurance Plan Type List (VVL)3. Situational4. Value must have an associated Insurance Plan ID
07/17/2025	4.0.14	TPL.003.036	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	TPL.003.036	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must not contain a pipe symbol3. Conditional	1. Value must be 20 characters or less2. Value must not contain a pipe symbol3. Situational
07/17/2025	4.0.14	TPL.003.035	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	TPL.003.035	UPDATE	Coding requirement	1. Value must be 16 characters or less2. Value must not contain a pipe symbol3. Conditional	1. Value must be 16 characters or less2. Value must not contain a pipe symbol3. Situational
07/17/2025	4.0.14	TPL.003.034	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	TPL.003.034	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional	1. Value must be 20 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
07/17/2025	4.0.14	TPL.003.033	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	TPL.003.033	UPDATE	Coding requirement	1. Value must be 12 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional	1. Value must be 12 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
07/17/2025	4.0.14	TPL.002.023	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	TPL.002.023	UPDATE	Coding requirement	1. Value must be 1 character2. Value must not contain a pipe or asterisk symbols3. Conditional	1. Value must be 1 character2. Value must not contain a pipe or asterisk symbols3. Situational
02/27/2025	4.0.3	TPL.002.020	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in TPL Health Insurance Coverage Indicator List (VVL)4. Mandatory5. When value equals "1", there must be one corresponding TPL Medicaid Eligible Person Health Insurance Coverage Information (TPL.003) segment with the same MSIS ID	1. Value must be 1 character2. Value must be in TPL Health Insurance Coverage Indicator List (VVL)3. Mandatory4. When value equals "1", there must be one corresponding TPL Medicaid Eligible Person Health Insurance Coverage Information (TPL.003) segment with the same MSIS ID
05/07/2025	4.0.8	TPL.001.088	UPDATE	Coding requirement	1. Value must be 4 characters or less2. Value must between 1 and 99993. Value must be equal to the largest of any prior values for the same reporting period and file type, plus 1 (i.e. incremented by 1)4. Value must not contain a pipe symbol5. Mandatory	1. Value must be 4 characters or less2. Value must be between 1 and 99993. Value must be equal to the largest of any prior values for the same reporting period and file type, plus 1 (i.e. incremented by 1)4. Value must not contain a pipe symbol5. Mandatory
12/19/2024	4.0.1	TPL.001.003	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Subcaptitation Indicator List (VVL)3. Mandatory	1. Value must be 1 character2. Value must be in Submission Transaction Type List (VVL)3. Mandatory
12/19/2024	4.0.1	PRV.009.122	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99]
12/19/2024	4.0.1	PRV.008.112	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99]
12/19/2024	4.0.1	PRV.007.099	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99]
12/19/2024	4.0.1	PRV.006.091	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99]
12/19/2024	4.0.1	PRV.006.089	UPDATE	Coding requirement	1. Value must be 20 characters or less2. If associated Provider Classification Type equals "1", value must be in Provider Taxonomy List (VVL)3. If associated Provider Classification Type equals "2", value must be in Provider Specialty List (VVL)4. If associated Provider Classification Type equals "3", value must be in Provider Type Code List (VVL)5. If associated Provider Classification Type equals "4", value must be in Provider Authorized Category of Service Code List (VVL)6. Mandatory	1. Value must be 20 characters or less2. If associated Provider Classification Type equals "1", value must be in Provider Taxonomy List (VVL)3. If associated Provider Classification Type equals "2", value must be in Provider Specialty List (VVL)4. If associated Provider Classification Type equals "3", value must be in Provider Type Code List (VVL)5. If associated Provider Classification Type equals "4", value must be in Provider Classification Code Type 4 List (VVL)6. Mandatory
12/19/2024	4.0.1	PRV.004.066	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99]
07/17/2025	4.0.14	PRV.003.049	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	PRV.003.049	UPDATE	Coding requirement	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 2 value(s)3. If Address Line 2 is not populated, then value should not be populated4. Value must not contain a pipe or asterisk symbols5. Conditional	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 2 value(s)3. If Address Line 2 is not populated, then value should not be populated4. Value must not contain a pipe or asterisk symbols5. Situational
07/17/2025	4.0.14	PRV.003.048	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	PRV.003.048	UPDATE	Coding requirement	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 3 value(s)3. There must be an Address Line 1 in order to have an Address Line 24. Value must not contain a pipe or asterisk symbols5. Conditional	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 3 value(s)3. There must be an Address Line 1 in order to have an Address Line 24. Value must not contain a pipe or asterisk symbols5. Situational
07/17/2025	4.0.14	PRV.002.035	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	PRV.002.035	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Conditional3. If populated, value must be on or after individual's Date of Birth4. Value must be less than or equal to associated End of Time Period (PRV.001.010)5. There can only be one value on all records when the value is populated6. When populated, the difference between value and Date of Birth (PRV.002.034) must be 18 years or greater	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Situational3. If populated, value must be on or after individual's Date of Birth4. Value must be less than or equal to associated End of Time Period (PRV.001.010)5. There can only be one value on all records when the value is populated6. When populated, the difference between value and Date of Birth (PRV.002.034) must be 18 years or greater
07/17/2025	4.0.14	PRV.002.034	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	PRV.002.034	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be less than or equal to associated End of Time Period (PRV.001.010)3. Conditional4. The difference between current value and Start of Time Period (PRV.001.009) must be between 18 and 85 years	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be less than or equal to associated End of Time Period (PRV.001.010)3. Situational4. The difference between current value and Start of Time Period (PRV.001.009) must be between 18 and 85 years
02/20/2025	4.0.3	PRV.002.031	UPDATE	Definition	Either individual's biological sex or their self-identified sex.	The individual's biological sex assigned at birth.
07/17/2025	4.0.14	PRV.002.030	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	PRV.002.030	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional	1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
07/17/2025	4.0.14	PRV.002.029	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	PRV.002.029	UPDATE	Coding requirement	1. Value must be 1 character2. Value must not contain a pipe or asterisk symbols3. Conditional	1. Value must be 1 character2. Value must not contain a pipe or asterisk symbols3. Situational
07/17/2025	4.0.14	PRV.002.028	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	PRV.002.028	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional	1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
12/19/2024	4.0.1	PRV.002.026	UPDATE	Coding requirement	1. Value must be in Facility Group Individual Code List (VVL)2. Value must be 2 characters3. Mandatory4. (individual) if value equals "03", then Provider First Name (PRV.002.028) must be populated5. (Individual) NPPES Entity Type Code associate with this NPI must equal "1" (Individual)6. (individual) if value equals "03", then Provider Last Name (PRV.002.030) must be populated7. (individual) if value equals "03", then Provider Sex (PRV.002.031) must be populated8. (individual) if value equals "03", then Provider Date of Birth (PRV.002.034) must be populated9. (Organization) If value equals "01" or "02", then Provider Date of Death (PRV.002.035) must not be populated10. (Organization) If value does not equal "03", then Provider Middle Initial (PRV.002.029) must not be populated11. (Organization) NPPES Entity Type Code associate with this NPI must equal "2" (Organization)	1. Value must be in Facility Group Individual Code List (VVL)2. Value must be 2 characters3. Mandatory4. (Individual) if value equals "03", then Provider First Name (PRV.002.028) must be populated5. (Individual) NPPES Entity Type Code associated with a Provider NPI reported in (PRV.005.081) must equal "1" (Individual)6. (Individual) if value equals "03", then Provider Last Name (PRV.002.030) must be populated7. (Individual) if value equals "03", then Provider Sex (PRV.002.031) must be populated8. (Individual) if value equals "03", then Provider Date of Birth (PRV.002.034) must be populated9. (Organization) If value equals "01" or "02", then Provider Date of Death (PRV.002.035) must not be populated10. (Organization) If value does not equal "03", then Provider Middle Initial (PRV.002.029) must not be populated11. (Organization) NPPES Entity Type Code associated with a Provider NPI reported in (PRV.005.081) must equal "2" (Organization)
07/17/2025	4.0.14	PRV.002.024	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	PRV.002.024	UPDATE	Coding requirement	1. Value must be 60 characters or less2. Value must not contain a pipe or asterisk symbol3. Conditional	1. Value must be 60 characters or less2. Value must not contain a pipe or asterisk symbol3. Situational
07/17/2025	4.0.14	PRV.002.022	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	PRV.002.022	UPDATE	Coding requirement	1. Value must be 100 characters or less2. Value must not contain a pipe or asterisk symbol3. Conditional	1. Value must be 100 characters or less2. Value must not contain a pipe or asterisk symbol3. Situational
05/07/2025	4.0.8	PRV.001.138	UPDATE	Coding requirement	1. Value must be 4 characters or less2. Value must between 1 and 99993. Value must be equal to the largest of any prior values for the same reporting period and file type, plus 1 (i.e. incremented by 1)4. Value must not contain a pipe symbol5. Mandatory	1. Value must be 4 characters or less2. Value must be between 1 and 99993. Value must be equal to the largest of any prior values for the same reporting period and file type, plus 1 (i.e. incremented by 1)4. Value must not contain a pipe symbol5. Mandatory
12/19/2024	4.0.1	PRV.001.003	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Subcaptitation Indicator List (VVL)3. Mandatory	1. Value must be 1 character2. Value must be in Submission Transaction Type List (VVL)3. Mandatory
10/01/2024	4.0.0	MCR.006.078	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]5. Value of the CC component must be in [18,19, 20]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]
12/19/2024	4.0.1	MCR.006.077	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Managed Care Plan Pop List (VVL)3. Mandatory	1. Value must be 2 characters2. Value must be in Eligibility Group List (VVL)3. Mandatory
07/10/2025	4.0.13	MCR.003.051	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	MCR.003.051	UPDATE	Coding requirement	1. Value must be 10-digit number2. Conditional	1. Value must be 10-digit number2. Situational
07/10/2025	4.0.13	MCR.003.044	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	MCR.003.044	UPDATE	Coding requirement	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 2 value(s)3. If Address Line 2 is not populated, then value should not be populated4. Value must not contain a pipe or asterisk symbols5. Conditional	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 2 value(s)3. If Address Line 2 is not populated, then value should not be populated4. Value must not contain a pipe or asterisk symbols5. SItuational
07/10/2025	4.0.13	MCR.003.043	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	MCR.003.043	UPDATE	Coding requirement	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 3 value(s)3. There must be an Address Line 1 in order to have an Address Line 24. Value must not contain a pipe or asterisk symbols5. Conditional	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 3 value(s)3. There must be an Address Line 1 in order to have an Address Line 24. Value must not contain a pipe or asterisk symbols5. Situational
05/07/2025	4.0.8	MCR.001.112	UPDATE	Coding requirement	1. Value must be 4 characters or less2. Value must between 1 and 99993. Value must be equal to the largest of any prior values for the same reporting period and file type, plus 1 (i.e. incremented by 1)4. Value must not contain a pipe symbol5. Mandatory	1. Value must be 4 characters or less2. Value must be between 1 and 99993. Value must be equal to the largest of any prior values for the same reporting period and file type, plus 1 (i.e. incremented by 1)4. Value must not contain a pipe symbol5. Mandatory
10/08/2024	4.0.0	MCR.001.007	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in State Code List (VVL)4. Value must be the same for all records3. Mandatory	1. Value must be 2 characters2. Value must be in State Code List (VVL)3. Mandatory4. Value must be the same for all records
12/19/2024	4.0.1	MCR.001.003	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Subcaptitation Indicator List (VVL)3. Mandatory	1. Value must be 1 character2. Value must be in Submission Transaction Type List (VVL)3. Mandatory
07/10/2025	4.0.13	FTX.095.404	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.095.404	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Conditional	1. Value must be 500 characters or less2. Situational
07/10/2025	4.0.13	FTX.095.401	UPDATE	Coding requirement	1. Value must be 50 characters or less2. Conditional	1. Value must be 50 characters or less2. Situational
12/19/2024	4.0.1	FTX.095.400	UPDATE	Definition	State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where: SS = State (use the two character postal abbreviation for your state); YY = Calendar Year (last two characters of the calendar year of the state plan amendment); NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions. The system will not permit reuse of a previously used SPA ID for a package that has been formally = an Situational entry for specific SPA types	State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where: SS = State (use the two character postal abbreviation for your state); YY = Calendar Year (last two characters of the calendar year of the state plan amendment); NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions. xxxx = Optional, 1 to 4 characters alpha/numeric modifier (Suffix) States should use the specific SPA that covered the services rendered.
08/29/2025	4.0.17	FTX.095.397	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Funding Source Nonfederal Share (VVL)3. Mandatory	1. Value must be 2 characters2. Value must be in Funding Source Nonfederal Share List (VVL)3. Mandatory
07/10/2025	4.0.13	FTX.095.395	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.095.395	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Conditional	1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Situational
05/29/2025	4.0.9	FTX.095.394	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional
04/15/2025	4.0.6	FTX.095.389	UPDATE	Coding requirement	1. Value must be 100 characters or less2. Value must be populated when Payee Identifier Type equals "95"3. Conditional	1. Value must be 100 characters or less2. Value must be populated when Transaction Type equals "95"3. Conditional
12/19/2024	4.0.1	FTX.095.374	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Payee Identifier Type List (VVL)3. If value equals "01", then Payee Identifier must equal Submitting State (FTX.001.007)4. If value equals "02", then Payee Identifier must equal State Plan Identification Number (MCR.002.019)5. If value in [04,05], then Payee Identifier must equal Submitting State Provider Identifier (PRV.002.019)6. If value equals "06", then Payee Identifier must equal Provider Identifier (PRV.005.081) where Provider Identifier Type (PRV.005.077) equals "2"7. If value equals "07", then Payee Identifier must equal Insurance Carrier Identification Number (TPL.006.075)8. If value equals "08", then Payee Identifier must equal MSIS Identification Number (ELG.002.019)9. Mandatory	1. Value must be 2 characters2. Value must be in Payee Identifier Type List (VVL)3. If value equals "01", then Payee Identifier must equal Submitting State (FTX.095.358)4. If value equals "02", then Payee Identifier must equal State Plan Identification Number (MCR.002.019)5. If value in [04,05], then Payee Identifier must equal Submitting State Provider Identifier (PRV.002.019)6. If value equals "06", then Payee Identifier must equal Provider Identifier (PRV.005.081) where Provider Identifier Type (PRV.005.077) equals "2"7. If value equals "07", then Payee Identifier must equal Insurance Carrier Identification Number (TPL.006.075)8. If value equals "08", then Payee Identifier must equal MSIS Identification Number (ELG.002.019)9. Mandatory
05/29/2025	4.0.9	FTX.095.372	UPDATE	Definition	The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.).	This is a description of what type of managed care plan or care coordination model the payer ID was reported with a PAYER-MCR-PLAN-OR-OTHER-TYPE of "Other".
05/29/2025	4.0.9	FTX.095.371	UPDATE	Definition	The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.).	This describes the type of managed care plan or care coordination model of the payer, when applicable. The valid value list is comprised of the standard managed care plan type list from the MCR and ELG files and a complementary list of care coordination models.
05/29/2025	4.0.9	FTX.095.370	UPDATE	Definition	The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.).	This is a description of what the payer ID represents when the payer ID was reported with a payer type of "Other".
12/19/2024	4.0.1	FTX.095.369	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Payer ID Type List (VVL)3. Mandatory4. When value equals "01" then Payer ID must equal Submitting State (FTX.001.007)5. When value equals "02" then Payer ID must equal State Plan Identification Number (MCR.002.019)6. When value equals "04" then Payer ID must equal must equal Submitting State Provider Identifier (PRV.002.019)	1. Value must be 2 characters2. Value must be in Payer ID Type List (VVL)3. Mandatory4. When value equals "01" then Payer ID must equal Submitting State (FTX.095.358)5. When value equals "02" then Payer ID must equal State Plan Identification Number (MCR.002.019)6. When value equals "04" then Payer ID must equal must equal Submitting State Provider Identifier (PRV.002.019)
05/29/2025	4.0.9	FTX.095.367	UPDATE	Definition	The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.).	The check or electronic funds transfer number.
05/29/2025	4.0.9	FTX.095.366	UPDATE	Definition	The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.).	The date a check is issued to the payee. In the case of electronic funds transfer, it is the date the transfer is made.
05/29/2025	4.0.9	FTX.095.359	UPDATE	Definition	The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.).	A sequential number assigned by the submitter to identify each record segment row in the submission file. The Record Number, in conjunction with the Record Identifier, uniquely identifies a single record within the submission file.
07/10/2025	4.0.13	FTX.009.354	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.009.354	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Conditional	1. Value must be 500 characters or less2. Situational
12/19/2024	4.0.1	FTX.009.351	UPDATE	Definition	State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where: SS = State (use the two character postal abbreviation for your state); YY = Calendar Year (last two characters of the calendar year of the state plan amendment); NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions. The system will not permit reuse of a previously used SPA ID for a package that has been formally = an Situational entry for specific SPA types	State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where: SS = State (use the two character postal abbreviation for your state); YY = Calendar Year (last two characters of the calendar year of the state plan amendment); NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions. xxxx = Optional, 1 to 4 characters alpha/numeric modifier (Suffix) States should use the specific SPA that covered the services rendered
08/29/2025	4.0.17	FTX.009.349	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Funding Source Nonfederal Share (VVL)3. Mandatory	1. Value must be 2 characters2. Value must be in Funding Source Nonfederal Share List (VVL)3. Mandatory
07/10/2025	4.0.13	FTX.009.347	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.009.347	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Conditional	1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Situational
05/29/2025	4.0.9	FTX.009.346	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional
12/19/2024	4.0.1	FTX.009.333	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Payee Identifier Type List (VVL)3. If value equals "01", then Payee Identifier must equal Submitting State (FTX.001.007)4. If value equals "02", then Payee Identifier must equal State Plan Identification Number (MCR.002.019)5. If value in [04,05], then Payee Identifier must equal Submitting State Provider Identifier (PRV.002.019)6. If value equals "06", then Payee Identifier must equal Provider Identifier (PRV.005.081) where Provider Identifier Type (PRV.005.077) equals "2"7. If value equals "07", then Payee Identifier must equal Insurance Carrier Identification Number (TPL.006.075)8. If value equals "08", then Payee Identifier must equal MSIS Identification Number (ELG.002.019)9. Mandatory	1. Value must be 2 characters2. Value must be in Payee Identifier Type List (VVL)3. If value equals "01", then Payee Identifier must equal Submitting State (FTX.009.319)4. If value equals "02", then Payee Identifier must equal State Plan Identification Number (MCR.002.019)5. If value in [04,05], then Payee Identifier must equal Submitting State Provider Identifier (PRV.002.019)6. If value equals "06", then Payee Identifier must equal Provider Identifier (PRV.005.081) where Provider Identifier Type (PRV.005.077) equals "2"7. If value equals "07", then Payee Identifier must equal Insurance Carrier Identification Number (TPL.006.075)8. If value equals "08", then Payee Identifier must equal MSIS Identification Number (ELG.002.019)9. Mandatory
12/19/2024	4.0.1	FTX.009.330	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Payer ID Type List (VVL)3. Mandatory4. When value equals "01" then Payer ID must equal Submitting State (FTX.001.007)5. When value equals "02" then Payer ID must equal State Plan Identification Number (MCR.002.019)6. When value equals "04" then Payer ID must equal must equal Submitting State Provider Identifier (PRV.002.019)	1. Value must be 2 characters2. Value must be in Payer ID Type List (VVL)3. Mandatory4. When value equals "01" then Payer ID must equal Submitting State (FTX.009.319)5. When value equals "02" then Payer ID must equal State Plan Identification Number (MCR.002.019)6. When value equals "04" then Payer ID must equal must equal Submitting State Provider Identifier (PRV.002.019)
07/10/2025	4.0.13	FTX.009.328	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.009.328	UPDATE	Coding requirement	1. Value must be 15 characters or less2. When populated, value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Conditional	1. Value must be 15 characters or less2. When populated, value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Situational
07/10/2025	4.0.13	FTX.009.327	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.009.327	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Conditional4. Value of the CC component must be equal to "20"	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Situational4. Value of the CC component must be equal to "20"
07/10/2025	4.0.13	FTX.008.315	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.008.315	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Conditional	1. Value must be 500 characters or less2. Situational
12/19/2024	4.0.1	FTX.008.312	UPDATE	Definition	State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where: SS = State (use the two character postal abbreviation for your state); YY = Calendar Year (last two characters of the calendar year of the state plan amendment); NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions. The system will not permit reuse of a previously used SPA ID for a package that has been formally = an Situational entry for specific SPA types	State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where: SS = State (use the two character postal abbreviation for your state); YY = Calendar Year (last two characters of the calendar year of the state plan amendment); NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions. xxxx = Optional, 1 to 4 characters alpha/numeric modifier (Suffix) States should use the specific SPA that covered the services rendered.
08/29/2025	4.0.17	FTX.008.310	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Funding Source Nonfederal Share (VVL)3. Mandatory	1. Value must be 2 characters2. Value must be in Funding Source Nonfederal Share List (VVL)3. Mandatory
07/10/2025	4.0.13	FTX.008.308	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.008.308	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Conditional	1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Situational
05/29/2025	4.0.9	FTX.008.307	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional
12/19/2024	4.0.1	FTX.008.294	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Payee Identifier Type List (VVL)3. If value equals "01", then Payee Identifier must equal Submitting State (FTX.001.007)4. If value equals "02", then Payee Identifier must equal State Plan Identification Number (MCR.002.019)5. If value in [04,05], then Payee Identifier must equal Submitting State Provider Identifier (PRV.002.019)6. If value equals "06", then Payee Identifier must equal Provider Identifier (PRV.005.081) where Provider Identifier Type (PRV.005.077) equals "2"7. If value equals "07", then Payee Identifier must equal Insurance Carrier Identification Number (TPL.006.075)8. If value equals "08", then Payee Identifier must equal MSIS Identification Number (ELG.002.019)9. Mandatory	1. Value must be 2 characters2. Value must be in Payee Identifier Type List (VVL)3. If value equals "01", then Payee Identifier must equal Submitting State (FTX.008.280)4. If value equals "02", then Payee Identifier must equal State Plan Identification Number (MCR.002.019)5. If value in [04,05], then Payee Identifier must equal Submitting State Provider Identifier (PRV.002.019)6. If value equals "06", then Payee Identifier must equal Provider Identifier (PRV.005.081) where Provider Identifier Type (PRV.005.077) equals "2"7. If value equals "07", then Payee Identifier must equal Insurance Carrier Identification Number (TPL.006.075)8. If value equals "08", then Payee Identifier must equal MSIS Identification Number (ELG.002.019)9. Mandatory
12/19/2024	4.0.1	FTX.008.291	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Payer ID Type List (VVL)3. Mandatory4. When value equals "01" then Payer ID must equal Submitting State (FTX.001.007)5. When value equals "02" then Payer ID must equal State Plan Identification Number (MCR.002.019)6. When value equals "04" then Payer ID must equal must equal Submitting State Provider Identifier (PRV.002.019)	1. Value must be 2 characters2. Value must be in Payer ID Type List (VVL)3. Mandatory4. When value equals "01" then Payer ID must equal Submitting State (FTX.008.280)5. When value equals "02" then Payer ID must equal State Plan Identification Number (MCR.002.019)6. When value equals "04" then Payer ID must equal must equal Submitting State Provider Identifier (PRV.002.019)
07/10/2025	4.0.13	FTX.008.289	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.008.289	UPDATE	Coding requirement	1. Value must be 15 characters or less2. When populated, value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Conditional	1. Value must be 15 characters or less2. When populated, value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Situational
07/10/2025	4.0.13	FTX.008.288	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.008.288	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Conditional4. Value of the CC component must be equal to "20"	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Situational4. Value of the CC component must be equal to "20"
07/10/2025	4.0.13	FTX.007.276	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.007.276	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Conditional	1. Value must be 500 characters or less2. Situational
07/10/2025	4.0.13	FTX.007.273	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.007.273	UPDATE	Coding requirement	1. Value must be 50 characters or less2. Conditional	1. Value must be 50 characters or less2. Situational
12/19/2024	4.0.1	FTX.007.272	UPDATE	Definition	State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where: SS = State (use the two character postal abbreviation for your state); YY = Calendar Year (last two characters of the calendar year of the state plan amendment); NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions. The system will not permit reuse of a previously used SPA ID for a package that has been formally = an Situational entry for specific SPA types	State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where: SS = State (use the two character postal abbreviation for your state); YY = Calendar Year (last two characters of the calendar year of the state plan amendment); NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions. xxxx = Optional, 1 to 4 characters alpha/numeric modifier (Suffix) States should use the specific SPA that covered the services rendered.
08/29/2025	4.0.17	FTX.007.270	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Funding Source Nonfederal Share (VVL)3. Mandatory	1. Value must be 2 characters2. Value must be in Funding Source Nonfederal Share List (VVL)3. Mandatory
07/10/2025	4.0.13	FTX.007.268	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.007.268	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Conditional	1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Situational
05/29/2025	4.0.9	FTX.007.267	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional
12/19/2024	4.0.1	FTX.007.251	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Payee Identifier Type List (VVL)3. If value equals "01", then Payee Identifier must equal Submitting State (FTX.001.007)4. If value equals "02", then Payee Identifier must equal State Plan Identification Number (MCR.002.019)5. If value in [04,05], then Payee Identifier must equal Submitting State Provider Identifier (PRV.002.019)6. If value equals "06", then Payee Identifier must equal Provider Identifier (PRV.005.081) where Provider Identifier Type (PRV.005.077) equals "2"7. If value equals "07", then Payee Identifier must equal Insurance Carrier Identification Number (TPL.006.075)8. If value equals "08", then Payee Identifier must equal MSIS Identification Number (ELG.002.019)9. Mandatory	1. Value must be 2 characters2. Value must be in Payee Identifier Type List (VVL)3. If value equals "01", then Payee Identifier must equal Submitting State (FTX.007.237)4. If value equals "02", then Payee Identifier must equal State Plan Identification Number (MCR.002.019)5. If value in [04,05], then Payee Identifier must equal Submitting State Provider Identifier (PRV.002.019)6. If value equals "06", then Payee Identifier must equal Provider Identifier (PRV.005.081) where Provider Identifier Type (PRV.005.077) equals "2"7. If value equals "07", then Payee Identifier must equal Insurance Carrier Identification Number (TPL.006.075)8. If value equals "08", then Payee Identifier must equal MSIS Identification Number (ELG.002.019)9. Mandatory
12/19/2024	4.0.1	FTX.007.248	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Payer ID Type List (VVL)3. Mandatory4. When value equals "01" then Payer ID must equal Submitting State (FTX.001.007)5. When value equals "02" then Payer ID must equal State Plan Identification Number (MCR.002.019)6. When value equals "04" then Payer ID must equal must equal Submitting State Provider Identifier (PRV.002.019)	1. Value must be 2 characters2. Value must be in Payer ID Type List (VVL)3. Mandatory4. When value equals "01" then Payer ID must equal Submitting State (FTX.007.237)5. When value equals "02" then Payer ID must equal State Plan Identification Number (MCR.002.019)6. When value equals "04" then Payer ID must equal must equal Submitting State Provider Identifier (PRV.002.019)
07/10/2025	4.0.13	FTX.007.246	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.007.246	UPDATE	Coding requirement	1. Value must be 15 characters or less2. When populated, value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Conditional	1. Value must be 15 characters or less2. When populated, value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Situational
07/10/2025	4.0.13	FTX.007.245	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.007.245	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Conditional4. Value of the CC component must be equal to "20"	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Situational4. Value of the CC component must be equal to "20"
07/10/2025	4.0.13	FTX.006.233	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.006.233	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Conditional	1. Value must be 500 characters or less2. Situational
07/10/2025	4.0.13	FTX.006.230	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.006.230	UPDATE	Coding requirement	1. Value must be 50 characters or less2. Conditional	1. Value must be 50 characters or less2. Situational
12/19/2024	4.0.1	FTX.006.229	UPDATE	Definition	This is the type of value-based payment model to which the financial transaction applies. These values come from the “Alternative Payment Model (APM) Framework Final White Paper”, produced by the Healthcare Learning and Action Network. https://hcp-lan.org/work products/apm-whitepaper.pdf	This is the type of value-based payment model to which the financial transaction applies. These values come from the â€śAlternative Payment Model (APM) Framework Final White Paperâ€ť, produced by the Healthcare Learning and Action Network. https://hcp-lan.org/work products/apm-whitepaper.pdf
12/19/2024	4.0.1	FTX.006.228	UPDATE	Definition	State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where: SS = State (use the two character postal abbreviation for your state); YY = Calendar Year (last two characters of the calendar year of the state plan amendment); NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions. The system will not permit reuse of a previously used SPA ID for a package that has been formally = an Situational entry for specific SPA types	State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where: SS = State (use the two character postal abbreviation for your state); YY = Calendar Year (last two characters of the calendar year of the state plan amendment); NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions. xxxx = Optional, 1 to 4 characters alpha/numeric modifier (Suffix) States should use the specific SPA that covered the services rendered.
08/29/2025	4.0.17	FTX.006.225	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Funding Source Nonfederal Share (VVL)3. Mandatory	1. Value must be 2 characters2. Value must be in Funding Source Nonfederal Share List (VVL)3. Mandatory
07/10/2025	4.0.13	FTX.006.223	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.006.223	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Conditional	1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Situational
05/29/2025	4.0.9	FTX.006.222	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional
12/19/2024	4.0.1	FTX.006.207	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Payee Identifier Type List (VVL)3. If value equals "01", then Payee Identifier must equal Submitting State (FTX.001.007)4. If value equals "02", then Payee Identifier must equal State Plan Identification Number (MCR.002.019)5. If value in [04,05], then Payee Identifier must equal Submitting State Provider Identifier (PRV.002.019)6. If value equals "06", then Payee Identifier must equal Provider Identifier (PRV.005.081) where Provider Identifier Type (PRV.005.077) equals "2"7. If value equals "07", then Payee Identifier must equal Insurance Carrier Identification Number (TPL.006.075)8. If value equals "08", then Payee Identifier must equal MSIS Identification Number (ELG.002.019)9. Mandatory	1. Value must be 2 characters2. Value must be in Payee Identifier Type List (VVL)3. If value equals "01", then Payee Identifier must equal Submitting State (FTX.006.193)4. If value equals "02", then Payee Identifier must equal State Plan Identification Number (MCR.002.019)5. If value in [04,05], then Payee Identifier must equal Submitting State Provider Identifier (PRV.002.019)6. If value equals "06", then Payee Identifier must equal Provider Identifier (PRV.005.081) where Provider Identifier Type (PRV.005.077) equals "2"7. If value equals "07", then Payee Identifier must equal Insurance Carrier Identification Number (TPL.006.075)8. If value equals "08", then Payee Identifier must equal MSIS Identification Number (ELG.002.019)9. Mandatory
12/19/2024	4.0.1	FTX.006.204	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Payer ID Type List (VVL)3. Mandatory4. When value equals "01" then Payer ID must equal Submitting State (FTX.001.007)5. When value equals "02" then Payer ID must equal State Plan Identification Number (MCR.002.019)6. When value equals "04" then Payer ID must equal must equal Submitting State Provider Identifier (PRV.002.019)	1. Value must be 2 characters2. Value must be in Payer ID Type List (VVL)3. Mandatory4. When value equals "01" then Payer ID must equal Submitting State (FTX.006.193)5. When value equals "02" then Payer ID must equal State Plan Identification Number (MCR.002.019)6. When value equals "04" then Payer ID must equal must equal Submitting State Provider Identifier (PRV.002.019)
07/10/2025	4.0.13	FTX.006.202	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.006.202	UPDATE	Coding requirement	1. Value must be 15 characters or less2. When populated, value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Conditional	1. Value must be 15 characters or less2. When populated, value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Situational
07/10/2025	4.0.13	FTX.006.201	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.006.201	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Conditional4. Value of the CC component must be equal to "20"	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Situational4. Value of the CC component must be equal to "20"
07/10/2025	4.0.13	FTX.005.189	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.005.189	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Conditional	1. Value must be 500 characters or less2. Situational
12/19/2024	4.0.1	FTX.005.186	UPDATE	Definition	State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where: SS = State (use the two character postal abbreviation for your state); YY = Calendar Year (last two characters of the calendar year of the state plan amendment); NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions. The system will not permit reuse of a previously used SPA ID for a package that has been formally = an Situational entry for specific SPA types	State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where: SS = State (use the two character postal abbreviation for your state); YY = Calendar Year (last two characters of the calendar year of the state plan amendment); NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions. xxxx = Optional, 1 to 4 characters alpha/numeric modifier (Suffix) States should use the specific SPA that covered the services rendered.
07/10/2025	4.0.13	FTX.005.184	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.005.184	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Offset Transaction Type List (VVL)3. Conditional	1. Value must be 1 character2. Value must be in Offset Transaction Type List (VVL)3. Situational
08/29/2025	4.0.17	FTX.005.183	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Funding Source Nonfederal Share (VVL)3. Mandatory	1. Value must be 2 characters2. Value must be in Funding Source Nonfederal Share List (VVL)3. Mandatory
07/10/2025	4.0.13	FTX.005.181	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.005.181	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Conditional	1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Situational
05/29/2025	4.0.9	FTX.005.180	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional
07/10/2025	4.0.13	FTX.005.172	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.005.172	UPDATE	Coding requirement	1. Value must not contain a pipe or asterisk symbol2. Value must be 20 characters or less3. Conditional	1. Value must not contain a pipe or asterisk symbol2. Value must be 20 characters or less3. Situational
12/19/2024	4.0.1	FTX.005.164	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Payee Identifier Type List (VVL)3. If value equals "01", then Payee Identifier must equal Submitting State (FTX.001.007)4. If value equals "02", then Payee Identifier must equal State Plan Identification Number (MCR.002.019)5. If value in [04,05], then Payee Identifier must equal Submitting State Provider Identifier (PRV.002.019)6. If value equals "06", then Payee Identifier must equal Provider Identifier (PRV.005.081) where Provider Identifier Type (PRV.005.077) equals "2"7. If value equals "07", then Payee Identifier must equal Insurance Carrier Identification Number (TPL.006.075)8. If value equals "08", then Payee Identifier must equal MSIS Identification Number (ELG.002.019)9. Mandatory	1. Value must be 2 characters2. Value must be in Payee Identifier Type List (VVL)3. If value equals "01", then Payee Identifier must equal Submitting State (FTX.005.150)4. If value equals "02", then Payee Identifier must equal State Plan Identification Number (MCR.002.019)5. If value in [04,05], then Payee Identifier must equal Submitting State Provider Identifier (PRV.002.019)6. If value equals "06", then Payee Identifier must equal Provider Identifier (PRV.005.081) where Provider Identifier Type (PRV.005.077) equals "2"7. If value equals "07", then Payee Identifier must equal Insurance Carrier Identification Number (TPL.006.075)8. If value equals "08", then Payee Identifier must equal MSIS Identification Number (ELG.002.019)9. Mandatory
12/19/2024	4.0.1	FTX.005.161	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Payer ID Type List (VVL)3. Mandatory4. When value equals "01" then Payer ID must equal Submitting State (FTX.001.007)	1. Value must be 2 characters2. Value must be in Payer ID Type List (VVL)3. Mandatory4. When value equals "01" then Payer ID must equal Submitting State (FTX.005.150)
07/10/2025	4.0.13	FTX.005.159	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.005.159	UPDATE	Coding requirement	1. Value must be 15 characters or less2. When populated, value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Conditional	1. Value must be 15 characters or less2. When populated, value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Situational
07/10/2025	4.0.13	FTX.005.158	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.005.158	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Conditional4. Value of the CC component must be equal to "20"	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Situational4. Value of the CC component must be equal to "20"
03/14/2025	4.0.4	FTX.004.146	UPDATE	Definition	This represents any notes from the state's ledger/accounting system associated with the payment/recoupment.	This represents any notes from the state's ledger/accounting system associated with the payment.
12/19/2024	4.0.1	FTX.004.143	UPDATE	Definition	State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where: SS = State (use the two character postal abbreviation for your state); YY = Calendar Year (last two characters of the calendar year of the state plan amendment); NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions. The system will not permit reuse of a previously used SPA ID for a package that has been formally = an Situational entry for specific SPA types	State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where: SS = State (use the two character postal abbreviation for your state); YY = Calendar Year (last two characters of the calendar year of the state plan amendment); NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions. xxxx = Optional, 1 to 4 characters alpha/numeric modifier (Suffix) States should use the specific SPA that covered the services rendered.
07/10/2025	4.0.13	FTX.004.139	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.004.139	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period5. Conditional	1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period5. Situational
05/29/2025	4.0.9	FTX.004.138	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional
07/10/2025	4.0.13	FTX.004.131	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.004.131	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Policy Owner Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Policy Owner Code List (VVL)3. Situational
07/10/2025	4.0.13	FTX.004.130	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.004.130	UPDATE	Coding requirement	1. Value must be 16 characters or less2. Value must not contain a pipe symbol3. Conditional	1. Value must be 16 characters or less2. Value must not contain a pipe symbol3. Situational
07/10/2025	4.0.13	FTX.004.129	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.004.129	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Conditional	1. Value must be 20 characters or less2. Situational
07/10/2025	4.0.13	FTX.004.126	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.004.126	UPDATE	Coding requirement	1. Value must not contain a pipe or asterisk symbol2. Value must be 20 characters or less3. Conditional	1. Value must not contain a pipe or asterisk symbol2. Value must be 20 characters or less3. Situational
03/14/2025	4.0.4	FTX.004.122	UPDATE	Definition	This is the identifier that corresponds with the payee's role in relation to the Medicaid/CHIP system. The payee is the individual or entity that is either receiving a payment or having a previous payment recouped. The payee is the object of the transaction, as opposed to the payer who is the subject taking the action of either making a payment or taking a recoupment. This will typically belong to the entity identified as the X12 820 Premium Receiver.	This is the identifier that corresponds with the payee's role in relation to the Medicaid/CHIP system. The payee is the individual or entity that is receiving a payment. The payee is the object of the transaction, as opposed to the payer who is the subject taking the action of making a payment. This will typically belong to the entity identified as the X12 820 Premium Receiver.
12/19/2024	4.0.1	FTX.004.120	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Payee Identifier Type List (VVL)3. If value equals "01", then Payee Identifier must equal Submitting State (FTX.001.007)4. If value equals "02", then Payee Identifier must equal State Plan Identification Number (MCR.002.019)5. If value in [04,05], then Payee Identifier must equal Submitting State Provider Identifier (PRV.002.019)6. If value equals "06", then Payee Identifier must equal Provider Identifier (PRV.005.081) where Provider Identifier Type (PRV.005.077) equals "2"7. If value equals "07", then Payee Identifier must equal Insurance Carrier Identification Number (TPL.006.075)8. If value equals "08", then Payee Identifier must equal MSIS Identification Number (ELG.002.019)9. Mandatory	1. Value must be 2 characters2. Value must be in Payee Identifier Type List (VVL)3. If value equals "01", then Payee Identifier must equal Submitting State (FTX.004.106)4. If value equals "02", then Payee Identifier must equal State Plan Identification Number (MCR.002.019)5. If value in [04,05], then Payee Identifier must equal Submitting State Provider Identifier (PRV.002.019)6. If value equals "06", then Payee Identifier must equal Provider Identifier (PRV.005.081) where Provider Identifier Type (PRV.005.077) equals "2"7. If value equals "07", then Payee Identifier must equal Insurance Carrier Identification Number (TPL.006.075)8. If value equals "08", then Payee Identifier must equal MSIS Identification Number (ELG.002.019)9. Mandatory
12/19/2024	4.0.1	FTX.004.117	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Payer ID Type List (VVL)3. Mandatory4. When value equals "01" then Payer ID must equal Submitting State (FTX.001.007)	1. Value must be 2 characters2. Value must be in Payer ID Type List (VVL)3. Mandatory4. When value equals "01" then Payer ID must equal Submitting State (FTX.004.106)
07/10/2025	4.0.13	FTX.004.115	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.004.115	UPDATE	Coding requirement	1. Value must be 15 characters or less2. When populated, value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Conditional	1. Value must be 15 characters or less2. When populated, value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Situational
07/10/2025	4.0.13	FTX.004.114	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.004.114	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Conditional4. Value of the CC component must be equal to "20"	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Situational4. Value of the CC component must be equal to "20"
03/14/2025	4.0.4	FTX.003.102	UPDATE	Definition	This represents any notes from the state's ledger/accounting system associated with the payment/recoupment.	This represents any notes from the state's ledger/accounting system associated with the payment.
12/19/2024	4.0.1	FTX.003.099	UPDATE	Definition	State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where: SS = State (use the two character postal abbreviation for your state); YY = Calendar Year (last two characters of the calendar year of the state plan amendment); NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions. The system will not permit reuse of a previously used SPA ID for a package that has been formally = an Situational entry for specific SPA types	State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where: SS = State (use the two character postal abbreviation for your state); YY = Calendar Year (last two characters of the calendar year of the state plan amendment); NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions. xxxx = Optional, 1 to 4 characters alpha/numeric modifier (Suffix) States should use the specific SPA that covered the services rendered.
07/10/2025	4.0.13	FTX.003.095	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.003.095	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period5. Conditional	1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period5. Situational
05/29/2025	4.0.9	FTX.003.094	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional
07/10/2025	4.0.13	FTX.003.087	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.003.087	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Conditional	1. Value must be 20 characters or less2. Situational
07/10/2025	4.0.13	FTX.003.085	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.003.085	UPDATE	Coding requirement	1. Value must not contain a pipe or asterisk symbol2. Value must be 20 characters or less3. Conditional	1. Value must not contain a pipe or asterisk symbol2. Value must be 20 characters or less3. Situational
03/14/2025	4.0.4	FTX.003.081	UPDATE	Definition	This is the identifier that corresponds with the payee's role in relation to the Medicaid/CHIP system. The payee is the individual or entity that is either receiving a payment or having a previous payment recouped. The payee is the object of the transaction, as opposed to the payer who is the subject taking the action of either making a payment or taking a recoupment. This will typically belong to the entity identified as the X12 820 Premium Receiver.	This is the identifier that corresponds with the payee's role in relation to the Medicaid/CHIP system. The payee is the individual or entity that is a payment. The payee is the object of the transaction, as opposed to the payer who is the subject taking the action of making a payment. This will typically belong to the entity identified as the X12 820 Premium Receiver.
12/19/2024	4.0.1	FTX.003.079	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Payee Identifier Type List (VVL)3. If value equals "01", then Payee Identifier must equal Submitting State (FTX.001.007)4. If value equals "02", then Payee Identifier must equal State Plan Identification Number (MCR.002.019)5. If value in [04,05], then Payee Identifier must equal Submitting State Provider Identifier (PRV.002.019)6. If value equals "06", then Payee Identifier must equal Provider Identifier (PRV.005.081) where Provider Identifier Type (PRV.005.077) equals "2"7. If value equals "07", then Payee Identifier must equal Insurance Carrier Identification Number (TPL.006.075)8. If value equals "08", then Payee Identifier must equal MSIS Identification Number (ELG.002.019)9. Mandatory	1. Value must be 2 characters2. Value must be in Payee Identifier Type List (VVL)3. If value equals "01", then Payee Identifier must equal Submitting State (FTX.003.065)4. If value equals "02", then Payee Identifier must equal State Plan Identification Number (MCR.002.019)5. If value in [04,05], then Payee Identifier must equal Submitting State Provider Identifier (PRV.002.019)6. If value equals "06", then Payee Identifier must equal Provider Identifier (PRV.005.081) where Provider Identifier Type (PRV.005.077) equals "2"7. If value equals "07", then Payee Identifier must equal Insurance Carrier Identification Number (TPL.006.075)8. If value equals "08", then Payee Identifier must equal MSIS Identification Number (ELG.002.019)9. Mandatory
12/19/2024	4.0.1	FTX.003.076	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Payer ID Type List (VVL)3. Mandatory4. When value equals "01" then Payer ID must equal Submitting State (FTX.001.007)	1. Value must be 2 characters2. Value must be in Payer ID Type List (VVL)3. Mandatory4. When value equals "01" then Payer ID must equal Submitting State (FTX.003.065)
07/10/2025	4.0.13	FTX.003.074	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.003.074	UPDATE	Coding requirement	1. Value must be 15 characters or less2. When populated, value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Conditional	1. Value must be 15 characters or less2. When populated, value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Situational
07/10/2025	4.0.13	FTX.003.073	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.003.073	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Conditional4. Value of the CC component must be equal to "20"	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Situational4. Value of the CC component must be equal to "20"
07/10/2025	4.0.13	FTX.002.061	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.002.061	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Conditional	1. Value must be 500 characters or less2. Situational
12/19/2024	4.0.1	FTX.002.059	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Expenditure Authority Type List (VVL)3. If Subcapitation Indicator equals "01", then value must be populated4. Conditional	1. Value must be 2 characters2. Value must be in Expenditure Authority Type List (VVL)3. If Subcapitation Indicator equals "1", then value must be populated4. Conditional
07/10/2025	4.0.13	FTX.002.058	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.002.058	UPDATE	Coding requirement	1. Value must be 100 characters or less2. Conditional	1. Value must be 100 characters or less2. Situational
12/19/2024	4.0.1	FTX.002.057	UPDATE	Coding requirement	1. Value must be 50 characters or less2. If Subcapitation Indicator equals "01", then value must be populated3. Conditional	1. Value must be 50 characters or less2. If Subcapitation Indicator equals "1", then value must be populated3. Conditional
12/19/2024	4.0.1	FTX.002.055	UPDATE	Definition	State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where: SS = State (use the two character postal abbreviation for your state); YY = Calendar Year (last two characters of the calendar year of the state plan amendment); NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions. The system will not permit reuse of a previously used SPA ID for a package that has been formally submitted; xxxx = an Situational entry for specific SPA types	State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where: SS = State (use the two character postal abbreviation for your state); YY = Calendar Year (last two characters of the calendar year of the state plan amendment); NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions. xxxx = Optional, 1 to 4 characters alpha/numeric modifier (Suffix) States should use the specific SPA that covered the services rendered.
12/19/2024	4.0.1	FTX.002.052	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Funding Source Nonfederal Share List (VVL)3. If Subcapitation Indicator equals "01", then value must be populated4. Conditional	1. Value must be 2 characters2. Value must be in Funding Source Nonfederal Share List (VVL)3. If Subcapitation Indicator equals "1", then value must be populated4. Conditional
12/19/2024	4.0.1	FTX.002.051	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Funding Code List (VVL)3. If Subcapitation Indicator equals "01", then value must be populated4. Conditional	1. Value must be 1 character2. Value must be in Funding Code List (VVL)3. If Subcapitation Indicator equals "1", then value must be populated4. Conditional
07/10/2025	4.0.13	FTX.002.050	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.002.050	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period5. Conditional	1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period5. Situational
05/29/2025	4.0.9	FTX.002.049	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional
12/19/2024	4.0.1	FTX.002.041	UPDATE	Coding requirement	1. Value must be 100 characters or less2. Conditional3. If Subcapitation Indicator equals "01", then value must be populated	1. Value must be 100 characters or less2. Conditional3. If Subcapitation Indicator equals "1", then value must be populated
12/19/2024	4.0.1	FTX.002.034	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Payee Identifier Type List (VVL)3. If value equals "01", then Payee Identifier must equal Submitting State (FTX.001.007)4. If value equals "02", then Payee Identifier must equal State Plan Identification Number (MCR.002.019)5. If value in [04,05], then Payee Identifier must equal Submitting State Provider Identifier (PRV.002.019)6. If value equals "06", then Payee Identifier must equal Provider Identifier (PRV.005.081) where Provider Identifier Type (PRV.005.077) equals "2"7. If value equals "07", then Payee Identifier must equal Insurance Carrier Identification Number (TPL.006.075)8. If value equals "08", then Payee Identifier must equal MSIS Identification Number (ELG.002.019)9. Mandatory	1. Value must be 2 characters2. Value must be in Payee Identifier Type List (VVL)3. If value equals "01", then Payee Identifier must equal Submitting State (FTX.002.018)4. If value equals "02", then Payee Identifier must equal State Plan Identification Number (MCR.002.019)5. If value in [04,05], then Payee Identifier must equal Submitting State Provider Identifier (PRV.002.019)6. If value equals "06", then Payee Identifier must equal Provider Identifier (PRV.005.081) where Provider Identifier Type (PRV.005.077) equals "2"7. If value equals "07", then Payee Identifier must equal Insurance Carrier Identification Number (TPL.006.075)8. If value equals "08", then Payee Identifier must equal MSIS Identification Number (ELG.002.019)9. Mandatory
12/19/2024	4.0.1	FTX.002.029	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Payer ID Type List (VVL)3. Mandatory4. When value equals "01" then Payer ID must equal Submitting State (FTX.001.007)5. When value equals "02" then Payer ID must equal State Plan Identification Number (MCR.002.019)6. When value equals "04" then Payer ID must equal must equal Submitting State Provider Identifier (PRV.002.019)	1. Value must be 2 characters2. Value must be in Payer ID Type List (VVL)3. Mandatory4. When value equals "01" then Payer ID must equal Submitting State (FTX.002.018)5. When value equals "02" then Payer ID must equal State Plan Identification Number (MCR.002.019)6. When value equals "04" then Payer ID must equal must equal Submitting State Provider Identifier (PRV.002.019)
07/10/2025	4.0.13	FTX.002.027	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.002.027	UPDATE	Coding requirement	1. Value must be 15 characters or less2. When populated, value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Conditional	1. Value must be 15 characters or less2. When populated, value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Situational
07/10/2025	4.0.13	FTX.002.026	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.002.026	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Conditional4. Value of the CC component must be equal to "20"	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Situational4. Value of the CC component must be equal to "20"
03/14/2025	4.0.4	FTX.002.017	UPDATE	Coding requirement	1. Value must be 8 characters2. Mandatory3. Value must be in Record ID List (VVL)4. Value must equal "FTX00002"11. Conditional	1. Value must be 8 characters2. Mandatory3. Value must be in Record ID List (VVL)4. Value must equal "FTX00002"
05/07/2025	4.0.8	FTX.001.014	UPDATE	Coding requirement	1. Value must be 4 characters or less2. Value must between 1 and 99993. Value must be equal to the largest of any prior values for the same reporting period and file type, plus 1 (i.e. incremented by 1)4. Value must not contain a pipe symbol5. Mandatory	1. Value must be 4 characters or less2. Value must be between 1 and 99993. Value must be equal to the largest of any prior values for the same reporting period and file type, plus 1 (i.e. incremented by 1)4. Value must not contain a pipe symbol5. Mandatory
06/05/2025	4.0.10	ELG.022.266	UPDATE	Coding requirement	1. Value must be 10 characters or less2. Value must be in Reason for Change List (VVL)3. Conditional4. (Old MSIS Identification Number) value must be populated when Eligible Identifier Type (ELG.022.261) equals "2"	1. Value must be 10 characters or less2. Value must be in Reason for Change List (VVL)3. ConditionalValue must be populated when Eligible Identifier Type (ELG.022.261) equals "2"(Old MSIS Identification Number)
12/19/2024	4.0.1	ELG.022.264	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]
12/19/2024	4.0.1	ELG.022.263	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]
05/07/2025	4.0.8	ELG.021.252	UPDATE	Coding requirement	1. Value must be in Enrollment Type List (VVL)2. Value must be 1 character3. If value equals "1", then associated CHIP Code (ELG.003.054) value must be in [1, 2]4. If value equals "2", then associated CHIP Code (ELG.003.054) value must be "3"5. A person enrolled in Medicaid/CHIP must have a primary eligibility group classification for any given day of enrollment. (There may or may not be a secondary eligibility group classification for that same day.)6. Mandatory	1. Value must be in Enrollment Type List (VVL)2. Value must be 1 character3. If value equals "1", then associated CHIP Code (ELG.003.054) value must be in [1, 2]4. If value equals "2", then associated CHIP Code (ELG.003.054) value must be "3"5. Mandatory
12/19/2024	4.0.1	ELG.020.244	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]
12/19/2024	4.0.1	ELG.020.243	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]
12/19/2024	4.0.1	ELG.018.235	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]
12/19/2024	4.0.1	ELG.018.234	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]
07/17/2025	4.0.14	ELG.018.233	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	ELG.018.233	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in 1115A Demonstration Indicator List (VVL)3. Conditional	1. Value must be 1 character2. Value must be in 1115A Demonstration Indicator List (VVL)3. Situational
12/19/2024	4.0.1	ELG.017.226	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]
12/19/2024	4.0.1	ELG.017.225	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]
12/19/2024	4.0.1	ELG.016.217	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99]
12/19/2024	4.0.1	ELG.016.216	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]
07/17/2025	4.0.14	ELG.016.215	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	ELG.016.215	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in American Indian Alaskan Native Indicator List (VVL)3. Conditional	1. Value must be 1 character2. Value must be in American Indian Alaskan Native Indicator List (VVL)3. Situational
12/19/2024	4.0.1	ELG.015.206	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]
12/19/2024	4.0.1	ELG.015.205	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]
10/08/2024	4.0.0	ELG.015.202	UPDATE	Coding requirement	2. Value must be unique within record segment over all records associated with a given Record ID1. Value must be 11 digits or less3. Mandatory	1. Value must be 11 digits or less2. Value must be unique within record segment over all records associated with a given Record ID3. Mandatory
10/08/2024	4.0.0	ELG.015.200	UPDATE	Coding requirement	1. Mandatory4. Value must equal "ELG00015"2. Value must be 8 characters3. Value must be in Record ID List (VVL)	1. Mandatory2. Value must be 8 characters3. Value must be in Record ID List (VVL)4. Value must equal "ELG00015"
12/19/2024	4.0.1	ELG.014.197	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]
12/19/2024	4.0.1	ELG.014.196	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]
12/19/2024	4.0.1	ELG.013.185	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]
12/19/2024	4.0.1	ELG.013.184	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]
12/19/2024	4.0.1	ELG.012.175	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99]
12/19/2024	4.0.1	ELG.012.174	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]
12/19/2024	4.0.1	ELG.012.173	UPDATE	Segment key field identifier	Not Applicable	4
05/29/2025	4.0.9	ELG.012.172	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Value must have a corresponding value in Waiver Type (ELG.012.173)7. Mandatory	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Value must have a corresponding value in Waiver Type (ELG.012.173)7. Mandatory
12/19/2024	4.0.1	ELG.011.165	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99]
12/19/2024	4.0.1	ELG.011.164	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]
12/19/2024	4.0.1	ELG.010.156	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]
12/19/2024	4.0.1	ELG.010.155	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]
07/17/2025	4.0.14	ELG.010.154	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	ELG.010.154	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in MFP Reinstitutionalized Reason List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in MFP Reinstitutionalized Reason List (VVL)3. Situational
07/17/2025	4.0.14	ELG.009.270	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	ELG.009.270	UPDATE	Coding requirement	1. Value must be 3 characters2. Conditional3. Value must be in Type of Service List (VVL)	1. Value must be 3 characters2. Situational3. Value must be in Type of Service List (VVL)
12/19/2024	4.0.1	ELG.009.143	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]
12/19/2024	4.0.1	ELG.009.142	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]
12/19/2024	4.0.1	ELG.008.133	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]
12/19/2024	4.0.1	ELG.008.132	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]
12/19/2024	4.0.1	ELG.007.122	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]
12/19/2024	4.0.1	ELG.007.121	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]
12/19/2024	4.0.1	ELG.006.110	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]
12/19/2024	4.0.1	ELG.006.109	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]
12/19/2024	4.0.1	ELG.005.100	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]
12/19/2024	4.0.1	ELG.005.099	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]
07/17/2025	4.0.14	ELG.005.098	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	ELG.005.098	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in TANF Cash Code List (VVL)3. Conditional	1. Value must be 1 character2. Value must be in TANF Cash Code List (VVL)3. Situational
04/24/2025	4.0.7	ELG.005.097	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Restricted Benefits Code List (VVL)3. (Restricted Benefits) if value equals "3" and Dual Eligible Code (ELG.005.085) value equals "05", then Eligibility Group (ELG.005.087) must be "24"4. (Restricted Benefits) if value equals "3" and Dual Eligible Code (ELG.005.085) value equals "06", then Eligibility Group (ELG.005.087) must be "26"5. (Restricted Benefits) if value equals "1" and Dual Eligible Code (ELG.005.085) value equals "02", then Eligibility Group (ELG.005.087) must be "23"6. (Restricted Benefits) if value equals "1" and Dual Eligible Code (ELG.005.085) value equals "04", then Eligibility Group (ELG.005.087) must be "25"7. (Restricted Benefits) if value equals "3", then Dual Eligible Code (ELG.005.085) cannot be "00"8. Mandatory9. If value is "6" then Eligibility Group(ELG.DE.087) must be in [35,70]10. If value is in [1,7] then Eligibility Group (EGL.DE.087) must be in [72,73,74,75] and State Plan Option Type (ELG.DE.163) must equal "06"11. (Restricted Pregnancy-Related) if value equals "4", then associated Sex (ELG.002.023) value must be "F"12. (Non-Citizen) if value equals "2", then associated Citizenship Indicator (ELG.003.040) value must not be equal to "1"13. If value is "D", there must be a corresponding MFP enrollment segment (ELG00010) with Effective and End dates that are within the timespan of this segment14. (Restricted Benefits) if value equals "3" and Dual Eligible Code (ELG.005.085) value equals "01", then Eligibility Group (ELG.005.087) must be "23"15. (Restricted Benefits) if value equals "3" and Dual Eligible Code (ELG.005.085) value equals "03", then Eligibility Group (ELG.005.087) must be "25"16. (Restricted Benefits) if value is "G", then Dual Eligible Code (ELG.005.085) must be in [01,03,06]	1. Value must be 1 character2. Value must be in Restricted Benefits Code List (VVL)3. (Restricted Benefits) if value equals "3" and Dual Eligible Code (ELG.005.085) value equals "05", then Eligibility Group (ELG.005.087) must be "24"4. (Restricted Benefits) if value equals "3" and Dual Eligible Code (ELG.005.085) value equals "06", then Eligibility Group (ELG.005.087) must be "26"5. (Restricted Benefits) if value equals "1" and Dual Eligible Code (ELG.005.085) value equals "02", then Eligibility Group (ELG.005.087) must be "23"6. (Restricted Benefits) if value equals "1" and Dual Eligible Code (ELG.005.085) value equals "04", then Eligibility Group (ELG.005.087) must be "25"7. (Restricted Benefits) if value equals "3", then Dual Eligible Code (ELG.005.085) cannot be "00"8. Mandatory9. If value is "6" then Eligibility Group(ELG.DE.087) must be in [35,70]10. If value is in [1,7] then Eligibility Group (ELG.DE.087) must be in [72,73,74,75] and State Plan Option Type (ELG.DE.163) must equal "06"11. (Restricted Pregnancy-Related) if value equals "4", then associated Sex (ELG.002.023) value must be "F"12. (Non-Citizen) if value equals "2", then associated Citizenship Indicator (ELG.003.040) value must not be equal to "1"13. If value is "D", there must be a corresponding MFP enrollment segment (ELG00010) with Effective and End dates that are within the timespan of this segment14. (Restricted Benefits) if value equals "3" and Dual Eligible Code (ELG.005.085) value equals "01", then Eligibility Group (ELG.005.087) must be "23"15. (Restricted Benefits) if value equals "3" and Dual Eligible Code (ELG.005.085) value equals "03", then Eligibility Group (ELG.005.087) must be "25"16. (Restricted Benefits) if value is "G", then Dual Eligible Code (ELG.005.085) must be in [01,03,06]
07/17/2025	4.0.14	ELG.005.094	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	ELG.005.094	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Conception to Birth Indicator List (VVL)3. If the value is equal to "1", then the Eligibility Group (ELG.005.087) must equal "64"4. If the value is equal to "1", then any associated claims must indicate the Program Type equals "14" (State Plan CHIP)5. If the value is equal to "1", then CHIP Code (ELG.003.054) must equal "3" (Individual was not Medicaid Expansion CHIP eligible, but was included in a separate title XXI CHIP Program)6. Conditional	1. Value must be 1 character2. Value must be in Conception to Birth Indicator List (VVL)3. If the value is equal to "1", then the Eligibility Group (ELG.005.087) must equal "64"4. If the value is equal to "1", then any associated claims must indicate the Program Type equals "14" (State Plan CHIP)5. If the value is equal to "1", then CHIP Code (ELG.003.054) must equal "3" (Individual was not Medicaid Expansion CHIP eligible, but was included in a separate title XXI CHIP Program)6. Situational
06/19/2025	4.0.11	ELG.005.091	UPDATE	Coding requirement	1. Value must be 3 characters2. Value must be in SSI State Supplement Status Code List (VVL)3. (individual not receiving Federal SSI) If value is "001" or "002", then SSI Status (ELG.005.092) must be "001" or "002"4. (Individual not receiving Federal SSI)If value is "001" or "002", then SSI Indicator (ELG.005.090) must be "1"5. Value must not be populated or must be "000" when SSI Status (ELG.005.092) is not populated or is "000"6. Conditional	1. Value must be 3 characters2. Value must be in SSI State Supplement Status Code List (VVL)3. If value is "001" or "002" (individual not receiving Federal SSI), then SSI Status (ELG.005.092) must be "001" or "002"4. If value is "001" or "002" (Individual not receiving Federal SSI), then SSI Indicator (ELG.005.090) must be "1"5. Value must not be populated or must be "000" when SSI Status (ELG.005.092) is not populated or is "000"6. Conditional
07/17/2025	4.0.14	ELG.005.089	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	ELG.005.089	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in SSDI Indicator List (VVL)3. Conditional	1. Value must be 1 character2. Value must be in SSDI Indicator List (VVL)3. Situational
12/19/2024	4.0.1	ELG.004.076	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]
12/19/2024	4.0.1	ELG.004.075	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]
07/17/2025	4.0.14	ELG.004.074	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	ELG.004.074	UPDATE	Coding requirement	1. Value must not contain a pipe or asterisk symbol2. Value must be 100 characters or less3. Conditional	1. Value must not contain a pipe or asterisk symbol2. Value must be 100 characters or less3. Situational
12/19/2024	4.0.1	ELG.004.073	UPDATE	Coding requirement	1. Value must be 10-digit number2. Conditional	1. Value must be 10-digit number2. Conditional3. If Eligible Address Type (ELG.004.065) equals "01", then value is mandatory and must be provided
07/17/2025	4.0.14	ELG.004.068	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	ELG.004.068	UPDATE	Coding requirement	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 2 value(s)3. If Address Line 2 is not populated, then value should not be populated4. Value must not contain a pipe or asterisk symbols5. Conditional	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 2 value(s)3. If Address Line 2 is not populated, then value should not be populated4. Value must not contain a pipe or asterisk symbols5. Situational
07/17/2025	4.0.14	ELG.004.067	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	ELG.004.067	UPDATE	Coding requirement	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 3 value(s)3. There must be an Address Line 1 in order to have an Address Line 24. Value must not contain a pipe or asterisk symbols5. Conditional	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 3 value(s)3. There must be an Address Line 1 in order to have an Address Line 24. Value must not contain a pipe or asterisk symbols5. Situational
12/19/2024	4.0.1	ELG.004.065	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Eligible Address Type List (VVL)3. Mandatory	1. Value must be 2 characters2. Value must be in Eligible Address Type List (VVL)3. Mandatory4. When value equals "01" (Primary), Eligible State(ELG.004.070) must equal Submitting State (ELG.001.007)
12/19/2024	4.0.1	ELG.003.269	UPDATE	Definition	This data element provides the beneficiary's or their household's income as a percentage of the federal poverty level. Used to assign the beneficiary to the eligibility group that covered their Medicaid or CHIP benefits. If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group. A beneficiary’s income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group.	This data element provides the beneficiary's or their household's income as a percentage of the federal poverty level. Used to assign the beneficiary to the eligibility group that covered their Medicaid or CHIP benefits. If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group. A beneficiaryâ€™s income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group.
12/19/2024	4.0.1	ELG.003.058	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99]
12/19/2024	4.0.1	ELG.003.057	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]
02/27/2025	4.0.3	ELG.003.051	UPDATE	Definition	The Medicare Beneficiary Identifier (MBI) is a randomly generated identifier used to identify all Medicare beneficiaries. It replaced the previously-used SSN-based Medicare HIC Number (HICN). To prevent identify theft, among other reasons, HICN gradually were retired and replaced by the MBI over the course of 2018 and 2019. Starting in 2020, the MBI became the primary identifier for Medicare beneficiaries.	The Medicare Beneficiary Identifier (MBI) is a randomly generated identifier used to identify all Medicare beneficiaries. It replaced the previously-used SSN-based Medicare HIC Number (HICN). To prevent identity theft, among other reasons, HICN gradually were retired and replaced by the MBI over the course of 2018 and 2019. Starting in 2020, the MBI became the primary identifier for Medicare beneficiaries.
06/19/2025	4.0.11	ELG.003.050	UPDATE	Coding requirement	1. Value must be 12 characters or less2. Conditional3. Value must not contain a pipe or asterisk symbols4. (Not Dual Eligible) if Dual Eligible Code (ELG.DE.085) value is "00", then value must not be populated.5. (Medicare Enrolled) if associated Dual Eligible Code (ELG.005.085) value is in [01,02,03,04,05,06,08,09,10], then value for either HICN or MBI is mandatory and must be provided	1. Value must be 12 characters or less2. Conditional3. Value must not contain a pipe or asterisk symbols4. If Dual Eligible Code (ELG.DE.085) value is "00" (Not Dual Eligible), then value must not be populated.Value for either HICN or MBI is mandatory and must be provided if associated Dual Eligible Code (ELG.005.085) value is in [01,02,03,04,05,06,08,09,10] (Medicare Enrolled)
07/17/2025	4.0.14	ELG.003.049	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	ELG.003.049	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Pregnancy Indicator List (VVL)3. Conditional	1. Value must be 1 character2. Value must be in Pregnancy Indicator List (VVL)3. Situational
07/17/2025	4.0.14	ELG.003.045	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	ELG.003.045	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Primary Language English Proficiency Code List (VVL)3. Conditional	1. Value must be 1 character2. Value must be in Primary Language English Proficiency Code List (VVL)3. Situational
10/01/2024	4.0.0	ELG.003.044	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"3. If Immigration Status (ELG.003.042) equals "8" (U.S. Citizen), then value should not be populated2. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Conditional3. If Immigration Status (ELG.003.042) equals "8" (U.S. Citizen), then value should not be populated
07/17/2025	4.0.14	ELG.003.043	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	ELG.003.043	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Immigration Verification Flag List (VVL)3. Conditional	1. Value must be 1 character2. Value must be in Immigration Verification Flag List (VVL)3. Situational
11/20/2025	4.0.22	ELG.003.042	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Immigration Status List (VVL)3. If associated Citizenship Indicator (ELG.003.040) value equals "0", then value must be in [1,2,3]4. If associated Citizenship Indicator (ELG.003.040) value equals "1", then value must equal "8"5. Mandatory	1. Value must be 1 character2. Value must be in Immigration Status List (VVL)3. If associated Citizenship Indicator (ELG.003.040) value equals "0", then value must be in [1,2,3]4. If associated Citizenship Indicator (ELG.003.040) value equals "1", then value must equal "8"5. Mandatory6. When value is in [1,2], then value must match a corresponding record with an ELG-IDENTIFIER-TYPE (ELG.022.261) equal to “3”
12/19/2024	4.0.1	ELG.003.038	UPDATE	Definition	A code indicating the federal poverty level range in which the family income falls. If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group. A beneficiary’s income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group.	A code indicating the federal poverty level range in which the family income falls. If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group. A beneficiaryâ€™s income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group.
12/19/2024	4.0.1	ELG.003.034	UPDATE	Definition	A code to classify eligible individual's marital/domestic-relationship status. This element should be reported by the state when the information is material to eligibility (i.e., institutionalization). Because there is no specific statutory or regulatory basis for defining marital status codes, they are being defined in a way that is as flexible for states and data users as possible. States can report at whatever level of granularity is available to them in their system and a data user can choose to use them as-is or roll the values up in broader categories depending on whichever approach best meets their needs. CMS periodically reviews the values reported to MARITAL-STATUS-OTHER-EXPLANATION to determine if states are appropriately using it only when there is no existing MARITAL-STATUS value that reflects the state’s marital status description for an individual AND to determine whether it is necessary to add additional T-MSIS MARITAL-STATUS values to reflect commonly used state martial status descriptions for which there is no existing T-MSIS MARITAL-STATUS value.	A code to classify eligible individual's marital/domestic-relationship status. This element should be reported by the state when the information is material to eligibility (i.e., institutionalization). Because there is no specific statutory or regulatory basis for defining marital status codes, they are being defined in a way that is as flexible for states and data users as possible. States can report at whatever level of granularity is available to them in their system and a data user can choose to use them as-is or roll the values up in broader categories depending on whichever approach best meets their needs. CMS periodically reviews the values reported to MARITAL-STATUS-OTHER-EXPLANATION to determine if states are appropriately using it only when there is no existing MARITAL-STATUS value that reflects the stateâ€™s marital status description for an individual AND to determine whether it is necessary to add additional T-MSIS MARITAL-STATUS values to reflect commonly used state martial status descriptions for which there is no existing T-MSIS MARITAL-STATUS value.
07/17/2025	4.0.14	ELG.002.025	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	ELG.002.025	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Conditional3. If populated, value must be on or after individual's Date of Birth4. Value must be less than or equal to associated Date File Created (ELG.001.008) value5. There must never be more than one Date of Death value reported across Primary Demographic segments that have the same MSIS Identification number6. When populated, Procedure Code Dates on a claim must be less than or equal to this value7. When populated, Admission Date on a claim must be less than or equal to this value8. When populated, Discharge Date on a claim must be less than or equal to this value9. When populated, Ending Date of Service on a claim must be less than or equal to this value10. When populated, value must be less than or equal to Enrollment End Date (ELG.021.254)11. When populated, value minus Date of Birth (ELG.002.024) is less than or equal to 125 years	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Situational3. If populated, value must be on or after individual's Date of Birth4. Value must be less than or equal to associated Date File Created (ELG.001.008) value5. There must never be more than one Date of Death value reported across Primary Demographic segments that have the same MSIS Identification number6. When populated, Procedure Code Dates on a claim must be less than or equal to this value7. When populated, Admission Date on a claim must be less than or equal to this value8. When populated, Discharge Date on a claim must be less than or equal to this value9. When populated, Ending Date of Service on a claim must be less than or equal to this value10. When populated, value must be less than or equal to Enrollment End Date (ELG.021.254)11. When populated, value minus Date of Birth (ELG.002.024) is less than or equal to 125 years
07/17/2025	4.0.14	ELG.002.022	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	ELG.002.022	UPDATE	Coding requirement	1. Value must be 1 character2. Value must not contain a pipe or asterisk symbols3. Conditional	1. Value must be 1 character2. Value must not contain a pipe or asterisk symbols3. Situational
05/07/2025	4.0.8	ELG.001.247	UPDATE	Coding requirement	1. Value must be 4 characters or less2. Value must between 1 and 99993. Value must be equal to the largest of any prior values for the same reporting period and file type, plus 1 (i.e. incremented by 1)4. Value must not contain a pipe symbol5. Mandatory	1. Value must be 4 characters or less2. Value must be between 1 and 99993. Value must be equal to the largest of any prior values for the same reporting period and file type, plus 1 (i.e. incremented by 1)4. Value must not contain a pipe symbol5. Mandatory
07/10/2025	4.0.13	CRX.003.171	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.003.171	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situaitional
07/10/2025	4.0.13	CRX.003.170	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.003.170	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CRX.003.169	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.003.169	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CRX.003.168	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.003.168	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CRX.003.167	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.003.167	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CRX.003.159	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.003.159	UPDATE	Coding requirement	1. Value must be 18 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional	1. Value must be 18 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
12/19/2024	4.0.1	CRX.003.157	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (CIP.001.010)3. Mandatory4. Value should be on or after associated Admission Date value	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (CRX.001.010)3. Mandatory
07/10/2025	4.0.13	CRX.003.152	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.003.152	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CRX.003.146	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.003.146	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Rebate Eligible Indicator List (VVL)3. Conditional	1. Value must be 1 character2. Value must be in Rebate Eligible Indicator List (VVL)3. Situational
07/10/2025	4.0.13	CRX.003.145	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.003.145	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Compound Dosage Form List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Compound Dosage Form List (VVL)3. Situational
12/19/2024	4.0.1	CRX.003.136	UPDATE	Definition	"A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012. To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting. Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as “extended state plan” services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment. The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a state’s service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc. Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf"	"A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012. To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting. Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as â€śextended state planâ€ť services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment. The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a stateâ€™s service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc. Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf"
07/10/2025	4.0.13	CRX.003.135	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.003.135	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in HCBS Service Code List (VVL)3. If value is in [1-7], then HCBS Taxonomy must be populated4. Conditional	1. Value must be 1 character2. Value must be in HCBS Service Code List (VVL)3. If value is in [1-7], then HCBS Taxonomy must be populated4. Situational
12/19/2024	4.0.1	CRX.003.132	UPDATE	Definition	The quantity of a drug that is dispensed for a prescription as reported by National Drug Code on the claim line. For use with CLAIMRX claims/encounters. For CLAIMOT claims/encounters, use the Service Quantity Actual field. For CLAIMIP and CLAIMLT claims/encounter records, use the Revenue Center Quantity Actual field.	The quantity of a drug that is dispensed for a prescription as reported ny National Drug Code on the claim line. For use with CLAIMOT and CLAIMRX claims. For CLAIMIP and CLAIMLT claims/encounter records, use the Revenue Center Quantity Actual field.
07/10/2025	4.0.13	CRX.003.129	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.003.129	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0", then the value must not be populated4. Conditional5. If value is populated, Crossover Indicator must be equal to "1"	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0", then the value must not be populated4. Situational5. If value is populated, Crossover Indicator must be equal to "1"
07/10/2025	4.0.13	CRX.003.128	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.003.128	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Medicare Combined Deductible Indicator equals "1", then value must not be populated (or must be 99998)4. Value must not be populated if Medicare Deductible Amount is not populated5. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Medicare Combined Deductible Indicator equals "1", then value must not be populated (or must be 99998)4. Value must not be populated if Medicare Deductible Amount is not populated5. Situational
07/10/2025	4.0.13	CRX.003.127	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.003.127	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional4. Value should not be populated if associated Crossover Indicator value equals "0" (not a crossover claim)5. If value is greater than "0", then Crossover Indicator must be "1"	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational4. Value should not be populated if associated Crossover Indicator value equals "0" (not a crossover claim)5. If value is greater than "0", then Crossover Indicator must be "1"
12/19/2024	4.0.1	CRX.003.125	UPDATE	Definition	The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity paid the provider at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.	The amount paid to the provider by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity paid the provider at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
07/10/2025	4.0.13	CRX.003.124	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.003.124	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CRX.003.123	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.003.123	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CRX.003.119	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.003.119	UPDATE	Coding requirement	1. Value must be 3 characters or less2. Value must be in Claim Status List (VVL)3. Conditional4. If value in [545,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be"F2"	1. Value must be 3 characters or less2. Value must be in Claim Status List (VVL)3. Situational4. If value in [545,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be"F2"
03/14/2025	4.0.4	CRX.003.118	UPDATE	Necessity	Mandatory	Conditional
03/14/2025	4.0.4	CRX.003.118	UPDATE	Coding requirement	1. Value must be 12 characters or less2. Mandatory	1. Value must be 12 characters or less2. Conditional
07/10/2025	4.0.13	CRX.002.166	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.166	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CRX.002.165	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.165	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CRX.002.164	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.164	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CRX.002.163	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.163	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
12/10/2024	4.0.1	CRX.002.162	UPDATE	Medicaid valid value info		For background and context, see https://www.ncpdp.org/
07/10/2025	4.0.13	CRX.002.160	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.160	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Medicare Combined Deductible Indicator List (VVL)3. If value equals "1", then Total Medicare Coinsurance amount must not be populated4. If value equals "0", then Crossover Indicator must equals "0"5. If value equals "1", then Crossover Indicator must equals "1"6. Conditional	1. Value must be 1 character2. Value must be in Medicare Combined Deductible Indicator List (VVL)3. If value equals "1", then Total Medicare Coinsurance amount must not be populated4. If value equals "0", then Crossover Indicator must equals "0"5. If value equals "1", then Crossover Indicator must equals "1"6. Situational
02/27/2025	4.0.3	CRX.002.105	UPDATE	Definition	The Medicare Beneficiary Identifier (MBI) is a randomly generated identifier used to identify all Medicare beneficiaries. It replaced the previously-used SSN-based Medicare HIC Number (HICN). To prevent identify theft, among other reasons, HICN gradually were retired and replaced by the MBI over the course of 2018 and 2019. Starting in 2020, the MBI became the primary identifier for Medicare beneficiaries.	The Medicare Beneficiary Identifier (MBI) is a randomly generated identifier used to identify all Medicare beneficiaries. It replaced the previously-used SSN-based Medicare HIC Number (HICN). To prevent identity theft, among other reasons, HICN gradually were retired and replaced by the MBI over the course of 2018 and 2019. Starting in 2020, the MBI became the primary identifier for Medicare beneficiaries.
07/10/2025	4.0.13	CRX.002.104	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.104	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier, where Provider Identifier Type (PRV.005.077) equals "2"3. Value must exist in the NPPES NPI data file4. Conditional	1. Value must be 10 digits2. Value must have an associated Provider Identifier, where Provider Identifier Type (PRV.005.077) equals "2"3. Value must exist in the NPPES NPI data file4. Situational
02/27/2025	4.0.3	CRX.002.102	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type (PRV.005.007) equal to '2'3. When Type of Claim not in [3,C,W], then value must match Provider Identifier (PRV.005.081)4. Mandatory5. Value must exist in the NPPES NPI data file6. NPPES Entity Type Code associate with this NPI must equal "1" (Individual)	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type (PRV.005.007) equal to '2'3. When Type of Claim not in [3,C,W], then value must match Provider Identifier (PRV.005.081)4. Mandatory5. Value must exist in the NPPES NPI data file6. NPPES Entity Type Code associated with this NPI must equal "1" (Individual)
07/10/2025	4.0.13	CRX.002.099	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.099	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Third Party Coinsurance Amount3. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Third Party Coinsurance Amount3. Situational
07/10/2025	4.0.13	CRX.002.096	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.096	UPDATE	Coding requirement	1. Value must not contain a pipe or asterisk symbols2. Value must 50 characters or less3. Conditional	1. Value must not contain a pipe or asterisk symbols2. Value must 50 characters or less3. Situational
07/10/2025	4.0.13	CRX.002.093	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.093	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Deductible Amount3. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Deductible Amount3. Situational
07/10/2025	4.0.13	CRX.002.092	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.092	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CRX.002.090	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.090	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Copayment Amount3. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Copayment Amount3. Situational
07/10/2025	4.0.13	CRX.002.089	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.089	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CRX.002.088	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.088	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Coinsurance Amount3. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Coinsurance Amount3. Situational
07/10/2025	4.0.13	CRX.002.087	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.087	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CRX.002.086	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.086	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Compound Drug Indicator List (VVL)3. Conditional	1. Value must be 1 character2. Value must be in Compound Drug Indicator List (VVL)3. Situational
07/10/2025	4.0.13	CRX.002.082	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.082	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Border State Indicator List (VVL)3. Conditional	1. Value must be 1 character2. Value must be in Border State Indicator List (VVL)3. Situational
06/19/2025	4.0.11	CRX.002.079	UPDATE	Coding requirement	1. Value must be 12 characters or less2. Conditional3. Value must not contain a pipe or asterisk symbols4. (Not Dual Eligible) if Dual Eligible Code (ELG.DE.085) value equals "00", then value must not be populated5. Value must be populated when Crossover Indicator (CRX.002.023) equals "1" and Medicare Beneficiary Identifier (CRX.002.105) is not populated	1. Value must be 12 characters or less2. Conditional3. Value must not contain a pipe or asterisk symbols4. If Dual Eligible Code (ELG.DE.085) value is "00" (Not Dual Eligible), then value must not be populated.5. Value must be populated when Crossover Indicator (CRX.002.023) equals "1" and Medicare Beneficiary Identifier (CRX.002.105) is not populated
02/27/2025	4.0.3	CRX.002.075	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Mandatory4. Value must exist in the NPPES NPI data file5. NPPES Entity Type Code associate with this NPI must equal ‘1’ (Individual)	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Mandatory4. Value must exist in the NPPES NPI data file5. NPPES Entity Type Code associated with this NPI must equal ‘1’ (Individual)
07/10/2025	4.0.13	CRX.002.073	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.073	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Provider Specialty List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Provider Specialty List (VVL)3. Situational
07/10/2025	4.0.13	CRX.002.072	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.072	UPDATE	Coding requirement	1. Value must be 12 characters or less2. Value must be in Provider Taxonomy List (VVL)3. Conditional	1. Value must be 12 characters or less2. Value must be in Provider Taxonomy List (VVL)3. Situational
07/10/2025	4.0.13	CRX.002.071	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.071	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization)	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Situational5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization)
12/19/2024	4.0.1	CRX.002.070	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in [3,C,W] then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in [3,C,W] then value may match (PRV.005.081) Provider Identifier where the Provider Identifier Type (PRV.005.077) equals "1"5. Discharge Date (CIP.002.096) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or6. Discharge Date (CIP.002.096) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080)	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in [3,C,W] then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in [3,C,W] then value may match (PRV.005.081) Provider Identifier where the Provider Identifier Type (PRV.005.077) equals "1"5. When Type of Claim is in [1,3,A,C], then value must be populated6. When Type of Claim in [1,3,A,C] then associated Provider Medicaid Enrollment Status Code (PRV.007.100) must be in [01,02,03,04,05,06] (active)7. Prescription Fill Date (CRX.002.085) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or8. Prescription Fill Date (CRX.002.085) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080)
05/29/2025	4.0.9	CRX.002.069	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional
12/19/2024	4.0.1	CRX.002.068	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period (by date of service)4. Value must have a corresponding value in Waiver ID (CRX.002.069)5. Conditional6. Value must be in [06,07,08,09,10,11,12,13,14,15,16,17,18,19,20,33] when associated Program Type equals "07"	1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period (by date of service)4. Value must have a corresponding value in Waiver ID (CRX.002.069)5. Conditional
07/10/2025	4.0.13	CRX.002.067	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.067	UPDATE	Coding requirement	1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. If there is an associated Health Home Entity Name value, then value must be "1"4. Conditional	1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. If there is an associated Health Home Entity Name value, then value must be "1"4. Situational
07/10/2025	4.0.13	CRX.002.065	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.065	UPDATE	Coding requirement	1. Value must be 1 character2. Value must not contain a pipe or asterisk symbols3. Conditional	1. Value must be 1 character2. Value must not contain a pipe or asterisk symbols3. Situational
07/10/2025	4.0.13	CRX.002.064	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.064	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional	1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
07/10/2025	4.0.13	CRX.002.063	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.063	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional	1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
07/10/2025	4.0.13	CRX.002.062	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.062	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must not contain a pipe or asterisk symbol3. Conditional	1. Value must be 20 characters or less2. Value must not contain a pipe or asterisk symbol3. Situational
07/10/2025	4.0.13	CRX.002.061	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.061	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Forced Claim Indicator List (VVL)3. Conditional	1. Value must be 1 character2. Value must be in Forced Claim Indicator List (VVL)3. Situational
12/19/2024	4.0.1	CRX.002.058	UPDATE	Definition	The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.	The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim linesâ€™ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.
04/24/2025	4.0.7	CRX.002.054	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Funding Source Non-Federal Share List (VVL)3. If Type of Claim is in [3,C,W], then value must be populated4. Conditional	1. Value must be 2 characters2. Value must be in Funding Source Non-Federal Share List (VVL)3. If Type of Claim is not in [3,C,W], then value must be populated4. Conditional
07/10/2025	4.0.13	CRX.002.052	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.052	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Fixed Payment Indicator List (VVL)3. Conditional	1. Value must be 1 character2. Value must be in Fixed Payment Indicator List (VVL)3. Situational
07/10/2025	4.0.13	CRX.002.048	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.048	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Other Insurance Indicator List (VVL)3. Conditional	1. Value must be 1 character2. Value must be in Other Insurance Indicator List (VVL)3. Situational
07/10/2025	4.0.13	CRX.002.047	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.047	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CRX.002.045	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.045	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Value must be less than associated Total Billed Amount - (Total Medicare Coinsurance Amount + Total Medicare Deductible Amount)4. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Value must be less than associated Total Billed Amount - (Total Medicare Coinsurance Amount + Total Medicare Deductible Amount)4. Situational
07/10/2025	4.0.13	CRX.002.044	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.044	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0" (not a crossover claim), then value should not be populated.4. Conditional5. If associated Medicare Combined Deductible Indicator equals "1", then value must not be populated6. When populated, value must be less than or equal to Total Billed Amount	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0" (not a crossover claim), then value should not be populated.4. Situational5. If associated Medicare Combined Deductible Indicator equals "1", then value must not be populated6. When populated, value must be less than or equal to Total Billed Amount
06/19/2025	4.0.11	CRX.002.043	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0" (not a crossover claim), then value should not be populated4. (Medicare Enrolled) if associated Dual Eligible Code (ELG.005.085) value is in [01,02,03,04,05,06,08,09,10], then value is mandatory and must be provided5. Conditional6. When populated, value must be less than or equal to Total Billed Amount	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0" (not a crossover claim), then value should not be populated4. If associated Dual Eligible Code (ELG.005.085) value is in [01,02,03,04,05,06,08,09,10] (Medicare Enrolled), then value is mandatory and must be provided5. Conditional6. When populated, value must be less than or equal to Total Billed Amount
12/19/2024	4.0.1	CRX.002.041	UPDATE	Definition	The total amount paid by Medicaid/CHIP or the managed care plan on this claim or adjustment at the claim header level, which is the sum of the amounts paid by Medicaid or the managed care plan at the detail level for the claim. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity paid the provider for the service. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.	The total amount paid to the provider by Medicaid/CHIP or the managed care plan on this claim or adjustment at the claim header level, which is the sum of the amounts paid to the provider by Medicaid or the managed care plan at the detail level for the claim. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity paid the provider for the service. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
07/10/2025	4.0.13	CRX.002.038	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.038	UPDATE	Coding requirement	1. Value must be in Claim Payment Remittance Code List (VVL)2. Value must be 5 characters or less3. Conditional4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 3 (CIP.002.110) is not populated	1. Value must be in Claim Payment Remittance Code List (VVL)2. Value must be 5 characters or less3. Situational4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 3 (CIP.002.110) is not populated
07/10/2025	4.0.13	CRX.002.037	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.037	UPDATE	Coding requirement	1. Value must be in Claim Payment Remittance Code List (VVL)2. Value must be 5 characters or less3. Conditional4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 2 (CRX.002.036) is not populated	1. Value must be in Claim Payment Remittance Code List (VVL)2. Value must be 5 characters or less3. Situational4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 2 (CRX.002.036) is not populated
07/10/2025	4.0.13	CRX.002.036	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.036	UPDATE	Coding requirement	1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Conditional4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 1 (CRX.002.035) is not populated	1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Situational4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 1 (CRX.002.035) is not populated
07/10/2025	4.0.13	CRX.002.035	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.035	UPDATE	Coding requirement	1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Conditional4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique	1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Situational4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique
07/10/2025	4.0.13	CRX.002.034	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.034	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Situational
07/10/2025	4.0.13	CRX.002.033	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.033	UPDATE	Coding requirement	1. Value must be 15 characters or less2. Value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Conditional	1. Value must be 15 characters or less2. Value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Situational
12/19/2024	4.0.1	CRX.002.032	UPDATE	Definition	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee.	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = â€ś23â€ť to indicate that the sub-capitated network provider provided the service directly to the enrollee.
07/10/2025	4.0.13	CRX.002.030	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.030	UPDATE	Coding requirement	1. Value must be 3 characters or less2. Value must be in Claim Status List (VVL)3. Conditional4. If value in [542,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be "F2"	1. Value must be 3 characters or less2. Value must be in Claim Status List (VVL)3. Situational4. If value in [542,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be "F2"
12/19/2024	4.0.1	CRX.002.029	UPDATE	Definition	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record.	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or â€śCâ€ť for an S-CHIP sub-capitated encounter record.
12/19/2024	4.0.1	CRX.002.027	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (CIP.001.010)3. Mandatory4. Value should be on or after associated Admission Date value	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (CRX.001.010)3. Mandatory
07/10/2025	4.0.13	CRX.002.024	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.024	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in 1115A Demonstration Indicator List (VVL)3. Conditional4. When value equals "0", is invalid or not populated, then the associated 1115A Demonstration Indicator (ELG.018.233) must equal "0", is invalid or not populated	1. Value must be 1 character2. Value must be in 1115A Demonstration Indicator List (VVL)3. Situational4. When value equals "0", is invalid or not populated, then the associated 1115A Demonstration Indicator (ELG.018.233) must equal "0", is invalid or not populated
05/07/2025	4.0.8	CRX.002.022	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Mandatory3. The Prescription Fill Date (CRX.002.085) on the claim must fall between Enrollment Timespan Effective Date (ELG.021.253) and Enrollment Timespan End Date (ELG.021.253)	1. Value must be 20 characters or less2. Mandatory3. The Prescription Fill Date (CRX.002.085) on the claim must fall between Enrollment Timespan Effective Date (ELG.021.253) and Enrollment Timespan End Date (ELG.021.253)4. Value must not contain Ampersand symbol
03/14/2025	4.0.4	CRX.002.021	UPDATE	Necessity	Mandatory	Conditional
03/14/2025	4.0.4	CRX.002.021	UPDATE	Coding requirement	1. Value must be 12 characters or less2. Mandatory	1. Value must be 12 characters or less2. Conditional
01/16/2025	4.0.2	CRX.002.020	UPDATE	Coding requirement	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated
05/07/2025	4.0.8	CRX.001.155	UPDATE	Coding requirement	1. Value must be 4 characters or less2. Value must between 1 and 99993. Value must be equal to the largest of any prior values for the same reporting period and file type, plus 1 (i.e. incremented by 1)4. Value must not contain a pipe symbol5. Mandatory	1. Value must be 4 characters or less2. Value must be between 1 and 99993. Value must be equal to the largest of any prior values for the same reporting period and file type, plus 1 (i.e. incremented by 1)4. Value must not contain a pipe symbol5. Mandatory
07/17/2025	4.0.14	COT.003.225	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.225	UPDATE	Coding requirement	1. Value may include up to 9 digits to the left of the decimal point, and 9 digits to the right e.g. 123456789.1234567892. Conditional	1. Value may include up to 9 digits to the left of the decimal point, and 9 digits to the right e.g. 123456789.1234567892. Situational
07/17/2025	4.0.14	COT.003.224	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.224	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in NDC Unit of Measure List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in NDC Unit of Measure List (VVL)3. Situational
07/17/2025	4.0.14	COT.003.223	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.223	UPDATE	Coding requirement	1. Value must be 18 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional	1. Value must be 18 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
02/27/2025	4.0.3	COT.003.221	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (COT.001.010)3. Mandatory4. Value should be on or after associated Admission Date value	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (COT.001.010)3. Mandatory4. Value should be on or after the associated Beginning Date of Service
07/17/2025	4.0.14	COT.003.219	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.219	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Conditional	1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Situational
07/17/2025	4.0.14	COT.003.218	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.218	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Conditional	1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Situational
07/17/2025	4.0.14	COT.003.227	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.227	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Conditional	1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Situational
07/17/2025	4.0.14	COT.003.217	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.217	UPDATE	Coding requirement	1. Value must be 12 digits or less2. Value must be a valid National Drug Code3. Conditional	1. Value must be 12 digits or less2. Value must be a valid National Drug Code3. Situational
07/17/2025	4.0.14	COT.003.213	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.213	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
10/08/2024	4.0.0	COT.003.208	UPDATE	Coding requirement	1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)3. Conditional2. Value must be in ZIP Code List (VVL)	1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Value must be in ZIP Code List (VVL)3. Conditional
07/17/2025	4.0.14	COT.003.207	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.207	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in State Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in State Code List (VVL)3. Situational
07/17/2025	4.0.14	COT.003.206	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.206	UPDATE	Coding requirement	1. Value must be 28 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional	1. Value must be 28 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
07/17/2025	4.0.14	COT.003.205	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.205	UPDATE	Coding requirement	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 3 value(s)3. There must be an Address Line 1 in order to have an Address Line 24. Value must not contain a pipe or asterisk symbols5. Conditional	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 3 value(s)3. There must be an Address Line 1 in order to have an Address Line 24. Value must not contain a pipe or asterisk symbols5. SItuational
07/17/2025	4.0.14	COT.003.204	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.204	UPDATE	Coding requirement	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 2 or Address Line 3 value(s)3. Value must not contain a pipe or asterisk symbols4. Conditional	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 2 or Address Line 3 value(s)3. Value must not contain a pipe or asterisk symbols4. Situational
07/17/2025	4.0.14	COT.003.203	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.203	UPDATE	Coding requirement	1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Value must be in ZIP Code List (VVL)3. Conditional	1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Value must be in ZIP Code List (VVL)3. Situational
07/17/2025	4.0.14	COT.003.202	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.202	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in State Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in State Code List (VVL)3. Situational
07/17/2025	4.0.14	COT.003.201	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.201	UPDATE	Coding requirement	1. Value must be 28 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional	1. Value must be 28 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
07/17/2025	4.0.14	COT.003.200	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.200	UPDATE	Coding requirement	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 3 value(s)3. There must be an Address Line 1 in order to have an Address Line 24. Value must not contain a pipe or asterisk symbols5. Conditional	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 3 value(s)3. There must be an Address Line 1 in order to have an Address Line 24. Value must not contain a pipe or asterisk symbols5. Situational
07/17/2025	4.0.14	COT.003.199	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.199	UPDATE	Coding requirement	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 2 or Address Line 3 value(s)3. Value must not contain a pipe or asterisk symbols4. Conditional	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 2 or Address Line 3 value(s)3. Value must not contain a pipe or asterisk symbols4. Situational
07/17/2025	4.0.14	COT.003.198	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.198	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Tooth Surface Code List (VVL)3. Conditional4. When populated, associated type of service value must be in [013,029,035]	1. Value must be 1 character2. Value must be in Tooth Surface Code List (VVL)3. Situational4. When populated, associated type of service value must be in [013,029,035]
07/17/2025	4.0.14	COT.003.197	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.197	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Tooth Quad Code List (VVL)3. Conditional4. When populated, associated type of service value must be in [013,029,035]	1. Value must be 2 characters2. Value must be in Tooth Quad Code List (VVL)3. Situational4. When populated, associated type of service value must be in [013,029,035]
07/17/2025	4.0.14	COT.003.195	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.195	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Tooth Designation System List (VVL)3. Value must not contain a pipe symbol4. Conditional	1. Value must be 2 characters2. Value must be in Tooth Designation System List (VVL)3. Value must not contain a pipe symbol4. Situational
07/17/2025	4.0.14	COT.003.193	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.193	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Provider Specialty List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Provider Specialty List (VVL)3. Situational
07/17/2025	4.0.14	COT.003.192	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.192	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Provider Type Code List (VVL).3. Conditional	1. Value must be 2 characters2. Value must be in Provider Type Code List (VVL).3. Situational
07/17/2025	4.0.14	COT.003.191	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.191	UPDATE	Coding requirement	1. Value must be 12 characters or less2. Value must be in Provider Taxonomy List (VVL)3. Conditional	1. Value must be 12 characters or less2. Value must be in Provider Taxonomy List (VVL)3. Situational
05/07/2025	4.0.8	COT.003.190	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Conditional4. If Type of Claim (COT.002.037) not in [3,C,W], then value must match Provider Identifier (PRV.005.081)5. Value must exist in the NPPES NPI data file	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Conditional4. If Type of Claim (COT.002.037) not in [3,C,W], then value must match Provider Identifier (PRV.005.081)5. NPPES Entity Type Code associate with this NPI must equal ‘1’ (Individual)6. Value must exist in the NPPES NPI data file
12/19/2024	4.0.1	COT.003.188	UPDATE	Definition	"A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012. To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting. Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as “extended state plan” services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment. The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a state’s service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc. Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf"	"A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012. To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting. Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as â€śextended state planâ€ť services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment. The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a stateâ€™s service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc. Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf"
07/17/2025	4.0.14	COT.003.187	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.187	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in HCBS Service Code List (VVL)3. If value is in [1-7], then HCBS Taxonomy must be populated4. Conditional	1. Value must be 1 character2. Value must be in HCBS Service Code List (VVL)3. If value is in [1-7], then HCBS Taxonomy must be populated4. Situational
12/19/2024	4.0.1	COT.003.186	UPDATE	Coding requirement	1. Value must be 3 characters.2. Mandatory3. Value must be in Type of Service OT List (VVL)4. When value is not in [025,085], Sex (ELG.002.023) equals "M"	1. Value must be 3 characters.2. Mandatory3. Value must be in Type of Service OT List (VVL)
07/17/2025	4.0.14	COT.003.184	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.184	UPDATE	Coding requirement	1. Value may include up to 8 digits to the left of the decimal point, and 3 digits to the right e.g. 12345678.9992. Conditional	1. Value may include up to 8 digits to the left of the decimal point, and 3 digits to the right e.g. 12345678.9992. Situational
07/17/2025	4.0.14	COT.003.182	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.182	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0", then the value must not be populated4. Conditional5. If value is populated, Crossover Indicator must be equal to "1"	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0", then the value must not be populated4. Situational5. If value is populated, Crossover Indicator must be equal to "1"
07/17/2025	4.0.14	COT.003.177	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.177	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/17/2025	4.0.14	COT.003.176	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.176	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/17/2025	4.0.14	COT.003.172	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.172	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Conditional	1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Situational
07/17/2025	4.0.14	COT.003.171	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.171	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Procedure Code Flag List (VVL)3. When populated, there must be a corresponding Procedure Code4. Conditional	1. Value must be 2 characters2. Value must be in Procedure Code Flag List (VVL)3. When populated, there must be a corresponding Procedure Code4. Situational
07/17/2025	4.0.14	COT.003.170	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.170	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before associated Discharge Date value3. Value must be provided with an associated Procedure Code value4. Value must be on or after associated Beginning Date of Service value5. Value must be on or before associated Eligible Date of Death value6. Value must be not be populated when associated Procedure Code is not populated7. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before associated Discharge Date value3. Value must be provided with an associated Procedure Code value4. Value must be on or after associated Beginning Date of Service value5. Value must be on or before associated Eligible Date of Death value6. Value must be not be populated when associated Procedure Code is not populated7. Situational
07/17/2025	4.0.14	COT.003.169	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.169	UPDATE	Coding requirement	1. Value must be 8 characters or less2. Value must be in Procedure Code List (VVL)3. When populated, there must be a corresponding Procedure Code Flag4. If associated Procedure Code Flag value indicates an CPT-4 encoding "01", then value must be a valid CPT-4 procedure code5. If associated Procedure Code Flag value indicates an "Other" encoding "10-87", then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code6. If associated Procedure Code Flag List (VVL) value indicates an HCPCS encoding "06", then value must be a valid HCPCS code7. Conditional	1. Value must be 8 characters or less2. Value must be in Procedure Code List (VVL)3. When populated, there must be a corresponding Procedure Code Flag4. If associated Procedure Code Flag value indicates an CPT-4 encoding "01", then value must be a valid CPT-4 procedure code5. If associated Procedure Code Flag value indicates an "Other" encoding "10-87", then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code6. If associated Procedure Code Flag List (VVL) value indicates an HCPCS encoding "06", then value must be a valid HCPCS code7. Situational
07/17/2025	4.0.14	COT.003.165	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.165	UPDATE	Coding requirement	1. Value must be 3 characters or less2. Value must be in Claim Status List (VVL)3. Conditional4. If value in [545,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be"F2"	1. Value must be 3 characters or less2. Value must be in Claim Status List (VVL)3. Situational4. If value in [545,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be"F2"
07/17/2025	4.0.14	COT.002.233	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.233	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/17/2025	4.0.14	COT.002.232	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.232	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/17/2025	4.0.14	COT.002.231	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.231	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/17/2025	4.0.14	COT.002.230	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.230	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
02/27/2025	4.0.3	COT.002.147	UPDATE	Definition	The Medicare Beneficiary Identifier (MBI) is a randomly generated identifier used to identify all Medicare beneficiaries. It replaced the previously-used SSN-based Medicare HIC Number (HICN). To prevent identify theft, among other reasons, HICN gradually were retired and replaced by the MBI over the course of 2018 and 2019. Starting in 2020, the MBI became the primary identifier for Medicare beneficiaries.	The Medicare Beneficiary Identifier (MBI) is a randomly generated identifier used to identify all Medicare beneficiaries. It replaced the previously-used SSN-based Medicare HIC Number (HICN). To prevent identity theft, among other reasons, HICN gradually were retired and replaced by the MBI over the course of 2018 and 2019. Starting in 2020, the MBI became the primary identifier for Medicare beneficiaries.
07/17/2025	4.0.14	COT.002.146	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.146	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier, where Provider Identifier Type (PRV.005.077) equals "2"3. Value must exist in the NPPES NPI data file4. Conditional	1. Value must be 10 digits2. Value must have an associated Provider Identifier, where Provider Identifier Type (PRV.005.077) equals "2"3. Value must exist in the NPPES NPI data file4. Situational
07/17/2025	4.0.14	COT.002.141	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.141	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Third Party Coinsurance Amount3. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Third Party Coinsurance Amount3. Situational
07/17/2025	4.0.14	COT.002.138	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.138	UPDATE	Coding requirement	1. Value must not contain a pipe or asterisk symbols2. Value must 50 characters or less3. Conditional	1. Value must not contain a pipe or asterisk symbols2. Value must 50 characters or less3. Situational
07/17/2025	4.0.14	COT.002.135	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.135	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Deductible Amount3. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Deductible Amount3. Situational
07/17/2025	4.0.14	COT.002.134	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.134	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/17/2025	4.0.14	COT.002.133	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.133	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Copayment Amount3. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Copayment Amount3. Situational
07/17/2025	4.0.14	COT.002.132	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.132	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/17/2025	4.0.14	COT.002.131	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.131	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Coinsurance Amount3. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Coinsurance Amount3. Situational
07/17/2025	4.0.14	COT.002.130	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.130	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/17/2025	4.0.14	COT.002.128	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.128	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Border State Indicator List (VVL)3. Conditional	1. Value must be 1 character2. Value must be in Border State Indicator List (VVL)3. Situational
07/17/2025	4.0.14	COT.002.127	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.127	UPDATE	Coding requirement	1. Value must be between 0.00 and 99999.992. Conditional3. Value must be expressed as a number with 2-digit precision (e.g. 100.50)	1. Value must be between 0.00 and 99999.992. Situational3. Value must be expressed as a number with 2-digit precision (e.g. 100.50)
12/19/2024	4.0.1	COT.002.123	UPDATE	Definition	A data element corresponding with line 24b on the CMS-1500 that indicates where the services took place. This is a pass-through data element that should not be modified or derived when missing unless otherwise specified.	A pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claim form (i.e., 837P or 837D - Place of Service is only captured at the line level of the CMS-1500). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than â€śBâ€ť, then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS-1450 (UB-04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled.
06/19/2025	4.0.11	COT.002.122	UPDATE	Coding requirement	1. Value must be 12 characters or less2. Conditional3. Value must not contain a pipe or asterisk symbols4. (Not Dual Eligible) if Dual Eligible Code (ELG.DE.085) value equals "00", then value must not be populated5. Value must be populated when Crossover Indicator (COT.002.023) equals "1" and Medicare Beneficiary Identifier (COT.002.147) is not populated	1. Value must be 12 characters or less2. Conditional3. Value must not contain a pipe or asterisk symbols4. If Dual Eligible Code (ELG.DE.085) value is "00" (Not Dual Eligible), then value must not be populated.5. Value must be populated when Crossover Indicator (COT.002.023) equals "1" and Medicare Beneficiary Identifier (COT.002.147) is not populated
07/17/2025	4.0.14	COT.002.118	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.118	UPDATE	Coding requirement	1. Value must be 10 digits2. Conditional3. Value must have an associated Provider Identifier Type equal to "2"4. Value must exist in the NPPES NPI File	1. Value must be 10 digits2. Situational3. Value must have an associated Provider Identifier Type equal to "2"4. Value must exist in the NPPES NPI File
07/17/2025	4.0.14	COT.002.117	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.117	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Conditional	1. Value must be 30 characters or less2. Situational
07/17/2025	4.0.14	COT.002.116	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.116	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Provider Specialty List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Provider Specialty List (VVL)3. Situational
07/17/2025	4.0.14	COT.002.115	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.115	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Provider Type Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Provider Type Code List (VVL)3. Situational
07/17/2025	4.0.14	COT.002.114	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.114	UPDATE	Coding requirement	1. Value must be in Provider Taxonomy List (VVL)2. Value must be 12 characters or less3. Conditional4. If associated Type of Service value is in [119,120,121,122], then value should not be populated	1. Value must be in Provider Taxonomy List (VVL)2. Value must be 12 characters or less3. Situational4. If associated Type of Service value is in [119,120,121,122], then value should not be populated
07/17/2025	4.0.14	COT.002.113	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.113	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization)	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Situational5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization)
07/17/2025	4.0.14	COT.002.112	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.112	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in [3,C,W] then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in [3,C,W] then value may match (PRV.005.081) Provider Identifier where the Provider Identifier Type (PRV.005.077) equals "1"5. Must have an enrollment where the Ending Date of Service (COT.003.167) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or6. Must have an enrollment where the Ending Date of Service (COT.003.167) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080).7. Value must be reported in Provider Identifier (PRV.005.080) with an associated Provider Identifier Type (PRV.005.081) equal to '1'.	1. Value must be 30 characters or less2. Situational3. When Type of Claim not in [3,C,W] then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in [3,C,W] then value may match (PRV.005.081) Provider Identifier where the Provider Identifier Type (PRV.005.077) equals "1"5. Must have an enrollment where the Ending Date of Service (COT.003.167) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or6. Must have an enrollment where the Ending Date of Service (COT.003.167) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080).7. Value must be reported in Provider Identifier (PRV.005.080) with an associated Provider Identifier Type (PRV.005.081) equal to '1'.
05/29/2025	4.0.9	COT.002.111	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional
07/17/2025	4.0.14	COT.002.110	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.110	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period (by date of service)4. When populated, Waiver ID (COT.002.111) must be populated5. Conditional6. Value must be in [06,07,08,09,10,11,12,13,14,15,16,17,18,19,20,33] when associated Program Type equals "07"	1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period (by date of service)4. When populated, Waiver ID (COT.002.111) must be populated5. Situational6. Value must be in [06,07,08,09,10,11,12,13,14,15,16,17,18,19,20,33] when associated Program Type equals "07"
07/17/2025	4.0.14	COT.002.109	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.109	UPDATE	Coding requirement	1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. If there is an associated Health Home Entity Name value, then value must be "1"4. Conditional	1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. If there is an associated Health Home Entity Name value, then value must be "1"4. Situational
07/17/2025	4.0.14	COT.002.107	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.107	UPDATE	Coding requirement	1. Value must be 1 character2. Value must not contain a pipe or asterisk symbols3. Conditional	1. Value must be 1 character2. Value must not contain a pipe or asterisk symbols3. Situational
07/17/2025	4.0.14	COT.002.106	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.106	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional	1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
07/17/2025	4.0.14	COT.002.105	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.105	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional	1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
07/17/2025	4.0.14	COT.002.104	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.104	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must not contain a pipe or asterisk symbol3. Conditional	1. Value must be 20 characters or less2. Value must not contain a pipe or asterisk symbol3. Situational
12/19/2024	4.0.1	COT.002.103	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional
12/19/2024	4.0.1	COT.002.102	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional
12/19/2024	4.0.1	COT.002.101	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional
12/19/2024	4.0.1	COT.002.100	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional
12/19/2024	4.0.1	COT.002.099	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional
12/19/2024	4.0.1	COT.002.098	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional
12/19/2024	4.0.1	COT.002.097	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional
12/19/2024	4.0.1	COT.002.096	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional
12/19/2024	4.0.1	COT.002.095	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional
12/19/2024	4.0.1	COT.002.094	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional
12/19/2024	4.0.1	COT.002.093	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date
12/19/2024	4.0.1	COT.002.092	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4.Value must be on or before the Occurrence Code End Date
12/19/2024	4.0.1	COT.002.091	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date
12/19/2024	4.0.1	COT.002.090	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date
12/19/2024	4.0.1	COT.002.089	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date
12/19/2024	4.0.1	COT.002.088	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date
12/19/2024	4.0.1	COT.002.087	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date
12/19/2024	4.0.1	COT.002.086	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date
12/19/2024	4.0.1	COT.002.085	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date
12/19/2024	4.0.1	COT.002.084	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date
02/27/2025	4.0.3	COT.002.083	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	4.0.3	COT.002.082	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	4.0.3	COT.002.081	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	4.0.3	COT.002.080	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	4.0.3	COT.002.079	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	4.0.3	COT.002.078	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	4.0.3	COT.002.077	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	4.0.3	COT.002.076	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	4.0.3	COT.002.075	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	4.0.3	COT.002.074	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
07/17/2025	4.0.14	COT.002.072	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.072	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Forced Claim Indicator List (VVL)3. Conditional	1. Value must be 1 character2. Value must be in Forced Claim Indicator List (VVL)3. Situational
12/19/2024	4.0.1	COT.002.068	UPDATE	Definition	The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.	The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim linesâ€™ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.
12/19/2024	4.0.1	COT.002.066	UPDATE	Coding requirement	1. Value must be 12 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional4. Value must match Managed Care Plan ID (ELG.014.192)5. Value must match State Plan ID Number (MCR.002.019)6. When Type of Claim (COT.002.037) in [3,C,W] value must have a managed care enrollment (ELG.014) for the beneficiary where the Beginning DOS (COT.002.033) occurs between the managed care plan enrollment eff/end dates (ELG.014.197/198)7. When Type of Claim (COT.002.037) in [3,C,W] value must have a managed care main record (MCR.002) for the plan where the Beginning DOS (COT.002.037) occurs between the managed care contract eff/end dates (MCR.002.020/021)	1. Value must be 12 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional4. Value must match Managed Care Plan ID (ELG.014.192)5. Value must match State Plan ID Number (MCR.002.019)6. When Type of Claim (COT.002.037) in [3,C,W] value must have a managed care enrollment (ELG.014) for the beneficiary where the Beginning DOS (COT.002.033) occurs between the managed care plan enrollment eff/end dates (ELG.014.197/198)7. When Type of Claim (COT.002.037) in [3,C,W] value must have a managed care main record (MCR.002) for the plan where the Beginning DOS (COT.002.033) occurs between the managed care contract eff/end dates (MCR.002.020/021)
07/17/2025	4.0.14	COT.002.064	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.064	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Medicare Combined Deductible Indicator List (VVL)3. If value equals "1", then Total Medicare Coinsurance amount must not be populated4. If value equals "0", then Crossover Indicator must equal "0"5. If value equals "1", then Crossover Indicator must equal "1"6. Conditional	1. Value must be 1 character2. Value must be in Medicare Combined Deductible Indicator List (VVL)3. If value equals "1", then Total Medicare Coinsurance amount must not be populated4. If value equals "0", then Crossover Indicator must equal "0"5. If value equals "1", then Crossover Indicator must equal "1"6. Situational
04/24/2025	4.0.7	COT.002.063	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Funding Source Non-Federal Share List (VVL)3. If Type of Claim is in [3,C,W], then value must be populated4. Conditional	1. Value must be 2 characters2. Value must be in Funding Source Non-Federal Share List (VVL)3. If Type of Claim is not in [3,C,W], then value must be populated4. Conditional
07/17/2025	4.0.14	COT.002.061	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.061	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Fixed Payment Indicator List (VVL)3. Conditional	1. Value must be 1 character2. Value must be in Fixed Payment Indicator List (VVL)3. Situational
07/17/2025	4.0.14	COT.002.057	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.057	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Other Insurance Indicator List (VVL)3. Conditional	1. Value must be 1 character2. Value must be in Other Insurance Indicator List (VVL)3. Situational
07/17/2025	4.0.14	COT.002.056	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.056	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/17/2025	4.0.14	COT.002.054	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.054	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Value must be less than associated Total Billed Amount - (Total Medicare Coinsurance Amount + Total Medicare Deductible Amount)4. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Value must be less than associated Total Billed Amount - (Total Medicare Coinsurance Amount + Total Medicare Deductible Amount)4. Situational
07/17/2025	4.0.14	COT.002.053	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.053	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0" (not a crossover claim), then value should not be populated.4. Conditional5. If associated Medicare Combined Deductible Indicator equals "1", then value must not be populated6. When populated, value must be less than or equal to Total Billed Amount	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0" (not a crossover claim), then value should not be populated.4. Situational5. If associated Medicare Combined Deductible Indicator equals "1", then value must not be populated6. When populated, value must be less than or equal to Total Billed Amount
06/19/2025	4.0.11	COT.002.052	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0" (not a crossover claim), then value should not be populated4. (Medicare Enrolled) if associated Dual Eligible Code (ELG.005.085) value is in [01,02,03,04,05,06,08,09,10], then value is mandatory and must be provided5. Conditional6. When populated, value must be less than or equal to Total Billed Amount	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0" (not a crossover claim), then value should not be populated4. If associated Dual Eligible Code (ELG.005.085) value is in [01,02,03,04,05,06,08,09,10] (Medicare Enrolled), then value is mandatory and must be provided5. Conditional6. When populated, value must be less than or equal to Total Billed Amount
07/17/2025	4.0.14	COT.002.047	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.047	UPDATE	Coding requirement	1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Conditional4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 3 (COT.002.046) is not populated	1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Situational4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 3 (COT.002.046) is not populated
07/17/2025	4.0.14	COT.002.046	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.046	UPDATE	Coding requirement	1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Conditional4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 2 (CLT.002.045) is not populated	1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Situational4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 2 (CLT.002.045) is not populated
07/17/2025	4.0.14	COT.002.045	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.045	UPDATE	Coding requirement	1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Conditional4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 1 (COT.002.044) is not populated	1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Situational4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 1 (COT.002.044) is not populated
07/17/2025	4.0.14	COT.002.044	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.044	UPDATE	Coding requirement	1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Conditional4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique	1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Situational4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique
07/17/2025	4.0.14	COT.002.043	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.043	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Situational
07/17/2025	4.0.14	COT.002.042	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.042	UPDATE	Coding requirement	1. Value must be 15 characters or less2. Value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Conditional	1. Value must be 15 characters or less2. Value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Situational
12/19/2024	4.0.1	COT.002.041	UPDATE	Definition	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee.	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = â€ś23â€ť to indicate that the sub-capitated network provider provided the service directly to the enrollee.
07/17/2025	4.0.14	COT.002.039	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.039	UPDATE	Coding requirement	1. Value must be 3 characters or less2. Value must be in Claim Status List (VVL)3. Conditional4. If value in [542,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be "F2"	1. Value must be 3 characters or less2. Value must be in Claim Status List (VVL)3. Situational4. If value in [542,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be "F2"
12/19/2024	4.0.1	COT.002.038	UPDATE	Coding requirement	1. Value must be 4 characters2. Value must be in Type of Bill List (VVL)3. First character must be a "0"4. Conditional	1. Value must be 4 characters2. First character value must be a "0"3. Second character value must be in Type of Bill 2 Facility Type List (VVL)4. Third character value must be in Type of Bill 3 Classification Clinics List (VVL)5. Fourth character value must be in Type of Bill 4 Frequency List (VVL)6. Conditional
12/19/2024	4.0.1	COT.002.037	UPDATE	Definition	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or â€śCâ€ť for an S-CHIP sub-capitated encounter record
02/27/2025	4.0.3	COT.002.035	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (CIP.001.010)3. Mandatory4. Value should be on or after associated Admission Date value	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (COT.001.010)3. Mandatory4. Value should be on or after the associated Beginning Date of Service
07/17/2025	4.0.14	COT.002.024	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.002.024	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in 1115A Demonstration Indicator List (VVL)3. Conditional4. When value equals "0", is invalid or not populated, then the associated 1115A Demonstration Indicator (ELG.018.233) must equal "0", is invalid or not populated	1. Value must be 1 character2. Value must be in 1115A Demonstration Indicator List (VVL)3. Situational4. When value equals "0", is invalid or not populated, then the associated 1115A Demonstration Indicator (ELG.018.233) must equal "0", is invalid or not populated
05/07/2025	4.0.8	COT.002.022	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.021.251) and the Beginning Date of Service (COT.002.033) must be between Enrollment Effective Date (ELG.021.253) and Enrollment End Date (ELG.021.254)	1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.021.251) and the Beginning Date of Service (COT.002.033) must be between Enrollment Effective Date (ELG.021.253) and Enrollment End Date (ELG.021.254)4. Value must not contain Ampersand symbol
01/16/2025	4.0.2	COT.002.020	UPDATE	Coding requirement	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated
05/07/2025	4.0.8	COT.001.216	UPDATE	Coding requirement	1. Value must be 4 characters or less2. Value must between 1 and 99993. Value must be equal to the largest of any prior values for the same reporting period and file type, plus 1 (i.e. incremented by 1)4. Value must not contain a pipe symbol5. Mandatory	1. Value must be 4 characters or less2. Value must be between 1 and 99993. Value must be equal to the largest of any prior values for the same reporting period and file type, plus 1 (i.e. incremented by 1)4. Value must not contain a pipe symbol5. Mandatory
07/10/2025	4.0.13	CLT.003.235	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.003.235	UPDATE	Coding requirement	1. Value must be 18 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional	1. Value must be 18 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
07/10/2025	4.0.13	CLT.003.230	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.003.230	UPDATE	Coding requirement	1. Value may include up to 9 digits to the left of the decimal point, and 9 digits to the right e.g. 123456789.1234567892. Conditional	1. Value may include up to 9 digits to the left of the decimal point, and 9 digits to the right e.g. 123456789.1234567892. Situational
07/10/2025	4.0.13	CLT.003.229	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.003.229	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in NDC Unit of Measure List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in NDC Unit of Measure List (VVL)3. Situational
07/10/2025	4.0.13	CLT.003.228	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.003.228	UPDATE	Coding requirement	1. Value must be 12 digits or less2. Value must be a valid National Drug Code3. Conditional	1. Value must be 12 digits or less2. Value must be a valid National Drug Code3. Situational
07/10/2025	4.0.13	CLT.003.216	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.003.216	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Provider Specialty List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Provider Specialty List (VVL)3. Situational
07/10/2025	4.0.13	CLT.003.215	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.003.215	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Provider Type Code List (VVL).3. Conditional	1. Value must be 2 characters2. Value must be in Provider Type Code List (VVL).3. Situational
05/07/2025	4.0.8	CLT.003.213	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Conditional4. If Type of Claim (CLT.002.052) not in [3,C,W], then value must match Provider Identifier (PRV.005.081)5. Value must exist in the NPPES NPI data file	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Conditional4. If Type of Claim (CLT.002.052) not in [3,C,W], then value must match Provider Identifier (PRV.005.081)5. NPPES Entity Type Code associate with this NPI must equal ‘1’ (Individual)6. Value must exist in the NPPES NPI data file
07/10/2025	4.0.13	CLT.003.210	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.003.210	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Billing Unit List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Billing Unit List (VVL)3. Situational
07/10/2025	4.0.13	CLT.003.207	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.003.207	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CLT.003.206	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.003.206	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CLT.003.203	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.003.203	UPDATE	Coding requirement	1. Value must be numeric2. Value may include up to 6 digits to the left of the decimal point, and 3 digits to the right, e.g. 123456.7893. Conditional	1. Value must be numeric2. Value may include up to 6 digits to the left of the decimal point, and 3 digits to the right, e.g. 123456.7893. Situational
07/10/2025	4.0.13	CLT.003.195	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.003.195	UPDATE	Coding requirement	1. Value must be 3 characters or less2. Value must be in Claim Status List (VVL)3. Conditional4. If value in [545,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be"F2"	1. Value must be 3 characters or less2. Value must be in Claim Status List (VVL)3. Situational4. If value in [545,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be"F2"
07/10/2025	4.0.13	CLT.002.242	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.242	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CLT.002.241	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.241	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CLT.002.240	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.240	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CLT.002.239	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.239	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CLT.002.179	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.179	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0", then the value must not be populated4. Conditional5. If value is populated, Crossover Indicator must be equal to "1"	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0", then the value must not be populated4. Situational5. If value is populated, Crossover Indicator must be equal to "1"
12/19/2024	4.0.1	CLT.002.178	UPDATE	Coding requirement	1. Value must be 12 characters or less2. Value must be in Provider Taxonomy List (VVL)3. Conditional	1. Value must be 12 characters or less2. Value must be in Provider Type Code List (VVL)3. Conditional
07/10/2025	4.0.13	CLT.002.177	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.177	UPDATE	Coding requirement	1. Value must be 12 characters or less2. Value must be in Provider Taxonomy List (VVL)3. Conditional	1. Value must be 12 characters or less2. Value must be in Provider Taxonomy List (VVL)3. Situational
07/10/2025	4.0.13	CLT.002.176	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.176	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Provider Specialty List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Provider Specialty List (VVL)3. Situational
07/10/2025	4.0.13	CLT.002.175	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.175	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Conditional	1. Value must be 30 characters or less2. Situational
07/10/2025	4.0.13	CLT.002.174	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.174	UPDATE	Coding requirement	1. Value must be 10 digits2. Conditional3. Value must have an associated Provider Identifier Type equal to "2"4. Value must exist in the NPPES NPI File	1. Value must be 10 digits2. Situational3. Value must have an associated Provider Identifier Type equal to "2"4. Value must exist in the NPPES NPI File
02/27/2025	4.0.3	CLT.002.168	UPDATE	Definition	The Medicare Beneficiary Identifier (MBI) is a randomly generated identifier used to identify all Medicare beneficiaries. It replaced the previously-used SSN-based Medicare HIC Number (HICN). To prevent identify theft, among other reasons, HICN gradually were retired and replaced by the MBI over the course of 2018 and 2019. Starting in 2020, the MBI became the primary identifier for Medicare beneficiaries.	The Medicare Beneficiary Identifier (MBI) is a randomly generated identifier used to identify all Medicare beneficiaries. It replaced the previously-used SSN-based Medicare HIC Number (HICN). To prevent identity theft, among other reasons, HICN gradually were retired and replaced by the MBI over the course of 2018 and 2019. Starting in 2020, the MBI became the primary identifier for Medicare beneficiaries.
04/24/2025	4.0.7	CLT.002.167	UPDATE	Coding requirement	1. Value must be 12 digits2. Value must have an associated Provider Identifier, where Provider Identifier Type (PRV.005.077) equals "2"3. Value must exist in the NPPES NPI data file4. Conditional	1. Value must be 10 digits2. Value must have an associated Provider Identifier, where Provider Identifier Type (PRV.005.077) equals "2"3. Value must exist in the NPPES NPI data file4. Conditional
07/10/2025	4.0.13	CLT.002.164	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.164	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Third Party Coinsurance Amount3. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Third Party Coinsurance Amount3. Situational
07/10/2025	4.0.13	CLT.002.161	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.161	UPDATE	Coding requirement	1. Value must not contain a pipe or asterisk symbols2. Value must 50 characters or less3. Conditional	1. Value must not contain a pipe or asterisk symbols2. Value must 50 characters or less3. Situational
07/10/2025	4.0.13	CLT.002.158	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.158	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Deductible Amount3. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Deductible Amount3. Situational
07/10/2025	4.0.13	CLT.002.157	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.157	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CLT.002.156	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.156	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Copayment Amount3. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Copayment Amount3. Situational
07/10/2025	4.0.13	CLT.002.155	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.155	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CLT.002.154	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.154	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Coinsurance Amount3. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Coinsurance Amount3. Situational
07/10/2025	4.0.13	CLT.002.153	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.153	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CLT.002.151	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.151	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Border State Indicator List (VVL)3. Conditional	1. Value must be 1 character2. Value must be in Border State Indicator List (VVL)3. Situational
07/10/2025	4.0.13	CLT.002.150	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.150	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Split Claim Indicator List (VVL)3. Conditional	1. Value must be 1 character2. Value must be in Split Claim Indicator List (VVL)3. Situational
06/05/2025	4.0.10	CLT.002.149	UPDATE	Coding requirement	1. Value must be 5 digits or less2. Value must be numeric3. Conditional4. When populated, value must be less than or equal to the number of days between (ending date of service minus beginning date of service) plus one day5. (nursing facility) value is required when the Type of Service in [009,045,047,059]6. When populated, if value is greater than zero, then Level of Care Status (ELG.005.088) for the associated MSIS Identification Number (CLT.002.022) must equal "003" (Nursing Facility) for the same month as the beginning and ending date of service	1. Value must be 5 digits or less2. Value must be numeric3. Conditional4. When populated, value must be less than or equal to the number of days between (ending date of service minus beginning date of service) plus one dayValue is required when the Type of Service in [009,045,047,059] (nursing facility)6. When populated, if value is greater than zero, then Level of Care Status (ELG.005.088) for the associated MSIS Identification Number (CLT.002.022) must equal "003" (Nursing Facility) for the same month as the beginning and ending date of service
06/05/2025	4.0.10	CLT.002.148	UPDATE	Coding requirement	1. Value must be numeric2. Value must be 5 digits or less3. Conditional4. (Intermediate Care Facility for Individuals with Intellectual Disabilities) value is required when Type of Service (CLT.003.211) in [009,045,046,047,059]	1. Value must be numeric2. Value must be 5 digits or less3. ConditionalValue must be populated when Type of Service (CLT.003.211) is in [009,045,046,047,059](Intermediate Care Facility for Individuals with Intellectual Disabilities)
07/10/2025	4.0.13	CLT.002.145	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.145	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
06/19/2025	4.0.11	CLT.002.140	UPDATE	Coding requirement	1. Value must be 12 characters or less2. Conditional3. Value must not contain a pipe or asterisk symbols4. (Not Dual Eligible) if Dual Eligible Code (ELG.DE.085) value equals "00", then value must not be populated5. Value must be populated when Crossover Indicator (CLT.002.023) equals "1" and Medicare Beneficiary Identifier (CLT.002.168) is not populated	1. Value must be 12 characters or less2. Conditional3. Value must not contain a pipe or asterisk symbols4. If Dual Eligible Code (ELG.DE.085) value is "00" (Not Dual Eligible), then value must not be populated.5. Value must be populated when Crossover Indicator (CLT.002.023) equals "1" and Medicare Beneficiary Identifier (CLT.002.168) is not populated
07/10/2025	4.0.13	CLT.002.136	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.136	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Situational
07/10/2025	4.0.13	CLT.002.135	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.135	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Conditional	1. Value must be 30 characters or less2. Situational
07/10/2025	4.0.13	CLT.002.134	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.134	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Provider Specialty List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Provider Specialty List (VVL)3. Situational
07/10/2025	4.0.13	CLT.002.133	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.133	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Provider Type Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Provider Type Code List (VVL)3. Situational
07/10/2025	4.0.13	CLT.002.132	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.132	UPDATE	Coding requirement	1. Value must be 12 characters or less2. Value must be in Provider Taxonomy List (VVL)3. Conditional	1. Value must be 12 characters or less2. Value must be in Provider Taxonomy List (VVL)3. Situational
07/10/2025	4.0.13	CLT.002.131	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.131	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization)	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Situational5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization)
12/19/2024	4.0.1	CLT.002.130	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in [3,C,W] then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in [3,C,W] then value may match (PRV.005.081) Provider Identifier where the Provider Identifier Type (PRV.005.077) equals "1"5. Discharge Date (CIP.002.096) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or6. Discharge Date (CIP.002.096) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080)	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in [3,C,W] then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in [3,C,W] then value may match (PRV.005.081) Provider Identifier where the Provider Identifier Type (PRV.005.077) equals "1"5. Ending Date of Service (CLT.002.049) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or6. Ending Date of Service (CLT.002.049) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080)7. Ending Date of Service (CLT.002.049) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or8. Ending Date of Service (CLT.002.049) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080)
05/29/2025	4.0.9	CLT.002.129	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional
07/10/2025	4.0.13	CLT.002.128	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.128	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period (by date of service)4. Value must have a corresponding value in Waiver ID (CLT.002.129)5. Conditional	1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period (by date of service)4. Value must have a corresponding value in Waiver ID (CLT.002.129)5. Situational
07/10/2025	4.0.13	CLT.002.127	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.127	UPDATE	Coding requirement	1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. If there is an associated Health Home Entity Name value, then value must be "1"4. Conditional	1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. If there is an associated Health Home Entity Name value, then value must be "1"4. Situational
07/10/2025	4.0.13	CLT.002.125	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.125	UPDATE	Coding requirement	1. Value must be 1 character2. Value must not contain a pipe or asterisk symbols3. Conditional	1. Value must be 1 character2. Value must not contain a pipe or asterisk symbols3. Situational
07/10/2025	4.0.13	CLT.002.124	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.124	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional	1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
07/10/2025	4.0.13	CLT.002.123	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.123	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional	1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
07/10/2025	4.0.13	CLT.002.122	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.122	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must not contain a pipe or asterisk symbol3. Conditional	1. Value must be 20 characters or less2. Value must not contain a pipe or asterisk symbol3. Situational
12/19/2024	4.0.1	CLT.002.121	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional
12/19/2024	4.0.1	CLT.002.120	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional
12/19/2024	4.0.1	CLT.002.119	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional
12/19/2024	4.0.1	CLT.002.118	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional
12/19/2024	4.0.1	CLT.002.117	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional
12/19/2024	4.0.1	CLT.002.116	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional
12/19/2024	4.0.1	CLT.002.115	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional
12/19/2024	4.0.1	CLT.002.114	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional
12/19/2024	4.0.1	CLT.002.113	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional
12/19/2024	4.0.1	CLT.002.112	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional
12/19/2024	4.0.1	CLT.002.111	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date
12/19/2024	4.0.1	CLT.002.110	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date
12/19/2024	4.0.1	CLT.002.109	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before theOccurrence Code End Date
12/19/2024	4.0.1	CLT.002.108	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date
12/19/2024	4.0.1	CLT.002.107	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date
12/19/2024	4.0.1	CLT.002.106	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date
12/19/2024	4.0.1	CLT.002.105	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date
12/19/2024	4.0.1	CLT.002.104	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date
12/19/2024	4.0.1	CLT.002.103	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date
12/19/2024	4.0.1	CLT.002.102	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date
02/27/2025	4.0.3	CLT.002.101	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	4.0.3	CLT.002.100	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	4.0.3	CLT.002.099	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	4.0.3	CLT.002.098	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	4.0.3	CLT.002.097	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	4.0.3	CLT.002.096	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	4.0.3	CLT.002.095	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	4.0.3	CLT.002.094	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	4.0.3	CLT.002.093	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	4.0.3	CLT.002.092	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
07/10/2025	4.0.13	CLT.002.090	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.090	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Forced Claim Indicator List (VVL)3. Conditional	1. Value must be 1 character2. Value must be in Forced Claim Indicator List (VVL)3. Situational
02/27/2025	4.0.3	CLT.002.086	UPDATE	Coding requirement	1. Value must be a positive integer2. Value must be between 00000:99999 (inclusive)3. Conditional4. Value must be less than or equal to double the number of days between Admission Date (CLT.002.044) and Discharge Date (CLT.002.046) plus one day5. Value must be 5 digits or less6. (inpatient mental health/psychiatric services) when associated Type of Service (CLT.003.211) in [044,048,050], this field must be populated	1. Value must be a positive integer2. Value must be between 00000:99999 (inclusive)3. Conditional4. The sum of the value provided here plus the Non Covered Days (CLT.002.084) must be less than or equal to the number of days between Beginning Date of Service (CLT.002.048) and Ending Date of Service (CLT.002.049) plus one day5. Value must be 5 digits or less6. (inpatient mental health/psychiatric services) when associated Type of Service (CLT.003.211) in [044,048,050], this field must be populated
07/10/2025	4.0.13	CLT.002.085	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.085	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CLT.002.084	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.084	UPDATE	Coding requirement	1. Value must be 5 digits or less2. Conditional	1. Value must be 5 digits or less2. Situational
12/19/2024	4.0.1	CLT.002.082	UPDATE	Definition	The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.	The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim linesâ€™ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.
07/10/2025	4.0.13	CLT.002.078	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.078	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Medicare Combined Deductible Indicator List (VVL)3. If value equals "1", then Total Medicare Coinsurance amount must not be populated4. If value equals "0", then Crossover Indicator must equal "0"5. If value equals "1", then Crossover Indicator must equals "1"6. Conditional	1. Value must be 1 character2. Value must be in Medicare Combined Deductible Indicator List (VVL)3. If value equals "1", then Total Medicare Coinsurance amount must not be populated4. If value equals "0", then Crossover Indicator must equal "0"5. If value equals "1", then Crossover Indicator must equals "1"6. Situational
04/24/2025	4.0.7	CLT.002.077	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Funding Source Non-Federal Share List (VVL)3. If Type of Claim is in [3,C,W], then value must be populated4. Conditional	1. Value must be 2 characters2. Value must be in Funding Source Non-Federal Share List (VVL)3. If Type of Claim is not in [3,C,W], then value must be populated4. Conditional
07/10/2025	4.0.13	CLT.002.075	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.075	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Fixed Payment Indicator List (VVL)3. Conditional	1. Value must be 1 character2. Value must be in Fixed Payment Indicator List (VVL)3. Situational
07/10/2025	4.0.13	CLT.002.071	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.071	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Other Insurance Indicator List (VVL)3. Conditional	1. Value must be 1 character2. Value must be in Other Insurance Indicator List (VVL)3. Situational
07/10/2025	4.0.13	CLT.002.070	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.070	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CLT.002.069	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.069	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Value must be less than associated Total Billed Amount - (Total Medicare Coinsurance Amount + Total Medicare Deductible Amount)4. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Value must be less than associated Total Billed Amount - (Total Medicare Coinsurance Amount + Total Medicare Deductible Amount)4. Situational
07/10/2025	4.0.13	CLT.002.068	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.068	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0" (not a crossover claim), then value should not be populated.4. Conditional5. If associated Medicare Combined Deductible Indicator equals "1", then value must not be populated6. When populated, value must be less than or equal to Total Billed Amount	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0" (not a crossover claim), then value should not be populated.4. Situational5. If associated Medicare Combined Deductible Indicator equals "1", then value must not be populated6. When populated, value must be less than or equal to Total Billed Amount
06/19/2025	4.0.11	CLT.002.067	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0" (not a crossover claim), then value should not be populated4. (Medicare Enrolled) if associated Dual Eligible Code (ELG.005.085) value is in [01,02,03,04,05,06,08,09,10], then value is mandatory and must be provided5. Conditional6. When populated, value must be less than or equal to Total Billed Amount	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0" (not a crossover claim), then value should not be populated4. If associated Dual Eligible Code (ELG.005.085) value is in [01,02,03,04,05,06,08,09,10] (Medicare Enrolled), then value is mandatory and must be provided5. Conditional6. When populated, value must be less than or equal to Total Billed Amount
07/10/2025	4.0.13	CLT.002.062	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.062	UPDATE	Coding requirement	1. Value must be in Claim Payment Remittance Code List (VVL)2. Value must be 5 characters or less3. Conditional4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 3 (CLT.002.061) is not populated	1. Value must be in Claim Payment Remittance Code List (VVL)2. Value must be 5 characters or less3. Situational4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 3 (CLT.002.061) is not populated
07/10/2025	4.0.13	CLT.002.061	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.061	UPDATE	Coding requirement	1. Value must be in Claim Payment Remittance Code List (VVL)2. Value must be 5 characters or less3. Conditional4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 2 (CLT.002.060) is not populated	1. Value must be in Claim Payment Remittance Code List (VVL)2. Value must be 5 characters or less3. Situational4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 2 (CLT.002.060) is not populated
07/10/2025	4.0.13	CLT.002.060	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.060	UPDATE	Coding requirement	1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Conditional4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 1 (CLT.002.059) is not populated	1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3.Situational4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 1 (CLT.002.059) is not populated
07/10/2025	4.0.13	CLT.002.059	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.059	UPDATE	Coding requirement	1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Conditional4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique	1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Situational4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique
07/10/2025	4.0.13	CLT.002.058	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.058	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Situational
07/10/2025	4.0.13	CLT.002.057	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.057	UPDATE	Coding requirement	1. Value must be 15 characters or less2. Value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Conditional	1. Value must be 15 characters or less2. Value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Situational
12/19/2024	4.0.1	CLT.002.056	UPDATE	Definition	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee.	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = â€ś23â€ť to indicate that the sub-capitated network provider provided the service directly to the enrollee.
07/10/2025	4.0.13	CLT.002.054	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.054	UPDATE	Coding requirement	1. Value must be 3 characters or less2. Value must be in Claim Status List (VVL)3. Conditional4. If value in [542,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be "F2"	1. Value must be 3 characters or less2. Value must be in Claim Status List (VVL)3. Situational4. If value in [542,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be "F2"
12/19/2024	4.0.1	CLT.002.053	UPDATE	Coding requirement	1. Value must be 4 characters2. Value must be in Type of Bill List (VVL)3. First character must be a "0"4. Mandatory	1. Value must be 4 characters2. First character value must be a "0"3. Second character value must be in Type of Bill 2 Facility Type List (VVL)4. Third character value must be in Type of Bill 3 Classification Clinics List (VVL)5. Fourth character value must be in Type of Bill 4 Frequency List (VVL)6. Mandatory
12/19/2024	4.0.1	CLT.002.052	UPDATE	Definition	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record.	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or â€śCâ€ť for an S-CHIP sub-capitated encounter record.
02/27/2025	4.0.3	CLT.002.050	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (CIP.001.010)3. Mandatory4. Value should be on or after associated Admission Date value	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (CLT.001.010)3. Mandatory4. Value should be on or after associated Admission Date value
07/10/2025	4.0.13	CLT.002.047	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.047	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Hour List (VVL)3. Conditional4. When populated, Discharge Date (CLT.002.046) must be populated	1. Value must be 2 characters2. Value must be in Hour List (VVL)3. Situational4. When populated, Discharge Date (CLT.002.046) must be populated
07/10/2025	4.0.13	CLT.002.046	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.046	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be less than or equal to associated Adjudication Date value.3. Value must be greater than or equal to associated Admission Date value.4. Value must be greater than or equal to associated eligible Date of Birth value.5. Value must be less than or equal to associated eligible Date of Death value.6. Conditional7. When populated, Discharge Hour (CLT.002.047) must be populated	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be less than or equal to associated Adjudication Date value.3. Value must be greater than or equal to associated Admission Date value.4. Value must be greater than or equal to associated eligible Date of Birth value.5. Value must be less than or equal to associated eligible Date of Death value.6. Situational7. When populated, Discharge Hour (CLT.002.047) must be populated
07/10/2025	4.0.13	CLT.002.045	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.045	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Hour List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Hour List (VVL)3. Situational
12/19/2024	4.0.1	CLT.002.025	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Adjustment Indicator List (VVL)3. Value must be in [0,1,4]4. Mandatory5. If value equals "0", then associated Adjustment ICN must not be populated6. Value must equal "1", when associated Claim Status equals "686"7. Value must match the adjustment indicator in the header (CIP.002.026)	1. Value must be 1 character2. Value must be in Adjustment Indicator List (VVL)3. Value must be in [0,1,4]4. Mandatory5. If value equals "0", then associated Adjustment ICN must not be populated6. Value must equal "1", when associated Claim Status equals "686"
07/10/2025	4.0.13	CLT.002.024	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.002.024	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in 1115A Demonstration Indicator List (VVL)3. Conditional4. When value equals "0", is invalid or not populated, then the associated 1115A Demonstration Indicator (ELG.018.233) must equal "0", is invalid or not populated	1. Value must be 1 character2. Value must be in 1115A Demonstration Indicator List (VVL)3. Situational4. When value equals "0", is invalid or not populated, then the associated 1115A Demonstration Indicator (ELG.018.233) must equal "0", is invalid or not populated
05/07/2025	4.0.8	CLT.002.022	UPDATE	Coding requirement	1. Mandatory2. Value must be 20 characters or less.3. The Beginning Date of Service on the claim must fall between (ELG.021.253) enrollment effective and (ELG.021.253) end date	1. Mandatory2. Value must be 20 characters or less.3. The Beginning Date of Service on the claim must fall between (ELG.021.253) enrollment effective and (ELG.021.253) end date4. Value must not contain Ampersand symbol
01/16/2025	4.0.2	CLT.002.020	UPDATE	Coding requirement	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated
05/07/2025	4.0.8	CLT.001.227	UPDATE	Coding requirement	1. Value must be 4 characters or less2. Value must between 1 and 99993. Value must be equal to the largest of any prior values for the same reporting period and file type, plus 1 (i.e. incremented by 1)4. Value must not contain a pipe symbol5. Mandatory	1. Value must be 4 characters or less2. Value must be between 1 and 99993. Value must be equal to the largest of any prior values for the same reporting period and file type, plus 1 (i.e. incremented by 1)4. Value must not contain a pipe symbol5. Mandatory
07/10/2025	4.0.13	CIP.003.288	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.003.288	UPDATE	Coding requirement	1. Value must be 18 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional	1. Value must be 18 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
02/27/2025	4.0.3	CIP.003.286	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (CRX.001.010)3. Mandatory4. Value should be on or after associated Admission Date value	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (CIP.001.010)3. Mandatory4. Value should be on or after associated Admission Date value
07/10/2025	4.0.13	CIP.003.285	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.003.285	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in NDC Unit of Measure List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in NDC Unit of Measure List (VVL)3. Situational
07/10/2025	4.0.13	CIP.003.284	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.003.284	UPDATE	Coding requirement	1. Value must be 12 digits or less2. Value must be a valid National Drug Code3. Conditional	1. Value must be 12 digits or less2. Value must be a valid National Drug Code3. Situational
07/10/2025	4.0.13	CIP.003.278	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.003.278	UPDATE	Coding requirement	1. Value may include up to 9 digits to the left of the decimal point, and 9 digits to the right e.g. 123456789.1234567892. Conditional	1. Value may include up to 9 digits to the left of the decimal point, and 9 digits to the right e.g. 123456789.1234567892. Situational
07/10/2025	4.0.13	CIP.003.272	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.003.272	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CIP.003.264	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.003.264	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Provider Specialty List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Provider Specialty List (VVL)3. Situational
07/10/2025	4.0.13	CIP.003.263	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.003.263	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Provider Type Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Provider Type Code List (VVL)3. Situational
05/07/2025	4.0.8	CIP.003.261	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. NPPES Entity Type Code associate with this NPI must equal ‘1’ (Individual)
12/19/2024	4.0.1	CIP.003.257	UPDATE	Coding requirement	1. Value must be 3 characters2. Mandatory3. Value must be in Type of Service IP List (VVL)4. If Sex (ELG.002.023) equals "M", then value must not equal "086"	1. Value must be 3 characters2. Mandatory3. Value must be in Type of Service IP List (VVL)
07/10/2025	4.0.13	CIP.003.256	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.003.256	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Billing Unit List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Billing Unit List (VVL)3. Situational
07/10/2025	4.0.13	CIP.003.250	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.003.250	UPDATE	Coding requirement	1. Value must be numeric2. Value may include up to 6 digits to the left of the decimal point, and 3 digits to the right, e.g. 123456.7893. Conditional	1. Value must be numeric2. Value may include up to 6 digits to the left of the decimal point, and 3 digits to the right, e.g. 123456.7893. Situational
07/10/2025	4.0.13	CIP.003.242	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.003.242	UPDATE	Coding requirement	1. Value must be 3 characters or less2. Value must be in Claim Status List (VVL)3. Conditional4. If value in [545,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be"F2"	1. Value must be 3 characters or less2. Value must be in Claim Status List (VVL)3. Situational4. If value in [545,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be"F2"
07/10/2025	4.0.13	CIP.002.295	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.295	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CIP.002.294	UPDATE	Necessity	Conditional	SItuational
07/10/2025	4.0.13	CIP.002.294	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CIP.002.293	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.293	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CIP.002.292	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.292	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CIP.002.228	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.228	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0", then the value must not be populated4. Conditional5. If value is populated, Crossover Indicator must be equal to "1"	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0", then the value must not be populated4. Situational5. If value is populated, Crossover Indicator must be equal to "1"
07/10/2025	4.0.13	CIP.002.223	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.223	UPDATE	Coding requirement	1. Value must be 12 characters or less2. Value must be in Provider Taxonomy List (VVL)3. Conditional	1. Value must be 12 characters or less2. Value must be in Provider Taxonomy List (VVL)3. Situational
02/27/2025	4.0.3	CIP.002.222	UPDATE	Definition	The Medicare Beneficiary Identifier (MBI) is a randomly generated identifier used to identify all Medicare beneficiaries. It replaced the previously-used SSN-based Medicare HIC Number (HICN). To prevent identify theft, among other reasons, HICN gradually were retired and replaced by the MBI over the course of 2018 and 2019. Starting in 2020, the MBI became the primary identifier for Medicare beneficiaries.	The Medicare Beneficiary Identifier (MBI) is a randomly generated identifier used to identify all Medicare beneficiaries. It replaced the previously-used SSN-based Medicare HIC Number (HICN). To prevent identity theft, among other reasons, HICN gradually were retired and replaced by the MBI over the course of 2018 and 2019. Starting in 2020, the MBI became the primary identifier for Medicare beneficiaries.
07/10/2025	4.0.13	CIP.002.221	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.221	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier, where Provider Identifier Type (PRV.005.077) equals "2"3. Value must exist in the NPPES NPI data file4. Conditional	1. Value must be 10 digits2. Value must have an associated Provider Identifier, where Provider Identifier Type (PRV.005.077) equals "2"3. Value must exist in the NPPES NPI data file4. Situational
07/10/2025	4.0.13	CIP.002.220	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.220	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CIP.002.217	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.217	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Third Party Coinsurance Amount3. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Third Party Coinsurance Amount3. Situational
07/10/2025	4.0.13	CIP.002.214	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.214	UPDATE	Coding requirement	1. Value must not contain a pipe or asterisk symbols2. Value must 50 characters or less3. Conditional	1. Value must not contain a pipe or asterisk symbols2. Value must 50 characters or less3. Situational
07/10/2025	4.0.13	CIP.002.211	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.211	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Deductible Amount3. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Deductible Amount3. Situational
07/10/2025	4.0.13	CIP.002.210	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.210	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CIP.002.209	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.209	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Copayment Amount3. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Copayment Amount3. Situational
07/10/2025	4.0.13	CIP.002.208	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.208	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CIP.002.207	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.207	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Coinsurance Amount3. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Coinsurance Amount3. Situational
07/10/2025	4.0.13	CIP.002.206	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.206	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CIP.002.204	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.204	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Border State Indicator List (VVL)3. Conditional	1. Value must be 1 character2. Value must be in Border State Indicator List (VVL)3. Situational
07/10/2025	4.0.13	CIP.002.203	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.203	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Split Claim Indicator List (VVL)3. Conditional	1. Value must be 1 character2. Value must be in Split Claim Indicator List (VVL)3. Situational
06/19/2025	4.0.11	CIP.002.196	UPDATE	Coding requirement	1. Value must be 12 characters or less2. Conditional3. Value must not contain a pipe or asterisk symbols4. (Not Dual Eligible) if Dual Eligible Code (ELG.DE.085) value equals "00", then value must not be populated5. Value must be populated when Crossover Indicator (CIP.002.023) equals "1" and Medicare Beneficiary Identifier (CIP.002.222) is not populated	1. Value must be 12 characters or less2. Conditional3. Value must not contain a pipe or asterisk symbols4. If Dual Eligible Code (ELG.DE.085) value is "00" (Not Dual Eligible), then value must not be populated.5. Value must be populated when Crossover Indicator (CIP.002.023) equals "1" and Medicare Beneficiary Identifier (CIP.002.222) is not populated
07/10/2025	4.0.13	CIP.002.195	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.195	UPDATE	Coding requirement	1. Value may include up to 3 digits to the left of the decimal point, and 5 digits to the right e.g. 123.456782. Conditional3. When populated value must be zero or greater	1. Value may include up to 3 digits to the left of the decimal point, and 5 digits to the right e.g. 123.456782. Situational3. When populated value must be zero or greater
07/10/2025	4.0.13	CIP.002.194	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.194	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Value must be populated when Outlier Code (CIP.002.197) is in [01,02,10]4. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Value must be populated when Outlier Code (CIP.002.197) is in [01,02,10]4. Situational
07/10/2025	4.0.13	CIP.002.190	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.190	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Situational
07/10/2025	4.0.13	CIP.002.189	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.189	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Conditional	1. Value must be 30 characters or less2. Situational
12/19/2024	4.0.1	CIP.002.188	UPDATE	Coding requirement	1. Value must be 12 characters or less2. Value must be in Provider Taxonomy List (VVL)3. Conditional	1. Value must be 12 characters or less2. Value must be in Provider Type Code List (VVL)3. Conditional
07/10/2025	4.0.13	CIP.002.187	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.187	UPDATE	Coding requirement	1. Value must be 12 characters or less2. Value must be in Provider Taxonomy List (VVL)3. Conditional	1. Value must be 12 characters or less2. Value must be in Provider Taxonomy List (VVL)3. Situational
07/10/2025	4.0.13	CIP.002.186	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.186	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Provider Specialty List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Provider Specialty List (VVL)3. Situational
07/10/2025	4.0.13	CIP.002.185	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.185	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Conditional	1. Value must be 30 characters or less2. Situational
07/10/2025	4.0.13	CIP.002.184	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.184	UPDATE	Coding requirement	1. Value must be 10 digits2. Conditional3. Value must have an associated Provider Identifier Type equal to "2"4. Value must exist in the NPPES NPI File	1. Value must be 10 digits2. Situational3. Value must have an associated Provider Identifier Type equal to "2"4. Value must exist in the NPPES NPI File
07/10/2025	4.0.13	CIP.002.183	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.183	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Provider Specialty List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Provider Specialty List (VVL)3. Situational
07/10/2025	4.0.13	CIP.002.182	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.182	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Provider Type Code List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Provider Type Code List (VVL)3. Situational
07/10/2025	4.0.13	CIP.002.181	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.181	UPDATE	Coding requirement	1. Value must be 12 characters or less2. Value must be in Provider Taxonomy List (VVL)3. Conditional	1. Value must be 12 characters or less2. Value must be in Provider Taxonomy List (VVL)3. Situational
07/10/2025	4.0.13	CIP.002.180	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.180	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization)	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Situational5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization)
07/10/2025	4.0.13	CIP.002.179	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.179	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in [3,C,W] then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in [3,C,W] then value may match (PRV.005.081) Provider Identifier where the Provider Identifier Type (PRV.005.077) equals "1"5. Discharge Date (CIP.002.096) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or6. Discharge Date (CIP.002.096) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080)	1. Value must be 30 characters or less2. Situational3. When Type of Claim not in [3,C,W] then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in [3,C,W] then value may match (PRV.005.081) Provider Identifier where the Provider Identifier Type (PRV.005.077) equals "1"5. Discharge Date (CIP.002.096) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or6. Discharge Date (CIP.002.096) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080)
05/29/2025	4.0.9	CIP.002.178	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional
07/10/2025	4.0.13	CIP.002.177	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.177	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period (by date of service)4. Value must have a corresponding value in Waiver ID (CIP.002.178)5. Conditional	1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period (by date of service)4. Value must have a corresponding value in Waiver ID (CIP.002.178)5. Situational
07/10/2025	4.0.13	CIP.002.176	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.176	UPDATE	Coding requirement	1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. If there is an associated Health Home Entity Name value, then value must be "1"4. Conditional	1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. If there is an associated Health Home Entity Name value, then value must be "1"4. Situational
07/10/2025	4.0.13	CIP.002.174	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.174	UPDATE	Coding requirement	1. Value must be 1 character2. Value must not contain a pipe or asterisk symbols3. Conditional	1. Value must be 1 character2. Value must not contain a pipe or asterisk symbols3. Situational
07/10/2025	4.0.13	CIP.002.173	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.173	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional	1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
07/10/2025	4.0.13	CIP.002.172	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.172	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional	1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
07/10/2025	4.0.13	CIP.002.171	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.171	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must not contain a pipe or asterisk symbol3. Conditional	1. Value must be 20 characters or less2. Value must not contain a pipe or asterisk symbol3. Situational
07/10/2025	4.0.13	CIP.002.170	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.170	UPDATE	Coding requirement	1. Value must not be greater than 6 digits to the left of the decimal and have no more than 3 digits to the right of the decimal (i.e. 999999.999)2. Conditional	1. Value must not be greater than 6 digits to the left of the decimal and have no more than 3 digits to the right of the decimal (i.e. 999999.999)2. Situational
12/19/2024	4.0.1	CIP.002.169	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional
12/19/2024	4.0.1	CIP.002.168	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional
12/19/2024	4.0.1	CIP.002.167	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional
12/19/2024	4.0.1	CIP.002.166	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional
12/19/2024	4.0.1	CIP.002.165	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional
12/19/2024	4.0.1	CIP.002.164	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional
12/19/2024	4.0.1	CIP.002.163	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional
12/19/2024	4.0.1	CIP.002.162	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional
12/19/2024	4.0.1	CIP.002.161	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional
12/19/2024	4.0.1	CIP.002.160	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional
12/19/2024	4.0.1	CIP.002.159	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date
12/19/2024	4.0.1	CIP.002.158	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date
12/19/2024	4.0.1	CIP.002.157	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date
12/19/2024	4.0.1	CIP.002.156	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date
12/19/2024	4.0.1	CIP.002.155	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date
07/10/2025	4.0.13	CIP.002.154	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.154	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be less than or equal to Occurrence Code End Date
12/19/2024	4.0.1	CIP.002.153	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date
07/10/2025	4.0.13	CIP.002.152	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.152	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be less than or equal to Occurrence Code End Date
12/19/2024	4.0.1	CIP.002.151	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date
12/19/2024	4.0.1	CIP.002.150	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date	1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date
02/27/2025	4.0.3	CIP.002.149	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	4.0.3	CIP.002.148	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	4.0.3	CIP.002.147	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	4.0.3	CIP.002.146	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	4.0.3	CIP.002.145	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	4.0.3	CIP.002.144	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	4.0.3	CIP.002.143	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	4.0.3	CIP.002.142	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	4.0.3	CIP.002.141	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	4.0.3	CIP.002.140	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
07/10/2025	4.0.13	CIP.002.138	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.138	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Forced Claim Indicator List (VVL)3. Conditional	1. Value must be 1 character2. Value must be in Forced Claim Indicator List (VVL)3. Situational
07/10/2025	4.0.13	CIP.002.135	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.135	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CIP.002.134	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.134	UPDATE	Coding requirement	1. Value must be 5 digits or less2. Conditional	1. Value must be 5 digits or less2. Situational
12/19/2024	4.0.1	CIP.002.132	UPDATE	Definition	The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.	The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim linesâ€™ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.
07/10/2025	4.0.13	CIP.002.128	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.128	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Medicare Combined Deductible Indicator List (VVL)3. If value equals "1", then Total Medicare Coinsurance amount must not be populated4. If value equals "0", then Crossover Indicator must equal "0"5. If value equals "1", then Crossover Indicator must equal "1"6. Conditional	1. Value must be 1 character2. Value must be in Medicare Combined Deductible Indicator List (VVL)3. If value equals "1", then Total Medicare Coinsurance amount must not be populated4. If value equals "0", then Crossover Indicator must equal "0"5. If value equals "1", then Crossover Indicator must equal "1"6. Situational
04/24/2025	4.0.7	CIP.002.127	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Funding Source Non-Federal Share List (VVL)3. If Type of Claim is in [3,C,W], then value must be populated4. Conditional	1. Value must be 2 characters2. Value must be in Funding Source Non-Federal Share List (VVL)3. If Type of Claim is not in [3,C,W], then value must be populated4. Conditional
07/10/2025	4.0.13	CIP.002.125	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.125	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Fixed Payment Indicator List (VVL)3. Conditional	1. Value must be 1 character2. Value must be in Fixed Payment Indicator List (VVL)3. Situational
02/27/2025	4.0.3	CIP.002.121	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Other Insurance Indicator List (VVL)3. Value must be in [0,1] or not populated4. Conditional	1. Value must be 1 character2. Value must be in Other Insurance Indicator List (VVL)3. Conditional
07/10/2025	4.0.13	CIP.002.119	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.119	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
07/10/2025	4.0.13	CIP.002.118	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.118	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Value must be less than associated Total Billed Amount - (Total Medicare Coinsurance Amount + Total Medicare Deductible Amount)4. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Value must be less than associated Total Billed Amount - (Total Medicare Coinsurance Amount + Total Medicare Deductible Amount)4. Situational
07/10/2025	4.0.13	CIP.002.117	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.117	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0" (not a crossover claim), then value should not be populated.4. Conditional5. If associated Medicare Combined Deductible Indicator equals "1", then value must not be populated6. When populated, value must be less than or equal to Total Billed Amount	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0" (not a crossover claim), then value should not be populated.4. Situational5. If associated Medicare Combined Deductible Indicator equals "1", then value must not be populated6. When populated, value must be less than or equal to Total Billed Amount
06/19/2025	4.0.11	CIP.002.116	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0" (not a crossover claim), then value should not be populated4. (Medicare Enrolled) if associated Dual Eligible Code (ELG.005.085) value is in [01,02,03,04,05,06,08,09,10], then value is mandatory and must be provided5. Conditional6. When populated, value must be less than or equal to Total Billed Amount	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0" (not a crossover claim), then value should not be populated4. If associated Dual Eligible Code (ELG.005.085) value is in [01,02,03,04,05,06,08,09,10] (Medicare Enrolled), then value is mandatory and must be provided5. Conditional6. When populated, value must be less than or equal to Total Billed Amount
07/10/2025	4.0.13	CIP.002.111	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.111	UPDATE	Coding requirement	1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Conditional4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 3 (CIP.002.110) is not populated	1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Situational4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 3 (CIP.002.110) is not populated
07/10/2025	4.0.13	CIP.002.110	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.110	UPDATE	Coding requirement	1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Conditional4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 2 (CIP.002.109) is not populated	1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Situational4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 2 (CIP.002.109) is not populated
07/10/2025	4.0.13	CIP.002.109	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.109	UPDATE	Coding requirement	1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Conditional4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 1 (CIP.002.108) is not populated	1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Situational4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 1 (CIP.002.108) is not populated
07/10/2025	4.0.13	CIP.002.108	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.108	UPDATE	Coding requirement	1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Conditional4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique	1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Situational4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique
07/10/2025	4.0.13	CIP.002.106	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.106	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Situational
07/10/2025	4.0.13	CIP.002.105	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.105	UPDATE	Coding requirement	1. Value must be 15 characters or less2. Value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Conditional	1. Value must be 15 characters or less2. Value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Situational
12/19/2024	4.0.1	CIP.002.104	UPDATE	Definition	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee.	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = â€ś23â€ť to indicate that the sub-capitated network provider provided the service directly to the enrollee.
07/10/2025	4.0.13	CIP.002.102	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.102	UPDATE	Coding requirement	1. Value must be 3 characters or less2. Value must be in Claim Status List (VVL)3. Conditional4. If value in [542,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be "F2"	1. Value must be 3 characters or less2. Value must be in Claim Status List (VVL)3. Situational4. If value in [542,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be "F2"
12/19/2024	4.0.1	CIP.002.101	UPDATE	Coding requirement	1. Value must be 4 characters2. Value must be in Type of Bill List (VVL)3. First character must be a "0"4. Mandatory	1. Value must be 4 characters2. First character value must be a "0"3. Second character value must be in Type of Bill 2 Facility Type List (VVL)4. Third character value must be in Type of Bill 3 Classification Clinics List (VVL)5. Fourth character value must be in Type of Bill 4 Frequency List (VVL)6. Mandatory
12/19/2024	4.0.1	CIP.002.100	UPDATE	Definition	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = "3" for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record.	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = "3" for a Medicaid sub-capitated encounter record or â€śCâ€ť for an S-CHIP sub-capitated encounter record.
07/10/2025	4.0.13	CIP.002.097	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.097	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Hour List (VVL)3. Conditional4. When populated, Discharge Date (CIP.002.096) must be populated	1. Value must be 2 characters2. Value must be in Hour List (VVL)3. Situational4. When populated, Discharge Date (CIP.002.096) must be populated
07/10/2025	4.0.13	CIP.002.095	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.095	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Hour List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Hour List (VVL)3. Situational
07/10/2025	4.0.13	CIP.002.093	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.093	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before associated Discharge Date value3. Value must be provided with an associated Procedure Code value4. Value must be on or after associated Beginning Date of Service value5. Value must be on or before associated Eligible Date of Death value6. Value must be not be populated when associated Procedure Code is not populated7. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before associated Discharge Date value3. Value must be provided with an associated Procedure Code value4. Value must be on or after associated Beginning Date of Service value5. Value must be on or before associated Eligible Date of Death value6. Value must be not be populated when associated Procedure Code is not populated7. Situational
07/10/2025	4.0.13	CIP.002.092	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.092	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Procedure Code Flag List (VVL)3. Conditional4. When populated, there must be a corresponding Procedure Code	1. Value must be 2 characters2. Value must be in Procedure Code Flag List (VVL)3. Situational4. When populated, there must be a corresponding Procedure Code
07/10/2025	4.0.13	CIP.002.090	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.090	UPDATE	Coding requirement	1. Value must be 8 characters or less2. When populated, there must be a corresponding Procedure Code Flag3. If associated Procedure Code Flag value indicates an ICD-9-CM encoding "02", then value must be a valid ICD-9-CM procedure code4. If associated Procedure Code Flag value indicates an ICD-10-CM encoding "07", then value must be a valid ICD-10-CM procedure code5. If associated Procedure Code Flag value indicates an "Other" encoding "10-87", then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code6. Value must be in Procedure Code List (VVL)7. Conditional	1. Value must be 8 characters or less2. When populated, there must be a corresponding Procedure Code Flag3. If associated Procedure Code Flag value indicates an ICD-9-CM encoding "02", then value must be a valid ICD-9-CM procedure code4. If associated Procedure Code Flag value indicates an ICD-10-CM encoding "07", then value must be a valid ICD-10-CM procedure code5. If associated Procedure Code Flag value indicates an "Other" encoding "10-87", then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code6. Value must be in Procedure Code List (VVL)7. Situational
07/10/2025	4.0.13	CIP.002.089	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.089	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before associated Discharge Date value3. Value must be provided with an associated Procedure Code value4. Value must be on or after associated Beginning Date of Service value5. Value must be on or before associated Eligible Date of Death value6. Value must be not be populated when associated Procedure Code is not populated7. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before associated Discharge Date value3. Value must be provided with an associated Procedure Code value4. Value must be on or after associated Beginning Date of Service value5. Value must be on or before associated Eligible Date of Death value6. Value must be not be populated when associated Procedure Code is not populated7. Situational
07/10/2025	4.0.13	CIP.002.088	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.088	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Procedure Code Flag List (VVL)3. Conditional4. When populated, there must be a corresponding Procedure Code	1. Value must be 2 characters2. Value must be in Procedure Code Flag List (VVL)3. Situational4. When populated, there must be a corresponding Procedure Code
07/10/2025	4.0.13	CIP.002.086	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.086	UPDATE	Coding requirement	1. Value must be 8 characters or less2. When populated, there must be a corresponding Procedure Code Flag3. If associated Procedure Code Flag value indicates an ICD-9-CM encoding "02", then value must be a valid ICD-9-CM procedure code4. If associated Procedure Code Flag value indicates an ICD-10-CM encoding "07", then value must be a valid ICD-10-CM procedure code5. If associated Procedure Code Flag value indicates an "Other" encoding "10-87", then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code6. Value must be in Procedure Code List (VVL)7. Conditional	1. Value must be 8 characters or less2. When populated, there must be a corresponding Procedure Code Flag3. If associated Procedure Code Flag value indicates an ICD-9-CM encoding "02", then value must be a valid ICD-9-CM procedure code4. If associated Procedure Code Flag value indicates an ICD-10-CM encoding "07", then value must be a valid ICD-10-CM procedure code5. If associated Procedure Code Flag value indicates an "Other" encoding "10-87", then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code6. Value must be in Procedure Code List (VVL)7. Situational
07/10/2025	4.0.13	CIP.002.085	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.085	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before associated Discharge Date value3. Value must be provided with an associated Procedure Code value4. Value must be on or after associated Beginning Date of Service value5. Value must be on or before associated Eligible Date of Death value6. Value must be not be populated when associated Procedure Code is not populated7. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before associated Discharge Date value3. Value must be provided with an associated Procedure Code value4. Value must be on or after associated Beginning Date of Service value5. Value must be on or before associated Eligible Date of Death value6. Value must be not be populated when associated Procedure Code is not populated7. Situational
07/10/2025	4.0.13	CIP.002.084	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.084	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Procedure Code Flag List (VVL)3. Conditional4. When populated, there must be a corresponding Procedure Code	1. Value must be 2 characters2. Value must be in Procedure Code Flag List (VVL)3. Situational4. When populated, there must be a corresponding Procedure Code
07/10/2025	4.0.13	CIP.002.082	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.082	UPDATE	Coding requirement	1. Value must be 8 characters or less2. When populated, there must be a corresponding Procedure Code Flag3. If associated Procedure Code Flag value indicates an ICD-9-CM encoding "02", then value must be a valid ICD-9-CM procedure code4. If associated Procedure Code Flag value indicates an ICD-10-CM encoding "07", then value must be a valid ICD-10-CM procedure code5. If associated Procedure Code Flag value indicates an "Other" encoding "10-87", then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code6. Value must be in Procedure Code List (VVL)7. Conditional	1. Value must be 8 characters or less2. When populated, there must be a corresponding Procedure Code Flag3. If associated Procedure Code Flag value indicates an ICD-9-CM encoding "02", then value must be a valid ICD-9-CM procedure code4. If associated Procedure Code Flag value indicates an ICD-10-CM encoding "07", then value must be a valid ICD-10-CM procedure code5. If associated Procedure Code Flag value indicates an "Other" encoding "10-87", then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code6. Value must be in Procedure Code List (VVL)7. Situational
07/10/2025	4.0.13	CIP.002.081	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.081	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before associated Discharge Date value3. Value must be provided with an associated Procedure Code value4. Value must be on or after associated Beginning Date of Service value5. Value must be on or before associated Eligible Date of Death value6. Value must be not be populated when associated Procedure Code is not populated7. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before associated Discharge Date value3. Value must be provided with an associated Procedure Code value4. Value must be on or after associated Beginning Date of Service value5. Value must be on or before associated Eligible Date of Death value6. Value must be not be populated when associated Procedure Code is not populated7. Situational
07/10/2025	4.0.13	CIP.002.080	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.080	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Procedure Code Flag List (VVL)3. Conditional4. When populated, there must be a corresponding Procedure Code	1. Value must be 2 characters2. Value must be in Procedure Code Flag List (VVL)3. Situational4. When populated, there must be a corresponding Procedure Code
07/10/2025	4.0.13	CIP.002.078	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.078	UPDATE	Coding requirement	1. Value must be 8 characters or less2. When populated, there must be a corresponding Procedure Code Flag3. If associated Procedure Code Flag value indicates an ICD-9-CM encoding "02", then value must be a valid ICD-9-CM procedure code4. If associated Procedure Code Flag value indicates an ICD-10-CM encoding "07", then value must be a valid ICD-10-CM procedure code5. If associated Procedure Code Flag value indicates an "Other" encoding "10-87", then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code6. Value must be in Procedure Code List (VVL)7. Conditional	1. Value must be 8 characters or less2. When populated, there must be a corresponding Procedure Code Flag3. If associated Procedure Code Flag value indicates an ICD-9-CM encoding "02", then value must be a valid ICD-9-CM procedure code4. If associated Procedure Code Flag value indicates an ICD-10-CM encoding "07", then value must be a valid ICD-10-CM procedure code5. If associated Procedure Code Flag value indicates an "Other" encoding "10-87", then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code6. Value must be in Procedure Code List (VVL)7. Situational
07/10/2025	4.0.13	CIP.002.077	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.077	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before associated Discharge Date value3. Value must be provided with an associated Procedure Code value4. Value must be on or after associated Beginning Date of Service value5. Value must be on or before associated Eligible Date of Death value6. Value must be not be populated when associated Procedure Code is not populated7. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before associated Discharge Date value3. Value must be provided with an associated Procedure Code value4. Value must be on or after associated Beginning Date of Service value5. Value must be on or before associated Eligible Date of Death value6. Value must be not be populated when associated Procedure Code is not populated7. Situational
07/10/2025	4.0.13	CIP.002.076	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.076	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Procedure Code Flag List (VVL)3. Conditional4. When populated, there must be a corresponding Procedure Code	1. Value must be 2 characters2. Value must be in Procedure Code Flag List (VVL)3. Situational4. When populated, there must be a corresponding Procedure Code
07/10/2025	4.0.13	CIP.002.074	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.074	UPDATE	Coding requirement	1. Value must be 8 characters or less2. When populated, there must be a corresponding Procedure Code Flag3. If associated Procedure Code Flag value indicates an ICD-9-CM encoding "02", then value must be a valid ICD-9-CM procedure code4. If associated Procedure Code Flag value indicates an ICD-10-CM encoding "07", then value must be a valid ICD-10-CM procedure code5. If associated Procedure Code Flag value indicates an "Other" encoding "10-87", then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code6. Value must be in Procedure Code List (VVL)7. Conditional	1. Value must be 8 characters or less2. When populated, there must be a corresponding Procedure Code Flag3. If associated Procedure Code Flag value indicates an ICD-9-CM encoding "02", then value must be a valid ICD-9-CM procedure code4. If associated Procedure Code Flag value indicates an ICD-10-CM encoding "07", then value must be a valid ICD-10-CM procedure code5. If associated Procedure Code Flag value indicates an "Other" encoding "10-87", then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code6. Value must be in Procedure Code List (VVL)7. Situational
07/10/2025	4.0.13	CIP.002.073	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.073	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before associated Discharge Date value3. Value must be provided with an associated Procedure Code value4. Value must be on or after associated Beginning Date of Service value5. Value must be on or before associated Eligible Date of Death value6. Value must be not be populated when associated Procedure Code is not populated7. Conditional	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before associated Discharge Date value3. Value must be provided with an associated Procedure Code value4. Value must be on or after associated Beginning Date of Service value5. Value must be on or before associated Eligible Date of Death value6. Value must be not be populated when associated Procedure Code is not populated7. Situational
07/10/2025	4.0.13	CIP.002.072	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.070	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.070	UPDATE	Coding requirement	1. Value must be 8 characters or less2. When populated, there must be a corresponding Procedure Code Flag3. If associated Procedure Code Flag value indicates an ICD-9-CM encoding "02", then value must be a valid ICD-9-CM procedure code4. If associated Procedure Code Flag value indicates an ICD-10-CM encoding "07", then value must be a valid ICD-10-CM procedure code5. If associated Procedure Code Flag value indicates an "Other" encoding "10-87", then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code6. Value must be in Procedure Code List (VVL)7. Conditional	1. Value must be 8 characters or less2. When populated, there must be a corresponding Procedure Code Flag3. If associated Procedure Code Flag value indicates an ICD-9-CM encoding "02", then value must be a valid ICD-9-CM procedure code4. If associated Procedure Code Flag value indicates an ICD-10-CM encoding "07", then value must be a valid ICD-10-CM procedure code5. If associated Procedure Code Flag value indicates an "Other" encoding "10-87", then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code6. Value must be in Procedure Code List (VVL)7. Situational
07/10/2025	4.0.13	CIP.002.068	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.068	UPDATE	Coding requirement	1. Value must be 4 characters or less2. Conditional	1. Value must be 4 characters or less2. Situational
07/10/2025	4.0.13	CIP.002.029	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.029	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Conditional	1. Value must be 20 characters or less2. Situational
07/10/2025	4.0.13	CIP.002.025	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.025	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in 1115A Demonstration Indicator List (VVL)3. Conditional4. When value equals "0", is invalid or not populated, then the associated 1115A Demonstration Indicator (ELG.018.233) must equal "0", is invalid or not populated	1. Value must be 1 character2. Value must be in 1115A Demonstration Indicator List (VVL)3. Situational4. When value equals "0", is invalid or not populated, then the associated 1115A Demonstration Indicator (ELG.018.233) must equal "0", is invalid or not populated
05/07/2025	4.0.8	CIP.002.022	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.021.251) and the Admission Date (CIP.002.094) must be between Enrollment Effective Date (ELG.021.253) and Enrollment End Date (ELG.021.254)	1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.021.251) and the Admission Date (CIP.002.094) must be between Enrollment Effective Date (ELG.021.253) and Enrollment End Date (ELG.021.254)4. Value must not contain Ampersand symbol
01/16/2025	4.0.2	CIP.002.020	UPDATE	Coding requirement	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated
05/07/2025	4.0.8	CIP.001.275	UPDATE	Coding requirement	1. Value must be 4 characters or less2. Value must between 1 and 99993. Value must be equal to the largest of any prior values for the same reporting period and file type, plus 1 (i.e. incremented by 1)4. Value must not contain a pipe symbol5. Mandatory	1. Value must be 4 characters or less2. Value must be between 1 and 99993. Value must be equal to the largest of any prior values for the same reporting period and file type, plus 1 (i.e. incremented by 1)4. Value must not contain a pipe symbol5. Mandatory
11/05/2024	4.0.0	File Segment Layouts	UPDATE	Icon	None	27
12/10/2024	4.0.1	MCR - MANAGED CARE PLAN INFORMATION	UPDATE	Overview	Managed Care File – Managed Care Entity Record Segment Relationships Description Each managed care entity in T-MSIS must have a record in the T-MSIS managed care file. Each managed care record is comprised of up to seven different types of record segments. The MANAGED-CARE-MAIN (MCR00002) segment is the parent segment to five segments: MANAGED-CARE-LOCATION-AND-CONTACT-INFO (MCR00003), MANAGED-CARE-SERVICE-AREA (MCR00004), MANAGED-CARE-OPERATING-AUTHORITY (MCR00005), MANAGED-CARE-PLAN-POPULATION-ENROLLED (MCR00006), MANAGED-CARE-ACCREDITATION-ORGANIZATION (MCR00007) and MANAGED-CARE-PLAN-ID (MCR00010) all of which join to MANAGED-CARE-MAIN and to each other on the following two data elements: 1. SUBMITTING-STATE2. STATE-PLAN-ID-NUM	Managed Care File – Managed Care Entity Record Segment RelationshipsDescriptionEach managed care entity in T-MSIS must have a record in the T-MSIS managed care file. Each managed care record is comprised of up to seven different types of record segments. The MANAGED-CARE-MAIN (MCR00002) segment is the parent segment to five segments: MANAGED-CARE-LOCATION-AND-CONTACT-INFO (MCR00003), MANAGED-CARE-SERVICE-AREA (MCR00004), MANAGED-CARE-OPERATING-AUTHORITY (MCR00005), MANAGED-CARE-PLAN-POPULATION-ENROLLED (MCR00006), MANAGED-CARE-ACCREDITATION-ORGANIZATION (MCR00007) and MANAGED-CARE-PLAN-ID (MCR00010) all of which join to MANAGED-CARE-MAIN and to each other on the following two data elements:SUBMITTING-STATESTATE-PLAN-ID-NUM
10/14/2025	4.0.20	FTX - FINANCIAL TRANSACTION	UPDATE	Overview	Financial Transactions File – FTX Record Segment Relationships Description Unlike the other T-MSIS file types, the Financial Transactions file does not contain relationships among the segments. Each segment in this file represents a different type of financial transaction, except for the “miscellaneous” segment which can represent multiple types of financial transactions. The purpose of the “miscellaneous” segment is to represent financial transactions which are not common across states and/or occur in relatively low volumes within most states, as well as to provide a flexible mechanism for CMS and/or states to add new financial transactions in a much shorter time cycle than would be possible by adding an entirely new segment. The “miscellaneous” segment utilizes a generalized set of data elements and an expandable valid value list to distinguish different types of financial transactions from one another.	Financial Transactions File – FTX Record Segment RelationshipsDescriptionUnlike the other T-MSIS file types, the Financial Transactions file does not contain relationships among the segments. Each segment in this file represents a different type of financial transaction, except for the “miscellaneous” segment which can represent multiple types of financial transactions. The purpose of the “miscellaneous” segment is to represent financial transactions which are not common across states and/or occur in relatively low volumes within most states, as well as to provide a flexible mechanism for CMS and/or states to add new financial transactions in a much shorter time cycle than would be possible by adding an entirely new segment. The “miscellaneous” segment utilizes a generalized set of data elements and an expandable valid value list to distinguish different types of financial transactions from one another. As a reminder, states must not submit denied transactions in the FTX file submission.
02/20/2025	4.0.3	ELG - ELIGIBLE	UPDATE	Overview	Eligible File – Eligible Person Record Segment RelationshipsDescriptionEach eligible person in T-MSIS has a record in the T-MSIS eligibility file. Each of these records is comprised of up to twenty-one different types of record segments. The PRIMARY-DEMOGRAPHICS-ELIGIBILITY (ELG00002) segment is the parent segment and all other segments, except for the HEALTH-HOME-SPA-PROVIDERS (ELG00007) segment, join to it on the following two data elements:1. SUBMITTING-STATE2. MSIS-IDENTIFICATION-NUMThe exception, the HEALTH-HOME-SPA-PROVIDERS (ELG00007) segment, is a child of the HEALTH-HOME-SPA-PARTICIPATION-INFORMATION (ELG00006) segment and joins to it on:1. SUBMITTING-STATE2. MSIS-IDENTIFICATION-NUM3. HEALTH-HOME-SPA-ID4. HEALTH-HOME-ENTITY-NAME	Eligible File – Eligible Person Record Segment RelationshipsDescriptionEach eligible person in T-MSIS has a record in the T-MSIS eligibility file. Each of these records is comprised of up to twenty-one different types of record segments. The PRIMARY-DEMOGRAPHICS-ELIGIBILITY (ELG00002) segment is the parent segment and all other segments, except for the HEALTH-HOME-SPA-PROVIDERS (ELG00007) segment, join to it on the following two data elements:SUBMITTING-STATEMSIS-IDENTIFICATION-NUMThe exception, the HEALTH-HOME-SPA-PROVIDERS (ELG00007) segment, is a child of the HEALTH-HOME-SPA-PARTICIPATION-INFORMATION (ELG00006) segment and joins to it on:SUBMITTING-STATEMSIS-IDENTIFICATION-NUMHEALTH-HOME-SPA-IDHEALTH-HOME-ENTITY-NAME
09/16/2024	4.0.0	TPL - THIRD-PARTY LIABILITY	UPDATE	Overview	Third-Party Liability (TPL) File – TPL Record Segment RelationshipsDescription:Each instance of potential third-party liability for T-MSIS eligibles must have a record in the T-MSIS TPL file. There are two sets of information captured (called “subject areas”) in the TPL file: One set of records captures general information about non-Medicaid, non-Medicare health insurers, while the other set of records captures information about third party sources of funds that individual Medicaid/CHIP eligibles have.TPL Health Insurance Entity Subject AreaTwo types of record segments comprise the “TPL health insurance entity subject area:” the TPL-ENTITY-CONTACT-INFORMATION (TPL00006) and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES (TPL00004) segments. There is a one-to-many relationship between these segment types (one TPL-ENTITY-CONTACT-INFORMATION segment type to many TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES segments). The TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES segment joins to the TPL-ENTITY-CONTACT-INFORMATION segment on two fields:1. SUBMITTING-STATE2. INSURANCE-CARRIER-ID-NUMMedicaid/CHIP Enrollees with TPL Funding Subject AreaThree types of segments make up the “Medicaid/CHIP Enrollees with TPL Funding Subject Area.” The TPL-MEDICAID-ELIGIBLE-PERSON-MAIN(TPL00002) segment type is the parent segment, with TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO (TPL00003) and TPL-MEDICAID-ELIGIBLE-OTHER-THIRD-PARTY-COVERAGE-INFORMATION (TPL00005) being the subordinate segments. The two subordinate segments join to TPL-MEDICAID-ELIGIBLE-PERSON-MAIN (TPL00002) segment on:1. SUBMITTING-STATE2. MSIS-IDENTIFICATION-NUM	Third-Party Liability (TPL) File – TPL Record Segment RelationshipsDescriptionEach instance of potential third-party liability for T-MSIS eligibles must have a record in the T-MSIS TPL file. There are two sets of information captured (called “subject areas”) in the TPL file: One set of records captures general information about non-Medicaid, non-Medicare health insurers, while the other set of records captures information about third party sources of funds that individual Medicaid/CHIP eligibles have.TPL Health Insurance Entity Subject AreaTwo types of record segments comprise the “TPL health insurance entity subject area:” the TPL-ENTITY-CONTACT-INFORMATION (TPL00006) and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES (TPL00004) segments. There is a one-to-many relationship between these segment types (one TPL-ENTITY-CONTACT-INFORMATION segment type to many TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES segments). The TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES segment joins to the TPL-ENTITY-CONTACT-INFORMATION segment on two fields:1. SUBMITTING-STATE2. INSURANCE-CARRIER-ID-NUMMedicaid/CHIP Enrollees with TPL Funding Subject AreaThree types of segments make up the “Medicaid/CHIP Enrollees with TPL Funding Subject Area.” The TPL-MEDICAID-ELIGIBLE-PERSON-MAIN(TPL00002) segment type is the parent segment, with TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO (TPL00003) and TPL-MEDICAID-ELIGIBLE-OTHER-THIRD-PARTY-COVERAGE-INFORMATION (TPL00005) being the subordinate segments. The two subordinate segments join to TPL-MEDICAID-ELIGIBLE-PERSON-MAIN (TPL00002) segment on:1. SUBMITTING-STATE2. MSIS-IDENTIFICATION-NUM
09/16/2024	4.0.0	TPL.006.086	UPDATE	File segment	None	103
09/16/2024	4.0.0	TPL.006.086	ADD	N/A		Created
09/16/2024	4.0.0	TPL.006.091	UPDATE	File segment	None	103
09/16/2024	4.0.0	TPL.006.091	ADD	N/A		Created
09/16/2024	4.0.0	TPL.006.090	UPDATE	File segment	None	103
09/16/2024	4.0.0	TPL.006.090	ADD	N/A		Created
09/16/2024	4.0.0	TPL.006.085	UPDATE	File segment	None	103
09/16/2024	4.0.0	TPL.006.085	ADD	N/A		Created
09/16/2024	4.0.0	TPL.006.084	UPDATE	File segment	None	103
09/16/2024	4.0.0	TPL.006.084	ADD	N/A		Created
09/16/2024	4.0.0	TPL.006.083	UPDATE	File segment	None	103
09/16/2024	4.0.0	TPL.006.083	ADD	N/A		Created
09/16/2024	4.0.0	TPL.006.082	UPDATE	File segment	None	103
09/16/2024	4.0.0	TPL.006.082	ADD	N/A		Created
09/16/2024	4.0.0	TPL.006.081	UPDATE	File segment	None	103
09/16/2024	4.0.0	TPL.006.081	ADD	N/A		Created
09/16/2024	4.0.0	TPL.006.080	UPDATE	File segment	None	103
09/16/2024	4.0.0	TPL.006.080	ADD	N/A		Created
09/16/2024	4.0.0	TPL.006.079	UPDATE	File segment	None	103
09/16/2024	4.0.0	TPL.006.079	ADD	N/A		Created
09/16/2024	4.0.0	TPL.006.078	UPDATE	File segment	None	103
09/16/2024	4.0.0	TPL.006.078	ADD	N/A		Created
09/16/2024	4.0.0	TPL.006.077	UPDATE	File segment	None	103
09/16/2024	4.0.0	TPL.006.077	ADD	N/A		Created
09/16/2024	4.0.0	TPL.006.076	UPDATE	File segment	None	103
09/16/2024	4.0.0	TPL.006.076	ADD	N/A		Created
09/16/2024	4.0.0	TPL.006.075	UPDATE	File segment	None	103
09/16/2024	4.0.0	TPL.006.075	ADD	N/A		Created
09/16/2024	4.0.0	TPL.006.074	UPDATE	File segment	None	103
09/16/2024	4.0.0	TPL.006.074	ADD	N/A		Created
09/16/2024	4.0.0	TPL.006.073	UPDATE	File segment	None	103
09/16/2024	4.0.0	TPL.006.073	ADD	N/A		Created
09/16/2024	4.0.0	TPL.006.072	UPDATE	File segment	None	103
09/16/2024	4.0.0	TPL.006.072	ADD	N/A		Created
09/16/2024	4.0.0	TPL.005.070	UPDATE	File segment	None	102
09/16/2024	4.0.0	TPL.005.070	ADD	N/A		Created
09/16/2024	4.0.0	TPL.005.069	UPDATE	File segment	None	102
09/16/2024	4.0.0	TPL.005.069	ADD	N/A		Created
09/16/2024	4.0.0	TPL.005.068	UPDATE	File segment	None	102
09/16/2024	4.0.0	TPL.005.068	ADD	N/A		Created
09/16/2024	4.0.0	TPL.005.067	UPDATE	File segment	None	102
09/16/2024	4.0.0	TPL.005.067	ADD	N/A		Created
09/16/2024	4.0.0	TPL.005.066	UPDATE	File segment	None	102
09/16/2024	4.0.0	TPL.005.066	ADD	N/A		Created
09/16/2024	4.0.0	TPL.005.065	UPDATE	File segment	None	102
09/16/2024	4.0.0	TPL.005.065	ADD	N/A		Created
09/16/2024	4.0.0	TPL.005.064	UPDATE	File segment	None	102
09/16/2024	4.0.0	TPL.005.064	ADD	N/A		Created
09/16/2024	4.0.0	TPL.005.063	UPDATE	File segment	None	102
09/16/2024	4.0.0	TPL.005.063	ADD	N/A		Created
09/16/2024	4.0.0	TPL.004.061	UPDATE	File segment	None	101
09/16/2024	4.0.0	TPL.004.061	ADD	N/A		Created
09/16/2024	4.0.0	TPL.004.060	UPDATE	File segment	None	101
09/16/2024	4.0.0	TPL.004.060	ADD	N/A		Created
09/16/2024	4.0.0	TPL.004.059	UPDATE	File segment	None	101
09/16/2024	4.0.0	TPL.004.059	ADD	N/A		Created
09/16/2024	4.0.0	TPL.004.058	UPDATE	File segment	None	101
09/16/2024	4.0.0	TPL.004.058	ADD	N/A		Created
09/16/2024	4.0.0	TPL.004.057	UPDATE	File segment	None	101
09/16/2024	4.0.0	TPL.004.057	ADD	N/A		Created
09/16/2024	4.0.0	TPL.004.056	UPDATE	File segment	None	101
09/16/2024	4.0.0	TPL.004.056	ADD	N/A		Created
09/16/2024	4.0.0	TPL.004.055	UPDATE	File segment	None	101
09/16/2024	4.0.0	TPL.004.055	ADD	N/A		Created
09/16/2024	4.0.0	TPL.004.054	UPDATE	File segment	None	101
09/16/2024	4.0.0	TPL.004.054	ADD	N/A		Created
09/16/2024	4.0.0	TPL.004.053	UPDATE	File segment	None	101
09/16/2024	4.0.0	TPL.004.053	ADD	N/A		Created
09/16/2024	4.0.0	TPL.004.052	UPDATE	File segment	None	101
09/16/2024	4.0.0	TPL.004.052	ADD	N/A		Created
09/16/2024	4.0.0	TPL.003.050	UPDATE	File segment	None	100
09/16/2024	4.0.0	TPL.003.050	ADD	N/A		Created
09/16/2024	4.0.0	TPL.003.089	UPDATE	File segment	None	100
09/16/2024	4.0.0	TPL.003.089	ADD	N/A		Created
09/16/2024	4.0.0	TPL.003.049	UPDATE	File segment	None	100
09/16/2024	4.0.0	TPL.003.049	ADD	N/A		Created
09/16/2024	4.0.0	TPL.003.048	UPDATE	File segment	None	100
09/16/2024	4.0.0	TPL.003.048	ADD	N/A		Created
09/16/2024	4.0.0	TPL.003.047	UPDATE	File segment	None	100
09/16/2024	4.0.0	TPL.003.047	ADD	N/A		Created
09/16/2024	4.0.0	TPL.003.046	UPDATE	File segment	None	100
09/16/2024	4.0.0	TPL.003.046	ADD	N/A		Created
09/16/2024	4.0.0	TPL.003.045	UPDATE	File segment	None	100
09/16/2024	4.0.0	TPL.003.045	ADD	N/A		Created
09/16/2024	4.0.0	TPL.003.044	UPDATE	File segment	None	100
09/16/2024	4.0.0	TPL.003.044	ADD	N/A		Created
09/16/2024	4.0.0	TPL.003.038	UPDATE	File segment	None	100
09/16/2024	4.0.0	TPL.003.038	ADD	N/A		Created
09/16/2024	4.0.0	TPL.003.037	UPDATE	File segment	None	100
09/16/2024	4.0.0	TPL.003.037	ADD	N/A		Created
09/16/2024	4.0.0	TPL.003.036	UPDATE	File segment	None	100
09/16/2024	4.0.0	TPL.003.036	ADD	N/A		Created
09/16/2024	4.0.0	TPL.003.035	UPDATE	File segment	None	100
09/16/2024	4.0.0	TPL.003.035	ADD	N/A		Created
09/16/2024	4.0.0	TPL.003.034	UPDATE	File segment	None	100
09/16/2024	4.0.0	TPL.003.034	ADD	N/A		Created
09/16/2024	4.0.0	TPL.003.033	UPDATE	File segment	None	100
09/16/2024	4.0.0	TPL.003.033	ADD	N/A		Created
09/16/2024	4.0.0	TPL.003.032	UPDATE	File segment	None	100
09/16/2024	4.0.0	TPL.003.032	ADD	N/A		Created
09/16/2024	4.0.0	TPL.003.031	UPDATE	File segment	None	100
09/16/2024	4.0.0	TPL.003.031	ADD	N/A		Created
09/16/2024	4.0.0	TPL.003.030	UPDATE	File segment	None	100
09/16/2024	4.0.0	TPL.003.030	ADD	N/A		Created
09/16/2024	4.0.0	TPL.003.029	UPDATE	File segment	None	100
09/16/2024	4.0.0	TPL.003.029	ADD	N/A		Created
09/16/2024	4.0.0	TPL.002.027	UPDATE	File segment	None	99
09/16/2024	4.0.0	TPL.002.027	ADD	N/A		Created
09/16/2024	4.0.0	TPL.002.026	UPDATE	File segment	None	99
09/16/2024	4.0.0	TPL.002.026	ADD	N/A		Created
09/16/2024	4.0.0	TPL.002.025	UPDATE	File segment	None	99
09/16/2024	4.0.0	TPL.002.025	ADD	N/A		Created
09/16/2024	4.0.0	TPL.002.024	UPDATE	File segment	None	99
09/16/2024	4.0.0	TPL.002.024	ADD	N/A		Created
09/16/2024	4.0.0	TPL.002.023	UPDATE	File segment	None	99
09/16/2024	4.0.0	TPL.002.023	ADD	N/A		Created
09/16/2024	4.0.0	TPL.002.022	UPDATE	File segment	None	99
09/16/2024	4.0.0	TPL.002.022	ADD	N/A		Created
09/16/2024	4.0.0	TPL.002.021	UPDATE	File segment	None	99
09/16/2024	4.0.0	TPL.002.021	ADD	N/A		Created
09/16/2024	4.0.0	TPL.002.020	UPDATE	File segment	None	99
09/16/2024	4.0.0	TPL.002.020	ADD	N/A		Created
09/16/2024	4.0.0	TPL.002.019	UPDATE	File segment	None	99
09/16/2024	4.0.0	TPL.002.019	ADD	N/A		Created
09/16/2024	4.0.0	TPL.002.018	UPDATE	File segment	None	99
09/16/2024	4.0.0	TPL.002.018	ADD	N/A		Created
09/16/2024	4.0.0	TPL.002.017	UPDATE	File segment	None	99
09/16/2024	4.0.0	TPL.002.017	ADD	N/A		Created
09/16/2024	4.0.0	TPL.002.016	UPDATE	File segment	None	99
09/16/2024	4.0.0	TPL.002.016	ADD	N/A		Created
09/16/2024	4.0.0	TPL.001.014	UPDATE	File segment	None	98
09/16/2024	4.0.0	TPL.001.014	ADD	N/A		Created
09/16/2024	4.0.0	TPL.001.088	UPDATE	File segment	None	98
09/16/2024	4.0.0	TPL.001.088	ADD	N/A		Created
09/16/2024	4.0.0	TPL.001.095	UPDATE	File segment	None	98
09/16/2024	4.0.0	TPL.001.095	ADD	N/A		Created
09/16/2024	4.0.0	TPL.001.013	UPDATE	File segment	None	98
09/16/2024	4.0.0	TPL.001.013	ADD	N/A		Created
09/16/2024	4.0.0	TPL.001.012	UPDATE	File segment	None	98
09/16/2024	4.0.0	TPL.001.012	ADD	N/A		Created
09/16/2024	4.0.0	TPL.001.011	UPDATE	File segment	None	98
09/16/2024	4.0.0	TPL.001.011	ADD	N/A		Created
09/16/2024	4.0.0	TPL.001.010	UPDATE	File segment	None	98
09/16/2024	4.0.0	TPL.001.010	ADD	N/A		Created
09/16/2024	4.0.0	TPL.001.009	UPDATE	File segment	None	98
09/16/2024	4.0.0	TPL.001.009	ADD	N/A		Created
09/16/2024	4.0.0	TPL.001.008	UPDATE	File segment	None	98
09/16/2024	4.0.0	TPL.001.008	ADD	N/A		Created
09/16/2024	4.0.0	TPL.001.007	UPDATE	File segment	None	98
09/16/2024	4.0.0	TPL.001.007	ADD	N/A		Created
09/16/2024	4.0.0	TPL.001.006	UPDATE	File segment	None	98
09/16/2024	4.0.0	TPL.001.006	ADD	N/A		Created
09/16/2024	4.0.0	TPL.001.005	UPDATE	File segment	None	98
09/16/2024	4.0.0	TPL.001.005	ADD	N/A		Created
09/16/2024	4.0.0	TPL.001.004	UPDATE	File segment	None	98
09/16/2024	4.0.0	TPL.001.004	ADD	N/A		Created
09/16/2024	4.0.0	TPL.001.003	UPDATE	File segment	None	98
09/16/2024	4.0.0	TPL.001.003	ADD	N/A		Created
09/16/2024	4.0.0	TPL.001.002	UPDATE	File segment	None	98
09/16/2024	4.0.0	TPL.001.002	ADD	N/A		Created
09/16/2024	4.0.0	TPL.001.001	UPDATE	File segment	None	98
09/16/2024	4.0.0	TPL.001.001	ADD	N/A		Created
09/16/2024	4.0.0	PRV.010.136	UPDATE	File segment	None	96
09/16/2024	4.0.0	PRV.010.136	ADD	N/A		Created
09/16/2024	4.0.0	PRV.010.135	UPDATE	File segment	None	96
09/16/2024	4.0.0	PRV.010.135	ADD	N/A		Created
09/16/2024	4.0.0	PRV.010.134	UPDATE	File segment	None	96
09/16/2024	4.0.0	PRV.010.134	ADD	N/A		Created
09/16/2024	4.0.0	PRV.010.131	UPDATE	File segment	None	96
09/16/2024	4.0.0	PRV.010.131	ADD	N/A		Created
09/16/2024	4.0.0	PRV.010.130	UPDATE	File segment	None	96
09/16/2024	4.0.0	PRV.010.130	ADD	N/A		Created
09/16/2024	4.0.0	PRV.010.129	UPDATE	File segment	None	96
09/16/2024	4.0.0	PRV.010.129	ADD	N/A		Created
09/16/2024	4.0.0	PRV.010.128	UPDATE	File segment	None	96
09/16/2024	4.0.0	PRV.010.128	ADD	N/A		Created
09/16/2024	4.0.0	PRV.010.127	UPDATE	File segment	None	96
09/16/2024	4.0.0	PRV.010.127	ADD	N/A		Created
09/16/2024	4.0.0	PRV.010.126	UPDATE	File segment	None	96
09/16/2024	4.0.0	PRV.010.126	ADD	N/A		Created
09/16/2024	4.0.0	PRV.010.125	UPDATE	File segment	None	96
09/16/2024	4.0.0	PRV.010.125	ADD	N/A		Created
09/16/2024	4.0.0	PRV.009.123	UPDATE	File segment	None	95
09/16/2024	4.0.0	PRV.009.123	ADD	N/A		Created
09/16/2024	4.0.0	PRV.009.122	UPDATE	File segment	None	95
09/16/2024	4.0.0	PRV.009.122	ADD	N/A		Created
09/16/2024	4.0.0	PRV.009.121	UPDATE	File segment	None	95
09/16/2024	4.0.0	PRV.009.121	ADD	N/A		Created
09/16/2024	4.0.0	PRV.009.120	UPDATE	File segment	None	95
09/16/2024	4.0.0	PRV.009.120	ADD	N/A		Created
09/16/2024	4.0.0	PRV.009.119	UPDATE	File segment	None	95
09/16/2024	4.0.0	PRV.009.119	ADD	N/A		Created
09/16/2024	4.0.0	PRV.009.118	UPDATE	File segment	None	95
09/16/2024	4.0.0	PRV.009.118	ADD	N/A		Created
09/16/2024	4.0.0	PRV.009.117	UPDATE	File segment	None	95
09/16/2024	4.0.0	PRV.009.117	ADD	N/A		Created
09/16/2024	4.0.0	PRV.009.116	UPDATE	File segment	None	95
09/16/2024	4.0.0	PRV.009.116	ADD	N/A		Created
09/16/2024	4.0.0	PRV.009.115	UPDATE	File segment	None	95
09/16/2024	4.0.0	PRV.009.115	ADD	N/A		Created
09/16/2024	4.0.0	PRV.008.113	UPDATE	File segment	None	94
09/16/2024	4.0.0	PRV.008.113	ADD	N/A		Created
09/16/2024	4.0.0	PRV.008.112	UPDATE	File segment	None	94
09/16/2024	4.0.0	PRV.008.112	ADD	N/A		Created
09/16/2024	4.0.0	PRV.008.111	UPDATE	File segment	None	94
09/16/2024	4.0.0	PRV.008.111	ADD	N/A		Created
09/16/2024	4.0.0	PRV.008.110	UPDATE	File segment	None	94
09/16/2024	4.0.0	PRV.008.110	ADD	N/A		Created
09/16/2024	4.0.0	PRV.008.109	UPDATE	File segment	None	94
09/16/2024	4.0.0	PRV.008.109	ADD	N/A		Created
09/16/2024	4.0.0	PRV.008.108	UPDATE	File segment	None	94
09/16/2024	4.0.0	PRV.008.108	ADD	N/A		Created
09/16/2024	4.0.0	PRV.008.107	UPDATE	File segment	None	94
09/16/2024	4.0.0	PRV.008.107	ADD	N/A		Created
09/16/2024	4.0.0	PRV.008.106	UPDATE	File segment	None	94
09/16/2024	4.0.0	PRV.008.106	ADD	N/A		Created
09/16/2024	4.0.0	PRV.007.104	UPDATE	File segment	None	93
09/16/2024	4.0.0	PRV.007.104	ADD	N/A		Created
09/16/2024	4.0.0	PRV.007.103	UPDATE	File segment	None	93
09/16/2024	4.0.0	PRV.007.103	ADD	N/A		Created
09/16/2024	4.0.0	PRV.007.102	UPDATE	File segment	None	93
09/16/2024	4.0.0	PRV.007.102	ADD	N/A		Created
09/16/2024	4.0.0	PRV.007.101	UPDATE	File segment	None	93
09/16/2024	4.0.0	PRV.007.101	ADD	N/A		Created
09/16/2024	4.0.0	PRV.007.100	UPDATE	File segment	None	93
09/16/2024	4.0.0	PRV.007.100	ADD	N/A		Created
09/16/2024	4.0.0	PRV.007.099	UPDATE	File segment	None	93
09/16/2024	4.0.0	PRV.007.099	ADD	N/A		Created
09/16/2024	4.0.0	PRV.007.098	UPDATE	File segment	None	93
09/16/2024	4.0.0	PRV.007.098	ADD	N/A		Created
09/16/2024	4.0.0	PRV.007.097	UPDATE	File segment	None	93
09/16/2024	4.0.0	PRV.007.097	ADD	N/A		Created
09/16/2024	4.0.0	PRV.007.096	UPDATE	File segment	None	93
09/16/2024	4.0.0	PRV.007.096	ADD	N/A		Created
09/16/2024	4.0.0	PRV.007.095	UPDATE	File segment	None	93
09/16/2024	4.0.0	PRV.007.095	ADD	N/A		Created
09/16/2024	4.0.0	PRV.007.094	UPDATE	File segment	None	93
09/16/2024	4.0.0	PRV.007.094	ADD	N/A		Created
09/16/2024	4.0.0	PRV.006.092	UPDATE	File segment	None	92
09/16/2024	4.0.0	PRV.006.092	ADD	N/A		Created
09/16/2024	4.0.0	PRV.006.091	UPDATE	File segment	None	92
09/16/2024	4.0.0	PRV.006.091	ADD	N/A		Created
09/16/2024	4.0.0	PRV.006.090	UPDATE	File segment	None	92
09/16/2024	4.0.0	PRV.006.090	ADD	N/A		Created
09/16/2024	4.0.0	PRV.006.089	UPDATE	File segment	None	92
09/16/2024	4.0.0	PRV.006.089	ADD	N/A		Created
09/16/2024	4.0.0	PRV.006.088	UPDATE	File segment	None	92
09/16/2024	4.0.0	PRV.006.088	ADD	N/A		Created
09/16/2024	4.0.0	PRV.006.087	UPDATE	File segment	None	92
09/16/2024	4.0.0	PRV.006.087	ADD	N/A		Created
09/16/2024	4.0.0	PRV.006.086	UPDATE	File segment	None	92
09/16/2024	4.0.0	PRV.006.086	ADD	N/A		Created
09/16/2024	4.0.0	PRV.006.085	UPDATE	File segment	None	92
09/16/2024	4.0.0	PRV.006.085	ADD	N/A		Created
09/16/2024	4.0.0	PRV.006.084	UPDATE	File segment	None	92
09/16/2024	4.0.0	PRV.006.084	ADD	N/A		Created
09/16/2024	4.0.0	PRV.005.082	UPDATE	File segment	None	91
09/16/2024	4.0.0	PRV.005.082	ADD	N/A		Created
09/16/2024	4.0.0	PRV.005.081	UPDATE	File segment	None	91
09/16/2024	4.0.0	PRV.005.081	ADD	N/A		Created
09/16/2024	4.0.0	PRV.005.080	UPDATE	File segment	None	91
09/16/2024	4.0.0	PRV.005.080	ADD	N/A		Created
09/16/2024	4.0.0	PRV.005.079	UPDATE	File segment	None	91
09/16/2024	4.0.0	PRV.005.079	ADD	N/A		Created
09/16/2024	4.0.0	PRV.005.078	UPDATE	File segment	None	91
09/16/2024	4.0.0	PRV.005.078	ADD	N/A		Created
09/16/2024	4.0.0	PRV.005.077	UPDATE	File segment	None	91
09/16/2024	4.0.0	PRV.005.077	ADD	N/A		Created
09/16/2024	4.0.0	PRV.005.076	UPDATE	File segment	None	91
09/16/2024	4.0.0	PRV.005.076	ADD	N/A		Created
09/16/2024	4.0.0	PRV.005.075	UPDATE	File segment	None	91
09/16/2024	4.0.0	PRV.005.075	ADD	N/A		Created
09/16/2024	4.0.0	PRV.005.074	UPDATE	File segment	None	91
09/16/2024	4.0.0	PRV.005.074	ADD	N/A		Created
09/16/2024	4.0.0	PRV.005.073	UPDATE	File segment	None	91
09/16/2024	4.0.0	PRV.005.073	ADD	N/A		Created
09/16/2024	4.0.0	PRV.005.072	UPDATE	File segment	None	91
09/16/2024	4.0.0	PRV.005.072	ADD	N/A		Created
09/16/2024	4.0.0	PRV.004.070	UPDATE	File segment	None	90
09/16/2024	4.0.0	PRV.004.070	ADD	N/A		Created
09/16/2024	4.0.0	PRV.004.069	UPDATE	File segment	None	90
09/16/2024	4.0.0	PRV.004.069	ADD	N/A		Created
09/16/2024	4.0.0	PRV.004.068	UPDATE	File segment	None	90
09/16/2024	4.0.0	PRV.004.068	ADD	N/A		Created
09/16/2024	4.0.0	PRV.004.067	UPDATE	File segment	None	90
09/16/2024	4.0.0	PRV.004.067	ADD	N/A		Created
09/16/2024	4.0.0	PRV.004.066	UPDATE	File segment	None	90
09/16/2024	4.0.0	PRV.004.066	ADD	N/A		Created
09/16/2024	4.0.0	PRV.004.065	UPDATE	File segment	None	90
09/16/2024	4.0.0	PRV.004.065	ADD	N/A		Created
09/16/2024	4.0.0	PRV.004.064	UPDATE	File segment	None	90
09/16/2024	4.0.0	PRV.004.064	ADD	N/A		Created
09/16/2024	4.0.0	PRV.004.063	UPDATE	File segment	None	90
09/16/2024	4.0.0	PRV.004.063	ADD	N/A		Created
09/16/2024	4.0.0	PRV.004.062	UPDATE	File segment	None	90
09/16/2024	4.0.0	PRV.004.062	ADD	N/A		Created
09/16/2024	4.0.0	PRV.004.061	UPDATE	File segment	None	90
09/16/2024	4.0.0	PRV.004.061	ADD	N/A		Created
09/16/2024	4.0.0	PRV.004.060	UPDATE	File segment	None	90
09/16/2024	4.0.0	PRV.004.060	ADD	N/A		Created
09/16/2024	4.0.0	PRV.003.058	UPDATE	File segment	None	89
09/16/2024	4.0.0	PRV.003.058	ADD	N/A		Created
09/16/2024	4.0.0	PRV.003.057	UPDATE	File segment	None	89
09/16/2024	4.0.0	PRV.003.057	ADD	N/A		Created
09/16/2024	4.0.0	PRV.003.056	UPDATE	File segment	None	89
09/16/2024	4.0.0	PRV.003.056	ADD	N/A		Created
09/16/2024	4.0.0	PRV.003.055	UPDATE	File segment	None	89
09/16/2024	4.0.0	PRV.003.055	ADD	N/A		Created
09/16/2024	4.0.0	PRV.003.054	UPDATE	File segment	None	89
09/16/2024	4.0.0	PRV.003.054	ADD	N/A		Created
09/16/2024	4.0.0	PRV.003.053	UPDATE	File segment	None	89
09/16/2024	4.0.0	PRV.003.053	ADD	N/A		Created
09/16/2024	4.0.0	PRV.003.052	UPDATE	File segment	None	89
09/16/2024	4.0.0	PRV.003.052	ADD	N/A		Created
09/16/2024	4.0.0	PRV.003.051	UPDATE	File segment	None	89
09/16/2024	4.0.0	PRV.003.051	ADD	N/A		Created
09/16/2024	4.0.0	PRV.003.050	UPDATE	File segment	None	89
09/16/2024	4.0.0	PRV.003.050	ADD	N/A		Created
09/16/2024	4.0.0	PRV.003.049	UPDATE	File segment	None	89
09/16/2024	4.0.0	PRV.003.049	ADD	N/A		Created
09/16/2024	4.0.0	PRV.003.048	UPDATE	File segment	None	89
09/16/2024	4.0.0	PRV.003.048	ADD	N/A		Created
09/16/2024	4.0.0	PRV.003.047	UPDATE	File segment	None	89
09/16/2024	4.0.0	PRV.003.047	ADD	N/A		Created
09/16/2024	4.0.0	PRV.003.046	UPDATE	File segment	None	89
09/16/2024	4.0.0	PRV.003.046	ADD	N/A		Created
09/16/2024	4.0.0	PRV.003.045	UPDATE	File segment	None	89
09/16/2024	4.0.0	PRV.003.045	ADD	N/A		Created
09/16/2024	4.0.0	PRV.003.044	UPDATE	File segment	None	89
09/16/2024	4.0.0	PRV.003.044	ADD	N/A		Created
09/16/2024	4.0.0	PRV.003.043	UPDATE	File segment	None	89
09/16/2024	4.0.0	PRV.003.043	ADD	N/A		Created
09/16/2024	4.0.0	PRV.003.042	UPDATE	File segment	None	89
09/16/2024	4.0.0	PRV.003.042	ADD	N/A		Created
09/16/2024	4.0.0	PRV.003.041	UPDATE	File segment	None	89
09/16/2024	4.0.0	PRV.003.041	ADD	N/A		Created
09/16/2024	4.0.0	PRV.003.040	UPDATE	File segment	None	89
09/16/2024	4.0.0	PRV.003.040	ADD	N/A		Created
09/16/2024	4.0.0	PRV.003.039	UPDATE	File segment	None	89
09/16/2024	4.0.0	PRV.003.039	ADD	N/A		Created
09/16/2024	4.0.0	PRV.002.037	UPDATE	File segment	None	88
09/16/2024	4.0.0	PRV.002.037	ADD	N/A		Created
09/16/2024	4.0.0	PRV.002.140	UPDATE	File segment	None	88
09/16/2024	4.0.0	PRV.002.140	ADD	N/A		Created
09/16/2024	4.0.0	PRV.002.036	UPDATE	File segment	None	88
09/16/2024	4.0.0	PRV.002.036	ADD	N/A		Created
09/16/2024	4.0.0	PRV.002.035	UPDATE	File segment	None	88
09/16/2024	4.0.0	PRV.002.035	ADD	N/A		Created
09/16/2024	4.0.0	PRV.002.034	UPDATE	File segment	None	88
09/16/2024	4.0.0	PRV.002.034	ADD	N/A		Created
09/16/2024	4.0.0	PRV.002.033	UPDATE	File segment	None	88
09/16/2024	4.0.0	PRV.002.033	ADD	N/A		Created
09/16/2024	4.0.0	PRV.002.032	UPDATE	File segment	None	88
09/16/2024	4.0.0	PRV.002.032	ADD	N/A		Created
09/16/2024	4.0.0	PRV.002.031	UPDATE	File segment	None	88
09/16/2024	4.0.0	PRV.002.031	ADD	N/A		Created
09/16/2024	4.0.0	PRV.002.030	UPDATE	File segment	None	88
09/16/2024	4.0.0	PRV.002.030	ADD	N/A		Created
09/16/2024	4.0.0	PRV.002.029	UPDATE	File segment	None	88
09/16/2024	4.0.0	PRV.002.029	ADD	N/A		Created
09/16/2024	4.0.0	PRV.002.028	UPDATE	File segment	None	88
09/16/2024	4.0.0	PRV.002.028	ADD	N/A		Created
09/16/2024	4.0.0	PRV.002.027	UPDATE	File segment	None	88
09/16/2024	4.0.0	PRV.002.027	ADD	N/A		Created
09/16/2024	4.0.0	PRV.002.026	UPDATE	File segment	None	88
09/16/2024	4.0.0	PRV.002.026	ADD	N/A		Created
09/16/2024	4.0.0	PRV.002.025	UPDATE	File segment	None	88
09/16/2024	4.0.0	PRV.002.025	ADD	N/A		Created
09/16/2024	4.0.0	PRV.002.024	UPDATE	File segment	None	88
09/16/2024	4.0.0	PRV.002.024	ADD	N/A		Created
09/16/2024	4.0.0	PRV.002.023	UPDATE	File segment	None	88
09/16/2024	4.0.0	PRV.002.023	ADD	N/A		Created
09/16/2024	4.0.0	PRV.002.022	UPDATE	File segment	None	88
09/16/2024	4.0.0	PRV.002.022	ADD	N/A		Created
09/16/2024	4.0.0	PRV.002.021	UPDATE	File segment	None	88
09/16/2024	4.0.0	PRV.002.021	ADD	N/A		Created
09/16/2024	4.0.0	PRV.002.020	UPDATE	File segment	None	88
09/16/2024	4.0.0	PRV.002.020	ADD	N/A		Created
09/16/2024	4.0.0	PRV.002.019	UPDATE	File segment	None	88
09/16/2024	4.0.0	PRV.002.019	ADD	N/A		Created
09/16/2024	4.0.0	PRV.002.018	UPDATE	File segment	None	88
09/16/2024	4.0.0	PRV.002.018	ADD	N/A		Created
09/16/2024	4.0.0	PRV.002.017	UPDATE	File segment	None	88
09/16/2024	4.0.0	PRV.002.017	ADD	N/A		Created
09/16/2024	4.0.0	PRV.002.016	UPDATE	File segment	None	88
09/16/2024	4.0.0	PRV.002.016	ADD	N/A		Created
09/16/2024	4.0.0	PRV.001.014	UPDATE	File segment	None	87
09/16/2024	4.0.0	PRV.001.014	ADD	N/A		Created
09/16/2024	4.0.0	PRV.001.138	UPDATE	File segment	None	87
09/16/2024	4.0.0	PRV.001.138	ADD	N/A		Created
09/16/2024	4.0.0	PRV.001.139	UPDATE	File segment	None	87
09/16/2024	4.0.0	PRV.001.139	ADD	N/A		Created
09/16/2024	4.0.0	PRV.001.013	UPDATE	File segment	None	87
09/16/2024	4.0.0	PRV.001.013	ADD	N/A		Created
09/16/2024	4.0.0	PRV.001.011	UPDATE	File segment	None	87
09/16/2024	4.0.0	PRV.001.011	ADD	N/A		Created
09/16/2024	4.0.0	PRV.001.010	UPDATE	File segment	None	87
09/16/2024	4.0.0	PRV.001.010	ADD	N/A		Created
09/16/2024	4.0.0	PRV.001.009	UPDATE	File segment	None	87
09/16/2024	4.0.0	PRV.001.009	ADD	N/A		Created
09/16/2024	4.0.0	PRV.001.008	UPDATE	File segment	None	87
09/16/2024	4.0.0	PRV.001.008	ADD	N/A		Created
09/16/2024	4.0.0	PRV.001.007	UPDATE	File segment	None	87
09/16/2024	4.0.0	PRV.001.007	ADD	N/A		Created
09/16/2024	4.0.0	PRV.001.006	UPDATE	File segment	None	87
09/16/2024	4.0.0	PRV.001.006	ADD	N/A		Created
09/16/2024	4.0.0	PRV.001.005	UPDATE	File segment	None	87
09/16/2024	4.0.0	PRV.001.005	ADD	N/A		Created
09/16/2024	4.0.0	PRV.001.004	UPDATE	File segment	None	87
09/16/2024	4.0.0	PRV.001.004	ADD	N/A		Created
09/16/2024	4.0.0	PRV.001.003	UPDATE	File segment	None	87
09/16/2024	4.0.0	PRV.001.003	ADD	N/A		Created
09/16/2024	4.0.0	PRV.001.002	UPDATE	File segment	None	87
09/16/2024	4.0.0	PRV.001.002	ADD	N/A		Created
09/16/2024	4.0.0	PRV.001.001	UPDATE	File segment	None	87
09/16/2024	4.0.0	PRV.001.001	ADD	N/A		Created
09/16/2024	4.0.0	MCR.010.122	UPDATE	File segment	None	85
09/16/2024	4.0.0	MCR.010.122	ADD	N/A		Created
12/19/2024	4.0.1	MCR.010.121	UPDATE	Definition	The date when organization's accreditation ends.	The last calendar day on which all of the other data elements in the same segment were effective.
09/16/2024	4.0.0	MCR.010.121	UPDATE	File segment	None	85
09/16/2024	4.0.0	MCR.010.121	ADD	N/A		Created
12/19/2024	4.0.1	MCR.010.120	UPDATE	Definition	The date the organization achieved accreditation.	The first calendar day on which all of the other data elements in the same segment were effective.
09/16/2024	4.0.0	MCR.010.120	UPDATE	File segment	None	85
09/16/2024	4.0.0	MCR.010.120	ADD	N/A		Created
12/19/2024	4.0.1	MCR.010.119	UPDATE	Coding requirement	1. Value must be 30 characters2. Value must not contain a pipe or asterisk symbol3. Mandatory	1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbol3. Mandatory
09/16/2024	4.0.0	MCR.010.119	UPDATE	File segment	None	85
09/16/2024	4.0.0	MCR.010.119	ADD	N/A		Created
09/16/2024	4.0.0	MCR.010.118	UPDATE	File segment	None	85
09/16/2024	4.0.0	MCR.010.118	ADD	N/A		Created
09/16/2024	4.0.0	MCR.010.117	UPDATE	File segment	None	85
09/16/2024	4.0.0	MCR.010.117	ADD	N/A		Created
09/16/2024	4.0.0	MCR.010.116	UPDATE	File segment	None	85
09/16/2024	4.0.0	MCR.010.116	ADD	N/A		Created
09/16/2024	4.0.0	MCR.010.115	UPDATE	File segment	None	85
09/16/2024	4.0.0	MCR.010.115	ADD	N/A		Created
09/16/2024	4.0.0	MCR.010.114	UPDATE	File segment	None	85
09/16/2024	4.0.0	MCR.010.114	ADD	N/A		Created
09/16/2024	4.0.0	MCR.007.089	UPDATE	File segment	None	84
09/16/2024	4.0.0	MCR.007.089	ADD	N/A		Created
09/16/2024	4.0.0	MCR.007.088	UPDATE	File segment	None	84
09/16/2024	4.0.0	MCR.007.088	ADD	N/A		Created
09/16/2024	4.0.0	MCR.007.087	UPDATE	File segment	None	84
09/16/2024	4.0.0	MCR.007.087	ADD	N/A		Created
09/16/2024	4.0.0	MCR.007.086	UPDATE	File segment	None	84
09/16/2024	4.0.0	MCR.007.086	ADD	N/A		Created
09/16/2024	4.0.0	MCR.007.085	UPDATE	File segment	None	84
09/16/2024	4.0.0	MCR.007.085	ADD	N/A		Created
09/16/2024	4.0.0	MCR.007.084	UPDATE	File segment	None	84
09/16/2024	4.0.0	MCR.007.084	ADD	N/A		Created
09/16/2024	4.0.0	MCR.007.083	UPDATE	File segment	None	84
09/16/2024	4.0.0	MCR.007.083	ADD	N/A		Created
09/16/2024	4.0.0	MCR.007.082	UPDATE	File segment	None	84
09/16/2024	4.0.0	MCR.007.082	ADD	N/A		Created
09/16/2024	4.0.0	MCR.006.080	UPDATE	File segment	None	83
09/16/2024	4.0.0	MCR.006.080	ADD	N/A		Created
09/16/2024	4.0.0	MCR.006.079	UPDATE	File segment	None	83
09/16/2024	4.0.0	MCR.006.079	ADD	N/A		Created
09/16/2024	4.0.0	MCR.006.078	UPDATE	File segment	None	83
09/16/2024	4.0.0	MCR.006.078	ADD	N/A		Created
09/16/2024	4.0.0	MCR.006.077	UPDATE	File segment	None	83
09/16/2024	4.0.0	MCR.006.077	ADD	N/A		Created
09/16/2024	4.0.0	MCR.006.076	UPDATE	File segment	None	83
09/16/2024	4.0.0	MCR.006.076	ADD	N/A		Created
09/16/2024	4.0.0	MCR.006.075	UPDATE	File segment	None	83
09/16/2024	4.0.0	MCR.006.075	ADD	N/A		Created
09/16/2024	4.0.0	MCR.006.074	UPDATE	File segment	None	83
09/16/2024	4.0.0	MCR.006.074	ADD	N/A		Created
09/16/2024	4.0.0	MCR.006.073	UPDATE	File segment	None	83
09/16/2024	4.0.0	MCR.006.073	ADD	N/A		Created
09/16/2024	4.0.0	MCR.005.071	UPDATE	File segment	None	82
09/16/2024	4.0.0	MCR.005.071	ADD	N/A		Created
09/16/2024	4.0.0	MCR.005.070	UPDATE	File segment	None	82
09/16/2024	4.0.0	MCR.005.070	ADD	N/A		Created
09/16/2024	4.0.0	MCR.005.069	UPDATE	File segment	None	82
09/16/2024	4.0.0	MCR.005.069	ADD	N/A		Created
09/16/2024	4.0.0	MCR.005.068	UPDATE	File segment	None	82
09/16/2024	4.0.0	MCR.005.068	ADD	N/A		Created
09/16/2024	4.0.0	MCR.005.067	UPDATE	File segment	None	82
09/16/2024	4.0.0	MCR.005.067	ADD	N/A		Created
09/16/2024	4.0.0	MCR.005.066	UPDATE	File segment	None	82
09/16/2024	4.0.0	MCR.005.066	ADD	N/A		Created
09/16/2024	4.0.0	MCR.005.065	UPDATE	File segment	None	82
09/16/2024	4.0.0	MCR.005.065	ADD	N/A		Created
09/16/2024	4.0.0	MCR.005.064	UPDATE	File segment	None	82
09/16/2024	4.0.0	MCR.005.064	ADD	N/A		Created
09/16/2024	4.0.0	MCR.005.063	UPDATE	File segment	None	82
09/16/2024	4.0.0	MCR.005.063	ADD	N/A		Created
09/16/2024	4.0.0	MCR.004.061	UPDATE	File segment	None	81
09/16/2024	4.0.0	MCR.004.061	ADD	N/A		Created
09/16/2024	4.0.0	MCR.004.060	UPDATE	File segment	None	81
09/16/2024	4.0.0	MCR.004.060	ADD	N/A		Created
09/16/2024	4.0.0	MCR.004.059	UPDATE	File segment	None	81
09/16/2024	4.0.0	MCR.004.059	ADD	N/A		Created
09/16/2024	4.0.0	MCR.004.058	UPDATE	File segment	None	81
09/16/2024	4.0.0	MCR.004.058	ADD	N/A		Created
09/16/2024	4.0.0	MCR.004.057	UPDATE	File segment	None	81
09/16/2024	4.0.0	MCR.004.057	ADD	N/A		Created
09/16/2024	4.0.0	MCR.004.056	UPDATE	File segment	None	81
09/16/2024	4.0.0	MCR.004.056	ADD	N/A		Created
09/16/2024	4.0.0	MCR.004.055	UPDATE	File segment	None	81
09/16/2024	4.0.0	MCR.004.055	ADD	N/A		Created
09/16/2024	4.0.0	MCR.004.054	UPDATE	File segment	None	81
09/16/2024	4.0.0	MCR.004.054	ADD	N/A		Created
09/16/2024	4.0.0	MCR.003.052	UPDATE	File segment	None	80
09/16/2024	4.0.0	MCR.003.052	ADD	N/A		Created
09/16/2024	4.0.0	MCR.003.051	UPDATE	File segment	None	80
09/16/2024	4.0.0	MCR.003.051	ADD	N/A		Created
09/16/2024	4.0.0	MCR.003.050	UPDATE	File segment	None	80
09/16/2024	4.0.0	MCR.003.050	ADD	N/A		Created
09/16/2024	4.0.0	MCR.003.049	UPDATE	File segment	None	80
09/16/2024	4.0.0	MCR.003.049	ADD	N/A		Created
09/16/2024	4.0.0	MCR.003.048	UPDATE	File segment	None	80
09/16/2024	4.0.0	MCR.003.048	ADD	N/A		Created
09/16/2024	4.0.0	MCR.003.047	UPDATE	File segment	None	80
09/16/2024	4.0.0	MCR.003.047	ADD	N/A		Created
09/16/2024	4.0.0	MCR.003.046	UPDATE	File segment	None	80
09/16/2024	4.0.0	MCR.003.046	ADD	N/A		Created
09/16/2024	4.0.0	MCR.003.045	UPDATE	File segment	None	80
09/16/2024	4.0.0	MCR.003.045	ADD	N/A		Created
09/16/2024	4.0.0	MCR.003.044	UPDATE	File segment	None	80
09/16/2024	4.0.0	MCR.003.044	ADD	N/A		Created
09/16/2024	4.0.0	MCR.003.043	UPDATE	File segment	None	80
09/16/2024	4.0.0	MCR.003.043	ADD	N/A		Created
09/16/2024	4.0.0	MCR.003.042	UPDATE	File segment	None	80
09/16/2024	4.0.0	MCR.003.042	ADD	N/A		Created
09/16/2024	4.0.0	MCR.003.041	UPDATE	File segment	None	80
09/16/2024	4.0.0	MCR.003.041	ADD	N/A		Created
09/16/2024	4.0.0	MCR.003.040	UPDATE	File segment	None	80
09/16/2024	4.0.0	MCR.003.040	ADD	N/A		Created
09/16/2024	4.0.0	MCR.003.039	UPDATE	File segment	None	80
09/16/2024	4.0.0	MCR.003.039	ADD	N/A		Created
09/16/2024	4.0.0	MCR.003.038	UPDATE	File segment	None	80
09/16/2024	4.0.0	MCR.003.038	ADD	N/A		Created
09/16/2024	4.0.0	MCR.003.037	UPDATE	File segment	None	80
09/16/2024	4.0.0	MCR.003.037	ADD	N/A		Created
09/16/2024	4.0.0	MCR.003.036	UPDATE	File segment	None	80
09/16/2024	4.0.0	MCR.003.036	ADD	N/A		Created
09/16/2024	4.0.0	MCR.003.035	UPDATE	File segment	None	80
09/16/2024	4.0.0	MCR.003.035	ADD	N/A		Created
09/16/2024	4.0.0	MCR.003.034	UPDATE	File segment	None	80
09/16/2024	4.0.0	MCR.003.034	ADD	N/A		Created
09/16/2024	4.0.0	MCR.002.032	UPDATE	File segment	None	79
09/16/2024	4.0.0	MCR.002.032	ADD	N/A		Created
09/16/2024	4.0.0	MCR.002.031	UPDATE	File segment	None	79
09/16/2024	4.0.0	MCR.002.031	ADD	N/A		Created
09/16/2024	4.0.0	MCR.002.030	UPDATE	File segment	None	79
09/16/2024	4.0.0	MCR.002.030	ADD	N/A		Created
09/16/2024	4.0.0	MCR.002.029	UPDATE	File segment	None	79
09/16/2024	4.0.0	MCR.002.029	ADD	N/A		Created
09/16/2024	4.0.0	MCR.002.028	UPDATE	File segment	None	79
09/16/2024	4.0.0	MCR.002.028	ADD	N/A		Created
09/16/2024	4.0.0	MCR.002.027	UPDATE	File segment	None	79
09/16/2024	4.0.0	MCR.002.027	ADD	N/A		Created
09/16/2024	4.0.0	MCR.002.026	UPDATE	File segment	None	79
09/16/2024	4.0.0	MCR.002.026	ADD	N/A		Created
09/16/2024	4.0.0	MCR.002.025	UPDATE	File segment	None	79
09/16/2024	4.0.0	MCR.002.025	ADD	N/A		Created
09/16/2024	4.0.0	MCR.002.024	UPDATE	File segment	None	79
09/16/2024	4.0.0	MCR.002.024	ADD	N/A		Created
09/16/2024	4.0.0	MCR.002.023	UPDATE	File segment	None	79
09/16/2024	4.0.0	MCR.002.023	ADD	N/A		Created
09/16/2024	4.0.0	MCR.002.022	UPDATE	File segment	None	79
09/16/2024	4.0.0	MCR.002.022	ADD	N/A		Created
09/16/2024	4.0.0	MCR.002.021	UPDATE	File segment	None	79
09/16/2024	4.0.0	MCR.002.021	ADD	N/A		Created
09/16/2024	4.0.0	MCR.002.020	UPDATE	File segment	None	79
09/16/2024	4.0.0	MCR.002.020	ADD	N/A		Created
09/16/2024	4.0.0	MCR.002.019	UPDATE	File segment	None	79
09/16/2024	4.0.0	MCR.002.019	ADD	N/A		Created
09/16/2024	4.0.0	MCR.002.018	UPDATE	File segment	None	79
09/16/2024	4.0.0	MCR.002.018	ADD	N/A		Created
09/16/2024	4.0.0	MCR.002.017	UPDATE	File segment	None	79
09/16/2024	4.0.0	MCR.002.017	ADD	N/A		Created
09/16/2024	4.0.0	MCR.002.016	UPDATE	File segment	None	79
09/16/2024	4.0.0	MCR.002.016	ADD	N/A		Created
09/16/2024	4.0.0	MCR.001.014	UPDATE	File segment	None	78
09/16/2024	4.0.0	MCR.001.014	ADD	N/A		Created
09/16/2024	4.0.0	MCR.001.112	UPDATE	File segment	None	78
09/16/2024	4.0.0	MCR.001.112	ADD	N/A		Created
09/16/2024	4.0.0	MCR.001.113	UPDATE	File segment	None	78
09/16/2024	4.0.0	MCR.001.113	ADD	N/A		Created
09/16/2024	4.0.0	MCR.001.013	UPDATE	File segment	None	78
09/16/2024	4.0.0	MCR.001.013	ADD	N/A		Created
09/16/2024	4.0.0	MCR.001.011	UPDATE	File segment	None	78
09/16/2024	4.0.0	MCR.001.011	ADD	N/A		Created
09/16/2024	4.0.0	MCR.001.010	UPDATE	File segment	None	78
09/16/2024	4.0.0	MCR.001.010	ADD	N/A		Created
09/16/2024	4.0.0	MCR.001.009	UPDATE	File segment	None	78
09/16/2024	4.0.0	MCR.001.009	ADD	N/A		Created
09/16/2024	4.0.0	MCR.001.008	UPDATE	File segment	None	78
09/16/2024	4.0.0	MCR.001.008	ADD	N/A		Created
09/16/2024	4.0.0	MCR.001.007	UPDATE	File segment	None	78
09/16/2024	4.0.0	MCR.001.007	ADD	N/A		Created
09/16/2024	4.0.0	MCR.001.006	UPDATE	File segment	None	78
09/16/2024	4.0.0	MCR.001.006	ADD	N/A		Created
09/16/2024	4.0.0	MCR.001.005	UPDATE	File segment	None	78
09/16/2024	4.0.0	MCR.001.005	ADD	N/A		Created
09/16/2024	4.0.0	MCR.001.004	UPDATE	File segment	None	78
09/16/2024	4.0.0	MCR.001.004	ADD	N/A		Created
09/16/2024	4.0.0	MCR.001.003	UPDATE	File segment	None	78
09/16/2024	4.0.0	MCR.001.003	ADD	N/A		Created
09/16/2024	4.0.0	MCR.001.002	UPDATE	File segment	None	78
09/16/2024	4.0.0	MCR.001.002	ADD	N/A		Created
09/16/2024	4.0.0	MCR.001.001	UPDATE	File segment	None	78
09/16/2024	4.0.0	MCR.001.001	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.405	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.405	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.404	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.404	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.403	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.403	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.402	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.402	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.401	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.401	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.400	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.400	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.399	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.399	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.398	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.398	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.397	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.397	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.396	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.396	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.395	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.395	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.394	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.394	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.391	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.391	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.392	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.392	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.393	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.393	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.390	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.390	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.389	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.389	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.388	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.388	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.387	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.387	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.386	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.386	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.385	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.385	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.384	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.384	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.383	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.383	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.382	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.382	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.381	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.381	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.380	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.380	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.379	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.379	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.378	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.378	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.377	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.377	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.376	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.376	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.375	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.375	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.374	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.374	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.373	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.373	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.372	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.372	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.371	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.371	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.370	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.370	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.369	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.369	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.368	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.368	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.367	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.367	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.366	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.366	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.365	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.365	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.364	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.364	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.363	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.363	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.361	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.361	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.360	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.360	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.359	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.359	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.358	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.358	ADD	N/A		Created
09/16/2024	4.0.0	FTX.095.357	UPDATE	File segment	None	76
09/16/2024	4.0.0	FTX.095.357	ADD	N/A		Created
09/16/2024	4.0.0	FTX.009.355	UPDATE	File segment	None	75
09/16/2024	4.0.0	FTX.009.355	ADD	N/A		Created
09/16/2024	4.0.0	FTX.009.354	UPDATE	File segment	None	75
09/16/2024	4.0.0	FTX.009.354	ADD	N/A		Created
09/16/2024	4.0.0	FTX.009.353	UPDATE	File segment	None	75
09/16/2024	4.0.0	FTX.009.353	ADD	N/A		Created
09/16/2024	4.0.0	FTX.009.352	UPDATE	File segment	None	75
09/16/2024	4.0.0	FTX.009.352	ADD	N/A		Created
09/16/2024	4.0.0	FTX.009.351	UPDATE	File segment	None	75
09/16/2024	4.0.0	FTX.009.351	ADD	N/A		Created
09/16/2024	4.0.0	FTX.009.350	UPDATE	File segment	None	75
09/16/2024	4.0.0	FTX.009.350	ADD	N/A		Created
09/16/2024	4.0.0	FTX.009.349	UPDATE	File segment	None	75
09/16/2024	4.0.0	FTX.009.349	ADD	N/A		Created
09/16/2024	4.0.0	FTX.009.348	UPDATE	File segment	None	75
09/16/2024	4.0.0	FTX.009.348	ADD	N/A		Created
09/16/2024	4.0.0	FTX.009.347	UPDATE	File segment	None	75
09/16/2024	4.0.0	FTX.009.347	ADD	N/A		Created
09/16/2024	4.0.0	FTX.009.346	UPDATE	File segment	None	75
09/16/2024	4.0.0	FTX.009.346	ADD	N/A		Created
09/16/2024	4.0.0	FTX.009.343	UPDATE	File segment	None	75
09/16/2024	4.0.0	FTX.009.343	ADD	N/A		Created
09/16/2024	4.0.0	FTX.009.344	UPDATE	File segment	None	75
09/16/2024	4.0.0	FTX.009.344	ADD	N/A		Created
09/16/2024	4.0.0	FTX.009.345	UPDATE	File segment	None	75
09/16/2024	4.0.0	FTX.009.345	ADD	N/A		Created
09/16/2024	4.0.0	FTX.009.342	UPDATE	File segment	None	75
09/16/2024	4.0.0	FTX.009.342	ADD	N/A		Created
09/16/2024	4.0.0	FTX.009.341	UPDATE	File segment	None	75
09/16/2024	4.0.0	FTX.009.341	ADD	N/A		Created
09/16/2024	4.0.0	FTX.009.340	UPDATE	File segment	None	75
09/16/2024	4.0.0	FTX.009.340	ADD	N/A		Created
09/16/2024	4.0.0	FTX.009.339	UPDATE	File segment	None	75
09/16/2024	4.0.0	FTX.009.339	ADD	N/A		Created
09/16/2024	4.0.0	FTX.009.338	UPDATE	File segment	None	75
09/16/2024	4.0.0	FTX.009.338	ADD	N/A		Created
09/16/2024	4.0.0	FTX.009.337	UPDATE	File segment	None	75
09/16/2024	4.0.0	FTX.009.337	ADD	N/A		Created
09/16/2024	4.0.0	FTX.009.336	UPDATE	File segment	None	75
09/16/2024	4.0.0	FTX.009.336	ADD	N/A		Created
09/16/2024	4.0.0	FTX.009.335	UPDATE	File segment	None	75
09/16/2024	4.0.0	FTX.009.335	ADD	N/A		Created
09/16/2024	4.0.0	FTX.009.334	UPDATE	File segment	None	75
09/16/2024	4.0.0	FTX.009.334	ADD	N/A		Created
09/16/2024	4.0.0	FTX.009.333	UPDATE	File segment	None	75
09/16/2024	4.0.0	FTX.009.333	ADD	N/A		Created
09/16/2024	4.0.0	FTX.009.332	UPDATE	File segment	None	75
09/16/2024	4.0.0	FTX.009.332	ADD	N/A		Created
09/16/2024	4.0.0	FTX.009.331	UPDATE	File segment	None	75
09/16/2024	4.0.0	FTX.009.331	ADD	N/A		Created
09/16/2024	4.0.0	FTX.009.330	UPDATE	File segment	None	75
09/16/2024	4.0.0	FTX.009.330	ADD	N/A		Created
09/16/2024	4.0.0	FTX.009.329	UPDATE	File segment	None	75
09/16/2024	4.0.0	FTX.009.329	ADD	N/A		Created
09/16/2024	4.0.0	FTX.009.328	UPDATE	File segment	None	75
09/16/2024	4.0.0	FTX.009.328	ADD	N/A		Created
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09/16/2024	4.0.0	FTX.009.327	ADD	N/A		Created
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09/16/2024	4.0.0	FTX.009.326	ADD	N/A		Created
09/16/2024	4.0.0	FTX.009.325	UPDATE	File segment	None	75
09/16/2024	4.0.0	FTX.009.325	ADD	N/A		Created
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09/16/2024	4.0.0	FTX.009.324	ADD	N/A		Created
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09/16/2024	4.0.0	FTX.009.322	ADD	N/A		Created
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09/16/2024	4.0.0	FTX.009.321	ADD	N/A		Created
09/16/2024	4.0.0	FTX.009.320	UPDATE	File segment	None	75
09/16/2024	4.0.0	FTX.009.320	ADD	N/A		Created
09/16/2024	4.0.0	FTX.009.319	UPDATE	File segment	None	75
09/16/2024	4.0.0	FTX.009.319	ADD	N/A		Created
09/16/2024	4.0.0	FTX.009.318	UPDATE	File segment	None	75
09/16/2024	4.0.0	FTX.009.318	ADD	N/A		Created
09/16/2024	4.0.0	FTX.008.316	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.316	ADD	N/A		Created
09/16/2024	4.0.0	FTX.008.315	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.315	ADD	N/A		Created
09/16/2024	4.0.0	FTX.008.314	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.314	ADD	N/A		Created
09/16/2024	4.0.0	FTX.008.313	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.313	ADD	N/A		Created
09/16/2024	4.0.0	FTX.008.312	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.312	ADD	N/A		Created
09/16/2024	4.0.0	FTX.008.311	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.311	ADD	N/A		Created
09/16/2024	4.0.0	FTX.008.310	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.310	ADD	N/A		Created
09/16/2024	4.0.0	FTX.008.309	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.309	ADD	N/A		Created
09/16/2024	4.0.0	FTX.008.308	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.308	ADD	N/A		Created
09/16/2024	4.0.0	FTX.008.307	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.307	ADD	N/A		Created
09/16/2024	4.0.0	FTX.008.304	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.304	ADD	N/A		Created
09/16/2024	4.0.0	FTX.008.305	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.305	ADD	N/A		Created
09/16/2024	4.0.0	FTX.008.306	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.306	ADD	N/A		Created
09/16/2024	4.0.0	FTX.008.303	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.303	ADD	N/A		Created
09/16/2024	4.0.0	FTX.008.302	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.302	ADD	N/A		Created
09/16/2024	4.0.0	FTX.008.301	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.301	ADD	N/A		Created
09/16/2024	4.0.0	FTX.008.300	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.300	ADD	N/A		Created
09/16/2024	4.0.0	FTX.008.299	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.299	ADD	N/A		Created
09/16/2024	4.0.0	FTX.008.298	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.298	ADD	N/A		Created
09/16/2024	4.0.0	FTX.008.297	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.297	ADD	N/A		Created
09/16/2024	4.0.0	FTX.008.296	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.296	ADD	N/A		Created
09/16/2024	4.0.0	FTX.008.295	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.295	ADD	N/A		Created
09/16/2024	4.0.0	FTX.008.294	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.294	ADD	N/A		Created
09/16/2024	4.0.0	FTX.008.293	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.293	ADD	N/A		Created
09/16/2024	4.0.0	FTX.008.292	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.292	ADD	N/A		Created
09/16/2024	4.0.0	FTX.008.291	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.291	ADD	N/A		Created
09/16/2024	4.0.0	FTX.008.290	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.290	ADD	N/A		Created
09/16/2024	4.0.0	FTX.008.289	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.289	ADD	N/A		Created
09/16/2024	4.0.0	FTX.008.288	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.288	ADD	N/A		Created
09/16/2024	4.0.0	FTX.008.287	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.287	ADD	N/A		Created
09/16/2024	4.0.0	FTX.008.286	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.286	ADD	N/A		Created
09/16/2024	4.0.0	FTX.008.285	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.285	ADD	N/A		Created
09/16/2024	4.0.0	FTX.008.283	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.283	ADD	N/A		Created
09/16/2024	4.0.0	FTX.008.282	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.282	ADD	N/A		Created
09/16/2024	4.0.0	FTX.008.281	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.281	ADD	N/A		Created
09/16/2024	4.0.0	FTX.008.280	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.280	ADD	N/A		Created
09/16/2024	4.0.0	FTX.008.279	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.279	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.277	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.277	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.276	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.276	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.275	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.275	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.274	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.274	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.273	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.273	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.272	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.272	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.271	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.271	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.270	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.270	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.269	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.269	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.268	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.268	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.267	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.267	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.264	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.264	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.265	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.265	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.266	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.266	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.263	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.263	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.262	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.262	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.261	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.261	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.260	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.260	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.259	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.259	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.258	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.258	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.257	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.257	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.256	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.256	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.255	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.255	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.254	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.254	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.253	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.253	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.252	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.252	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.251	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.251	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.250	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.250	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.249	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.249	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.248	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.248	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.247	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.247	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.246	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.246	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.245	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.245	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.244	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.244	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.243	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.243	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.242	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.242	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.240	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.240	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.239	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.239	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.238	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.238	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.237	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.237	ADD	N/A		Created
09/16/2024	4.0.0	FTX.007.236	UPDATE	File segment	None	73
09/16/2024	4.0.0	FTX.007.236	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.234	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.234	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.233	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.233	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.232	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.232	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.231	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.231	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.230	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.230	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.229	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.229	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.228	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.228	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.227	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.227	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.226	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.226	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.225	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.225	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.224	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.224	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.223	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.223	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.222	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.222	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.219	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.219	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.220	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.220	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.221	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.221	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.218	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.218	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.217	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.217	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.216	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.216	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.215	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.215	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.214	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.214	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.213	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.213	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.212	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.212	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.211	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.211	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.210	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.210	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.209	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.209	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.208	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.208	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.207	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.207	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.206	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.206	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.205	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.205	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.204	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.204	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.203	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.203	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.202	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.202	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.201	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.201	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.200	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.200	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.199	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.199	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.198	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.198	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.196	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.196	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.195	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.195	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.194	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.194	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.193	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.193	ADD	N/A		Created
09/16/2024	4.0.0	FTX.006.192	UPDATE	File segment	None	72
09/16/2024	4.0.0	FTX.006.192	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.190	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.190	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.189	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.189	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.188	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.188	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.187	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.187	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.186	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.186	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.185	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.185	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.184	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.184	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.183	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.183	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.182	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.182	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.181	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.181	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.180	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.180	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.177	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.177	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.178	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.178	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.179	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.179	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.176	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.176	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.175	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.175	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.174	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.174	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.173	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.173	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.172	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.172	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.171	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.171	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.170	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.170	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.169	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.169	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.168	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.168	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.167	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.167	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.166	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.166	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.165	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.165	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.164	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.164	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.163	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.163	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.162	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.162	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.161	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.161	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.160	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.160	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.159	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.159	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.158	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.158	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.157	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.157	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.156	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.156	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.155	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.155	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.153	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.153	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.152	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.152	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.151	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.151	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.150	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.150	ADD	N/A		Created
09/16/2024	4.0.0	FTX.005.149	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.149	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.147	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.147	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.146	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.146	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.145	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.145	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.144	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.144	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.143	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.143	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.142	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.142	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.141	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.141	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.140	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.140	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.139	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.139	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.138	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.138	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.135	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.135	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.136	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.136	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.137	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.137	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.134	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.134	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.133	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.133	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.132	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.132	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.131	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.131	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.130	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.130	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.129	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.129	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.128	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.128	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.127	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.127	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.126	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.126	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.125	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.125	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.124	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.124	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.123	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.123	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.122	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.122	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.121	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.121	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.120	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.120	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.119	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.119	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.118	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.118	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.117	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.117	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.116	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.116	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.115	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.115	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.114	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.114	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.113	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.113	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.112	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.112	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.111	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.111	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.109	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.109	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.108	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.108	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.107	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.107	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.106	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.106	ADD	N/A		Created
09/16/2024	4.0.0	FTX.004.105	UPDATE	File segment	None	70
09/16/2024	4.0.0	FTX.004.105	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.103	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.103	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.102	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.102	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.101	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.101	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.100	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.100	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.099	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.099	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.098	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.098	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.097	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.097	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.096	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.096	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.095	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.095	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.094	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.094	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.091	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.091	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.092	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.092	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.093	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.093	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.090	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.090	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.089	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.089	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.088	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.088	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.087	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.087	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.086	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.086	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.085	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.085	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.084	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.084	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.083	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.083	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.082	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.082	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.081	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.081	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.080	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.080	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.079	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.079	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.078	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.078	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.077	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.077	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.076	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.076	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.075	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.075	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.074	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.074	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.073	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.073	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.072	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.072	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.071	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.071	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.070	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.070	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.068	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.068	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.067	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.067	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.066	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.066	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.065	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.065	ADD	N/A		Created
09/16/2024	4.0.0	FTX.003.064	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.064	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.062	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.062	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.061	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.061	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.060	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.060	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.059	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.059	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.058	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.058	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.057	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.057	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.056	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.056	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.055	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.055	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.054	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.054	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.053	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.053	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.052	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.052	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.051	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.051	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.050	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.050	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.049	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.049	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.046	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.046	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.047	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.047	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.048	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.048	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.045	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.045	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.044	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.044	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.043	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.043	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.042	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.042	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.041	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.041	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.040	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.040	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.039	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.039	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.038	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.038	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.037	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.037	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.036	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.036	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.035	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.035	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.034	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.034	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.033	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.033	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.032	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.032	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.031	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.031	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.030	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.030	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.029	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.029	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.028	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.028	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.027	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.027	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.026	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.026	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.025	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.025	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.024	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.024	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.023	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.023	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.021	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.021	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.020	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.020	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.019	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.019	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.018	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.018	ADD	N/A		Created
09/16/2024	4.0.0	FTX.002.017	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.017	ADD	N/A		Created
09/16/2024	4.0.0	FTX.001.015	UPDATE	File segment	None	67
09/16/2024	4.0.0	FTX.001.015	ADD	N/A		Created
09/16/2024	4.0.0	FTX.001.014	UPDATE	File segment	None	67
09/16/2024	4.0.0	FTX.001.014	ADD	N/A		Created
09/16/2024	4.0.0	FTX.001.013	UPDATE	File segment	None	67
09/16/2024	4.0.0	FTX.001.013	ADD	N/A		Created
09/16/2024	4.0.0	FTX.001.012	UPDATE	File segment	None	67
09/16/2024	4.0.0	FTX.001.012	ADD	N/A		Created
09/16/2024	4.0.0	FTX.001.011	UPDATE	File segment	None	67
09/16/2024	4.0.0	FTX.001.011	ADD	N/A		Created
09/16/2024	4.0.0	FTX.001.010	UPDATE	File segment	None	67
09/16/2024	4.0.0	FTX.001.010	ADD	N/A		Created
09/16/2024	4.0.0	FTX.001.009	UPDATE	File segment	None	67
09/16/2024	4.0.0	FTX.001.009	ADD	N/A		Created
09/16/2024	4.0.0	FTX.001.008	UPDATE	File segment	None	67
09/16/2024	4.0.0	FTX.001.008	ADD	N/A		Created
09/16/2024	4.0.0	FTX.001.007	UPDATE	File segment	None	67
09/16/2024	4.0.0	FTX.001.007	ADD	N/A		Created
09/16/2024	4.0.0	FTX.001.006	UPDATE	File segment	None	67
09/16/2024	4.0.0	FTX.001.006	ADD	N/A		Created
09/16/2024	4.0.0	FTX.001.005	UPDATE	File segment	None	67
09/16/2024	4.0.0	FTX.001.005	ADD	N/A		Created
09/16/2024	4.0.0	FTX.001.004	UPDATE	File segment	None	67
09/16/2024	4.0.0	FTX.001.004	ADD	N/A		Created
09/16/2024	4.0.0	FTX.001.003	UPDATE	File segment	None	67
09/16/2024	4.0.0	FTX.001.003	ADD	N/A		Created
09/16/2024	4.0.0	FTX.001.002	UPDATE	File segment	None	67
09/16/2024	4.0.0	FTX.001.002	ADD	N/A		Created
09/16/2024	4.0.0	FTX.001.001	UPDATE	File segment	None	67
09/16/2024	4.0.0	FTX.001.001	ADD	N/A		Created
09/16/2024	4.0.0	ELG.023.294	ADD	N/A		Created
09/16/2024	4.0.0	ELG.023.293	ADD	N/A		Created
09/16/2024	4.0.0	ELG.023.292	ADD	N/A		Created
09/16/2024	4.0.0	ELG.023.291	ADD	N/A		Created
09/16/2024	4.0.0	ELG.023.290	ADD	N/A		Created
09/16/2024	4.0.0	ELG.023.289	ADD	N/A		Created
09/16/2024	4.0.0	ELG.023.288	ADD	N/A		Created
09/16/2024	4.0.0	ELG.023.287	ADD	N/A		Created
09/16/2024	4.0.0	ELG.023.286	ADD	N/A		Created
09/16/2024	4.0.0	ELG.023.285	ADD	N/A		Created
09/16/2024	4.0.0	ELG.023.284	ADD	N/A		Created
09/16/2024	4.0.0	ELG.023.283	ADD	N/A		Created
09/16/2024	4.0.0	ELG.023.282	ADD	N/A		Created
09/16/2024	4.0.0	ELG.022.267	UPDATE	File segment	None	64
09/16/2024	4.0.0	ELG.022.267	ADD	N/A		Created
09/16/2024	4.0.0	ELG.022.266	UPDATE	File segment	None	64
09/16/2024	4.0.0	ELG.022.266	ADD	N/A		Created
09/16/2024	4.0.0	ELG.022.265	UPDATE	File segment	None	64
09/16/2024	4.0.0	ELG.022.265	ADD	N/A		Created
09/16/2024	4.0.0	ELG.022.264	UPDATE	File segment	None	64
09/16/2024	4.0.0	ELG.022.264	ADD	N/A		Created
09/16/2024	4.0.0	ELG.022.263	UPDATE	File segment	None	64
09/16/2024	4.0.0	ELG.022.263	ADD	N/A		Created
09/16/2024	4.0.0	ELG.022.262	UPDATE	File segment	None	64
09/16/2024	4.0.0	ELG.022.262	ADD	N/A		Created
09/16/2024	4.0.0	ELG.022.261	UPDATE	File segment	None	64
09/16/2024	4.0.0	ELG.022.261	ADD	N/A		Created
09/16/2024	4.0.0	ELG.022.260	UPDATE	File segment	None	64
09/16/2024	4.0.0	ELG.022.260	ADD	N/A		Created
09/16/2024	4.0.0	ELG.022.259	UPDATE	File segment	None	64
09/16/2024	4.0.0	ELG.022.259	ADD	N/A		Created
09/16/2024	4.0.0	ELG.022.258	UPDATE	File segment	None	64
09/16/2024	4.0.0	ELG.022.258	ADD	N/A		Created
09/16/2024	4.0.0	ELG.022.257	UPDATE	File segment	None	64
09/16/2024	4.0.0	ELG.022.257	ADD	N/A		Created
09/16/2024	4.0.0	ELG.021.255	UPDATE	File segment	None	63
09/16/2024	4.0.0	ELG.021.255	ADD	N/A		Created
09/16/2024	4.0.0	ELG.021.254	UPDATE	File segment	None	63
09/16/2024	4.0.0	ELG.021.254	ADD	N/A		Created
09/16/2024	4.0.0	ELG.021.253	UPDATE	File segment	None	63
09/16/2024	4.0.0	ELG.021.253	ADD	N/A		Created
09/16/2024	4.0.0	ELG.021.252	UPDATE	File segment	None	63
09/16/2024	4.0.0	ELG.021.252	ADD	N/A		Created
09/16/2024	4.0.0	ELG.021.251	UPDATE	File segment	None	63
09/16/2024	4.0.0	ELG.021.251	ADD	N/A		Created
09/16/2024	4.0.0	ELG.021.250	UPDATE	File segment	None	63
09/16/2024	4.0.0	ELG.021.250	ADD	N/A		Created
09/16/2024	4.0.0	ELG.021.249	UPDATE	File segment	None	63
09/16/2024	4.0.0	ELG.021.249	ADD	N/A		Created
09/16/2024	4.0.0	ELG.021.248	UPDATE	File segment	None	63
09/16/2024	4.0.0	ELG.021.248	ADD	N/A		Created
09/16/2024	4.0.0	ELG.020.245	UPDATE	File segment	None	62
09/16/2024	4.0.0	ELG.020.245	ADD	N/A		Created
09/16/2024	4.0.0	ELG.020.244	UPDATE	File segment	None	62
09/16/2024	4.0.0	ELG.020.244	ADD	N/A		Created
09/16/2024	4.0.0	ELG.020.243	UPDATE	File segment	None	62
09/16/2024	4.0.0	ELG.020.243	ADD	N/A		Created
09/16/2024	4.0.0	ELG.020.242	UPDATE	File segment	None	62
09/16/2024	4.0.0	ELG.020.242	ADD	N/A		Created
09/16/2024	4.0.0	ELG.020.241	UPDATE	File segment	None	62
09/16/2024	4.0.0	ELG.020.241	ADD	N/A		Created
09/16/2024	4.0.0	ELG.020.240	UPDATE	File segment	None	62
09/16/2024	4.0.0	ELG.020.240	ADD	N/A		Created
09/16/2024	4.0.0	ELG.020.239	UPDATE	File segment	None	62
09/16/2024	4.0.0	ELG.020.239	ADD	N/A		Created
09/16/2024	4.0.0	ELG.020.238	UPDATE	File segment	None	62
09/16/2024	4.0.0	ELG.020.238	ADD	N/A		Created
09/16/2024	4.0.0	ELG.018.236	UPDATE	File segment	None	61
09/16/2024	4.0.0	ELG.018.236	ADD	N/A		Created
09/16/2024	4.0.0	ELG.018.235	UPDATE	File segment	None	61
09/16/2024	4.0.0	ELG.018.235	ADD	N/A		Created
09/16/2024	4.0.0	ELG.018.234	UPDATE	File segment	None	61
09/16/2024	4.0.0	ELG.018.234	ADD	N/A		Created
09/16/2024	4.0.0	ELG.018.233	UPDATE	File segment	None	61
09/16/2024	4.0.0	ELG.018.233	ADD	N/A		Created
09/16/2024	4.0.0	ELG.018.232	UPDATE	File segment	None	61
09/16/2024	4.0.0	ELG.018.232	ADD	N/A		Created
09/16/2024	4.0.0	ELG.018.231	UPDATE	File segment	None	61
09/16/2024	4.0.0	ELG.018.231	ADD	N/A		Created
09/16/2024	4.0.0	ELG.018.230	UPDATE	File segment	None	61
09/16/2024	4.0.0	ELG.018.230	ADD	N/A		Created
09/16/2024	4.0.0	ELG.018.229	UPDATE	File segment	None	61
09/16/2024	4.0.0	ELG.018.229	ADD	N/A		Created
09/16/2024	4.0.0	ELG.017.227	UPDATE	File segment	None	60
09/16/2024	4.0.0	ELG.017.227	ADD	N/A		Created
09/16/2024	4.0.0	ELG.017.226	UPDATE	File segment	None	60
09/16/2024	4.0.0	ELG.017.226	ADD	N/A		Created
09/16/2024	4.0.0	ELG.017.225	UPDATE	File segment	None	60
09/16/2024	4.0.0	ELG.017.225	ADD	N/A		Created
09/16/2024	4.0.0	ELG.017.224	UPDATE	File segment	None	60
09/16/2024	4.0.0	ELG.017.224	ADD	N/A		Created
09/16/2024	4.0.0	ELG.017.223	UPDATE	File segment	None	60
09/16/2024	4.0.0	ELG.017.223	ADD	N/A		Created
09/16/2024	4.0.0	ELG.017.222	UPDATE	File segment	None	60
09/16/2024	4.0.0	ELG.017.222	ADD	N/A		Created
09/16/2024	4.0.0	ELG.017.221	UPDATE	File segment	None	60
09/16/2024	4.0.0	ELG.017.221	ADD	N/A		Created
09/16/2024	4.0.0	ELG.017.220	UPDATE	File segment	None	60
09/16/2024	4.0.0	ELG.017.220	ADD	N/A		Created
09/16/2024	4.0.0	ELG.016.218	UPDATE	File segment	None	59
09/16/2024	4.0.0	ELG.016.218	ADD	N/A		Created
09/16/2024	4.0.0	ELG.016.217	UPDATE	File segment	None	59
09/16/2024	4.0.0	ELG.016.217	ADD	N/A		Created
09/16/2024	4.0.0	ELG.016.216	UPDATE	File segment	None	59
09/16/2024	4.0.0	ELG.016.216	ADD	N/A		Created
09/16/2024	4.0.0	ELG.016.215	UPDATE	File segment	None	59
09/16/2024	4.0.0	ELG.016.215	ADD	N/A		Created
09/16/2024	4.0.0	ELG.016.214	UPDATE	File segment	None	59
09/16/2024	4.0.0	ELG.016.214	ADD	N/A		Created
09/16/2024	4.0.0	ELG.016.213	UPDATE	File segment	None	59
09/16/2024	4.0.0	ELG.016.213	ADD	N/A		Created
09/16/2024	4.0.0	ELG.016.212	UPDATE	File segment	None	59
09/16/2024	4.0.0	ELG.016.212	ADD	N/A		Created
09/16/2024	4.0.0	ELG.016.211	UPDATE	File segment	None	59
09/16/2024	4.0.0	ELG.016.211	ADD	N/A		Created
09/16/2024	4.0.0	ELG.016.210	UPDATE	File segment	None	59
09/16/2024	4.0.0	ELG.016.210	ADD	N/A		Created
09/16/2024	4.0.0	ELG.016.209	UPDATE	File segment	None	59
09/16/2024	4.0.0	ELG.016.209	ADD	N/A		Created
09/16/2024	4.0.0	ELG.015.207	UPDATE	File segment	None	58
09/16/2024	4.0.0	ELG.015.207	ADD	N/A		Created
09/16/2024	4.0.0	ELG.015.271	UPDATE	File segment	None	58
09/16/2024	4.0.0	ELG.015.271	ADD	N/A		Created
09/16/2024	4.0.0	ELG.015.206	UPDATE	File segment	None	58
09/16/2024	4.0.0	ELG.015.206	ADD	N/A		Created
09/16/2024	4.0.0	ELG.015.205	UPDATE	File segment	None	58
09/16/2024	4.0.0	ELG.015.205	ADD	N/A		Created
09/16/2024	4.0.0	ELG.015.204	UPDATE	File segment	None	58
09/16/2024	4.0.0	ELG.015.204	ADD	N/A		Created
09/16/2024	4.0.0	ELG.015.203	UPDATE	File segment	None	58
09/16/2024	4.0.0	ELG.015.203	ADD	N/A		Created
09/16/2024	4.0.0	ELG.015.202	UPDATE	File segment	None	58
09/16/2024	4.0.0	ELG.015.202	ADD	N/A		Created
09/16/2024	4.0.0	ELG.015.201	UPDATE	File segment	None	58
09/16/2024	4.0.0	ELG.015.201	ADD	N/A		Created
09/16/2024	4.0.0	ELG.015.200	UPDATE	File segment	None	58
09/16/2024	4.0.0	ELG.015.200	ADD	N/A		Created
09/16/2024	4.0.0	ELG.014.198	UPDATE	File segment	None	57
09/16/2024	4.0.0	ELG.014.198	ADD	N/A		Created
09/16/2024	4.0.0	ELG.014.197	UPDATE	File segment	None	57
09/16/2024	4.0.0	ELG.014.197	ADD	N/A		Created
09/16/2024	4.0.0	ELG.014.196	UPDATE	File segment	None	57
09/16/2024	4.0.0	ELG.014.196	ADD	N/A		Created
09/16/2024	4.0.0	ELG.014.193	UPDATE	File segment	None	57
09/16/2024	4.0.0	ELG.014.193	ADD	N/A		Created
09/16/2024	4.0.0	ELG.014.192	UPDATE	File segment	None	57
09/16/2024	4.0.0	ELG.014.192	ADD	N/A		Created
09/16/2024	4.0.0	ELG.014.191	UPDATE	File segment	None	57
09/16/2024	4.0.0	ELG.014.191	ADD	N/A		Created
09/16/2024	4.0.0	ELG.014.190	UPDATE	File segment	None	57
09/16/2024	4.0.0	ELG.014.190	ADD	N/A		Created
09/16/2024	4.0.0	ELG.014.189	UPDATE	File segment	None	57
09/16/2024	4.0.0	ELG.014.189	ADD	N/A		Created
09/16/2024	4.0.0	ELG.014.188	UPDATE	File segment	None	57
09/16/2024	4.0.0	ELG.014.188	ADD	N/A		Created
09/16/2024	4.0.0	ELG.013.186	UPDATE	File segment	None	56
09/16/2024	4.0.0	ELG.013.186	ADD	N/A		Created
09/16/2024	4.0.0	ELG.013.185	UPDATE	File segment	None	56
09/16/2024	4.0.0	ELG.013.185	ADD	N/A		Created
09/16/2024	4.0.0	ELG.013.184	UPDATE	File segment	None	56
09/16/2024	4.0.0	ELG.013.184	ADD	N/A		Created
09/16/2024	4.0.0	ELG.013.183	UPDATE	File segment	None	56
09/16/2024	4.0.0	ELG.013.183	ADD	N/A		Created
09/16/2024	4.0.0	ELG.013.182	UPDATE	File segment	None	56
09/16/2024	4.0.0	ELG.013.182	ADD	N/A		Created
09/16/2024	4.0.0	ELG.013.181	UPDATE	File segment	None	56
09/16/2024	4.0.0	ELG.013.181	ADD	N/A		Created
09/16/2024	4.0.0	ELG.013.180	UPDATE	File segment	None	56
09/16/2024	4.0.0	ELG.013.180	ADD	N/A		Created
09/16/2024	4.0.0	ELG.013.179	UPDATE	File segment	None	56
09/16/2024	4.0.0	ELG.013.179	ADD	N/A		Created
09/16/2024	4.0.0	ELG.013.178	UPDATE	File segment	None	56
09/16/2024	4.0.0	ELG.013.178	ADD	N/A		Created
09/16/2024	4.0.0	ELG.012.176	UPDATE	File segment	None	55
09/16/2024	4.0.0	ELG.012.176	ADD	N/A		Created
09/16/2024	4.0.0	ELG.012.175	UPDATE	File segment	None	55
09/16/2024	4.0.0	ELG.012.175	ADD	N/A		Created
09/16/2024	4.0.0	ELG.012.174	UPDATE	File segment	None	55
09/16/2024	4.0.0	ELG.012.174	ADD	N/A		Created
09/16/2024	4.0.0	ELG.012.173	UPDATE	File segment	None	55
09/16/2024	4.0.0	ELG.012.173	ADD	N/A		Created
09/16/2024	4.0.0	ELG.012.172	UPDATE	File segment	None	55
09/16/2024	4.0.0	ELG.012.172	ADD	N/A		Created
09/16/2024	4.0.0	ELG.012.171	UPDATE	File segment	None	55
09/16/2024	4.0.0	ELG.012.171	ADD	N/A		Created
09/16/2024	4.0.0	ELG.012.170	UPDATE	File segment	None	55
09/16/2024	4.0.0	ELG.012.170	ADD	N/A		Created
09/16/2024	4.0.0	ELG.012.169	UPDATE	File segment	None	55
09/16/2024	4.0.0	ELG.012.169	ADD	N/A		Created
09/16/2024	4.0.0	ELG.012.168	UPDATE	File segment	None	55
09/16/2024	4.0.0	ELG.012.168	ADD	N/A		Created
09/16/2024	4.0.0	ELG.011.166	UPDATE	File segment	None	54
09/16/2024	4.0.0	ELG.011.166	ADD	N/A		Created
09/16/2024	4.0.0	ELG.011.165	UPDATE	File segment	None	54
09/16/2024	4.0.0	ELG.011.165	ADD	N/A		Created
09/16/2024	4.0.0	ELG.011.164	UPDATE	File segment	None	54
09/16/2024	4.0.0	ELG.011.164	ADD	N/A		Created
09/16/2024	4.0.0	ELG.011.163	UPDATE	File segment	None	54
09/16/2024	4.0.0	ELG.011.163	ADD	N/A		Created
09/16/2024	4.0.0	ELG.011.162	UPDATE	File segment	None	54
09/16/2024	4.0.0	ELG.011.162	ADD	N/A		Created
09/16/2024	4.0.0	ELG.011.161	UPDATE	File segment	None	54
09/16/2024	4.0.0	ELG.011.161	ADD	N/A		Created
09/16/2024	4.0.0	ELG.011.160	UPDATE	File segment	None	54
09/16/2024	4.0.0	ELG.011.160	ADD	N/A		Created
09/16/2024	4.0.0	ELG.011.159	UPDATE	File segment	None	54
09/16/2024	4.0.0	ELG.011.159	ADD	N/A		Created
09/16/2024	4.0.0	ELG.010.157	UPDATE	File segment	None	53
09/16/2024	4.0.0	ELG.010.157	ADD	N/A		Created
09/16/2024	4.0.0	ELG.010.156	UPDATE	File segment	None	53
09/16/2024	4.0.0	ELG.010.156	ADD	N/A		Created
09/16/2024	4.0.0	ELG.010.155	UPDATE	File segment	None	53
09/16/2024	4.0.0	ELG.010.155	ADD	N/A		Created
09/16/2024	4.0.0	ELG.010.154	UPDATE	File segment	None	53
09/16/2024	4.0.0	ELG.010.154	ADD	N/A		Created
09/16/2024	4.0.0	ELG.010.153	UPDATE	File segment	None	53
09/16/2024	4.0.0	ELG.010.153	ADD	N/A		Created
09/16/2024	4.0.0	ELG.010.152	UPDATE	File segment	None	53
09/16/2024	4.0.0	ELG.010.152	ADD	N/A		Created
09/16/2024	4.0.0	ELG.010.151	UPDATE	File segment	None	53
09/16/2024	4.0.0	ELG.010.151	ADD	N/A		Created
09/16/2024	4.0.0	ELG.010.150	UPDATE	File segment	None	53
09/16/2024	4.0.0	ELG.010.150	ADD	N/A		Created
09/16/2024	4.0.0	ELG.010.149	UPDATE	File segment	None	53
09/16/2024	4.0.0	ELG.010.149	ADD	N/A		Created
09/16/2024	4.0.0	ELG.010.148	UPDATE	File segment	None	53
09/16/2024	4.0.0	ELG.010.148	ADD	N/A		Created
09/16/2024	4.0.0	ELG.010.147	UPDATE	File segment	None	53
09/16/2024	4.0.0	ELG.010.147	ADD	N/A		Created
09/16/2024	4.0.0	ELG.010.146	UPDATE	File segment	None	53
09/16/2024	4.0.0	ELG.010.146	ADD	N/A		Created
09/16/2024	4.0.0	ELG.009.144	UPDATE	File segment	None	52
09/16/2024	4.0.0	ELG.009.144	ADD	N/A		Created
09/16/2024	4.0.0	ELG.009.270	UPDATE	File segment	None	52
09/16/2024	4.0.0	ELG.009.270	ADD	N/A		Created
09/16/2024	4.0.0	ELG.009.143	UPDATE	File segment	None	52
09/16/2024	4.0.0	ELG.009.143	ADD	N/A		Created
09/16/2024	4.0.0	ELG.009.142	UPDATE	File segment	None	52
09/16/2024	4.0.0	ELG.009.142	ADD	N/A		Created
09/16/2024	4.0.0	ELG.009.141	UPDATE	File segment	None	52
09/16/2024	4.0.0	ELG.009.141	ADD	N/A		Created
09/16/2024	4.0.0	ELG.009.140	UPDATE	File segment	None	52
09/16/2024	4.0.0	ELG.009.140	ADD	N/A		Created
09/16/2024	4.0.0	ELG.009.139	UPDATE	File segment	None	52
09/16/2024	4.0.0	ELG.009.139	ADD	N/A		Created
09/16/2024	4.0.0	ELG.009.138	UPDATE	File segment	None	52
09/16/2024	4.0.0	ELG.009.138	ADD	N/A		Created
09/16/2024	4.0.0	ELG.009.137	UPDATE	File segment	None	52
09/16/2024	4.0.0	ELG.009.137	ADD	N/A		Created
09/16/2024	4.0.0	ELG.009.136	UPDATE	File segment	None	52
09/16/2024	4.0.0	ELG.009.136	ADD	N/A		Created
09/16/2024	4.0.0	ELG.008.134	UPDATE	File segment	None	51
09/16/2024	4.0.0	ELG.008.134	ADD	N/A		Created
09/16/2024	4.0.0	ELG.008.133	UPDATE	File segment	None	51
09/16/2024	4.0.0	ELG.008.133	ADD	N/A		Created
09/16/2024	4.0.0	ELG.008.132	UPDATE	File segment	None	51
09/16/2024	4.0.0	ELG.008.132	ADD	N/A		Created
09/16/2024	4.0.0	ELG.008.131	UPDATE	File segment	None	51
09/16/2024	4.0.0	ELG.008.131	ADD	N/A		Created
09/16/2024	4.0.0	ELG.008.130	UPDATE	File segment	None	51
09/16/2024	4.0.0	ELG.008.130	ADD	N/A		Created
09/16/2024	4.0.0	ELG.008.129	UPDATE	File segment	None	51
09/16/2024	4.0.0	ELG.008.129	ADD	N/A		Created
09/16/2024	4.0.0	ELG.008.128	UPDATE	File segment	None	51
09/16/2024	4.0.0	ELG.008.128	ADD	N/A		Created
09/16/2024	4.0.0	ELG.008.127	UPDATE	File segment	None	51
09/16/2024	4.0.0	ELG.008.127	ADD	N/A		Created
09/16/2024	4.0.0	ELG.008.126	UPDATE	File segment	None	51
09/16/2024	4.0.0	ELG.008.126	ADD	N/A		Created
09/16/2024	4.0.0	ELG.007.124	UPDATE	File segment	None	50
09/16/2024	4.0.0	ELG.007.124	ADD	N/A		Created
09/16/2024	4.0.0	ELG.007.123	UPDATE	File segment	None	50
09/16/2024	4.0.0	ELG.007.123	ADD	N/A		Created
09/16/2024	4.0.0	ELG.007.122	UPDATE	File segment	None	50
09/16/2024	4.0.0	ELG.007.122	ADD	N/A		Created
09/16/2024	4.0.0	ELG.007.121	UPDATE	File segment	None	50
09/16/2024	4.0.0	ELG.007.121	ADD	N/A		Created
09/16/2024	4.0.0	ELG.007.120	UPDATE	File segment	None	50
09/16/2024	4.0.0	ELG.007.120	ADD	N/A		Created
09/16/2024	4.0.0	ELG.007.119	UPDATE	File segment	None	50
09/16/2024	4.0.0	ELG.007.119	ADD	N/A		Created
09/16/2024	4.0.0	ELG.007.118	UPDATE	File segment	None	50
09/16/2024	4.0.0	ELG.007.118	ADD	N/A		Created
09/16/2024	4.0.0	ELG.007.117	UPDATE	File segment	None	50
09/16/2024	4.0.0	ELG.007.117	ADD	N/A		Created
09/16/2024	4.0.0	ELG.007.116	UPDATE	File segment	None	50
09/16/2024	4.0.0	ELG.007.116	ADD	N/A		Created
09/16/2024	4.0.0	ELG.007.115	UPDATE	File segment	None	50
09/16/2024	4.0.0	ELG.007.115	ADD	N/A		Created
09/16/2024	4.0.0	ELG.007.114	UPDATE	File segment	None	50
09/16/2024	4.0.0	ELG.007.114	ADD	N/A		Created
09/16/2024	4.0.0	ELG.006.112	UPDATE	File segment	None	49
09/16/2024	4.0.0	ELG.006.112	ADD	N/A		Created
09/16/2024	4.0.0	ELG.006.111	UPDATE	File segment	None	49
09/16/2024	4.0.0	ELG.006.111	ADD	N/A		Created
09/16/2024	4.0.0	ELG.006.110	UPDATE	File segment	None	49
09/16/2024	4.0.0	ELG.006.110	ADD	N/A		Created
09/16/2024	4.0.0	ELG.006.109	UPDATE	File segment	None	49
09/16/2024	4.0.0	ELG.006.109	ADD	N/A		Created
09/16/2024	4.0.0	ELG.006.108	UPDATE	File segment	None	49
09/16/2024	4.0.0	ELG.006.108	ADD	N/A		Created
09/16/2024	4.0.0	ELG.006.107	UPDATE	File segment	None	49
09/16/2024	4.0.0	ELG.006.107	ADD	N/A		Created
09/16/2024	4.0.0	ELG.006.106	UPDATE	File segment	None	49
09/16/2024	4.0.0	ELG.006.106	ADD	N/A		Created
09/16/2024	4.0.0	ELG.006.105	UPDATE	File segment	None	49
09/16/2024	4.0.0	ELG.006.105	ADD	N/A		Created
09/16/2024	4.0.0	ELG.006.104	UPDATE	File segment	None	49
09/16/2024	4.0.0	ELG.006.104	ADD	N/A		Created
09/16/2024	4.0.0	ELG.006.103	UPDATE	File segment	None	49
09/16/2024	4.0.0	ELG.006.103	ADD	N/A		Created
09/16/2024	4.0.0	ELG.005.101	UPDATE	File segment	None	48
09/16/2024	4.0.0	ELG.005.101	ADD	N/A		Created
09/16/2024	4.0.0	ELG.005.281	UPDATE	File segment	None	48
09/16/2024	4.0.0	ELG.005.281	ADD	N/A		Created
09/16/2024	4.0.0	ELG.005.280	UPDATE	File segment	None	48
09/16/2024	4.0.0	ELG.005.280	ADD	N/A		Created
09/16/2024	4.0.0	ELG.005.279	UPDATE	File segment	None	48
09/16/2024	4.0.0	ELG.005.279	ADD	N/A		Created
09/16/2024	4.0.0	ELG.005.278	UPDATE	File segment	None	48
09/16/2024	4.0.0	ELG.005.278	ADD	N/A		Created
09/16/2024	4.0.0	ELG.005.277	UPDATE	File segment	None	48
09/16/2024	4.0.0	ELG.005.277	ADD	N/A		Created
09/16/2024	4.0.0	ELG.005.276	UPDATE	File segment	None	48
09/16/2024	4.0.0	ELG.005.276	ADD	N/A		Created
09/16/2024	4.0.0	ELG.005.275	UPDATE	File segment	None	48
09/16/2024	4.0.0	ELG.005.275	ADD	N/A		Created
09/16/2024	4.0.0	ELG.005.274	UPDATE	File segment	None	48
09/16/2024	4.0.0	ELG.005.274	ADD	N/A		Created
09/16/2024	4.0.0	ELG.005.100	UPDATE	File segment	None	48
09/16/2024	4.0.0	ELG.005.100	ADD	N/A		Created
09/16/2024	4.0.0	ELG.005.099	UPDATE	File segment	None	48
09/16/2024	4.0.0	ELG.005.099	ADD	N/A		Created
09/16/2024	4.0.0	ELG.005.098	UPDATE	File segment	None	48
09/16/2024	4.0.0	ELG.005.098	ADD	N/A		Created
09/16/2024	4.0.0	ELG.005.097	UPDATE	File segment	None	48
09/16/2024	4.0.0	ELG.005.097	ADD	N/A		Created
09/16/2024	4.0.0	ELG.005.095	UPDATE	File segment	None	48
09/16/2024	4.0.0	ELG.005.095	ADD	N/A		Created
09/16/2024	4.0.0	ELG.005.094	UPDATE	File segment	None	48
09/16/2024	4.0.0	ELG.005.094	ADD	N/A		Created
09/16/2024	4.0.0	ELG.005.093	UPDATE	File segment	None	48
09/16/2024	4.0.0	ELG.005.093	ADD	N/A		Created
09/16/2024	4.0.0	ELG.005.092	UPDATE	File segment	None	48
09/16/2024	4.0.0	ELG.005.092	ADD	N/A		Created
09/16/2024	4.0.0	ELG.005.091	UPDATE	File segment	None	48
09/16/2024	4.0.0	ELG.005.091	ADD	N/A		Created
09/16/2024	4.0.0	ELG.005.090	UPDATE	File segment	None	48
09/16/2024	4.0.0	ELG.005.090	ADD	N/A		Created
09/16/2024	4.0.0	ELG.005.089	UPDATE	File segment	None	48
09/16/2024	4.0.0	ELG.005.089	ADD	N/A		Created
09/16/2024	4.0.0	ELG.005.088	UPDATE	File segment	None	48
09/16/2024	4.0.0	ELG.005.088	ADD	N/A		Created
09/16/2024	4.0.0	ELG.005.087	UPDATE	File segment	None	48
09/16/2024	4.0.0	ELG.005.087	ADD	N/A		Created
09/16/2024	4.0.0	ELG.005.086	UPDATE	File segment	None	48
09/16/2024	4.0.0	ELG.005.086	ADD	N/A		Created
09/16/2024	4.0.0	ELG.005.085	UPDATE	File segment	None	48
09/16/2024	4.0.0	ELG.005.085	ADD	N/A		Created
09/16/2024	4.0.0	ELG.005.083	UPDATE	File segment	None	48
09/16/2024	4.0.0	ELG.005.083	ADD	N/A		Created
09/16/2024	4.0.0	ELG.005.082	UPDATE	File segment	None	48
09/16/2024	4.0.0	ELG.005.082	ADD	N/A		Created
09/16/2024	4.0.0	ELG.005.081	UPDATE	File segment	None	48
09/16/2024	4.0.0	ELG.005.081	ADD	N/A		Created
09/16/2024	4.0.0	ELG.005.080	UPDATE	File segment	None	48
09/16/2024	4.0.0	ELG.005.080	ADD	N/A		Created
09/16/2024	4.0.0	ELG.005.079	UPDATE	File segment	None	48
09/16/2024	4.0.0	ELG.005.079	ADD	N/A		Created
09/16/2024	4.0.0	ELG.004.077	UPDATE	File segment	None	47
09/16/2024	4.0.0	ELG.004.077	ADD	N/A		Created
09/16/2024	4.0.0	ELG.004.076	UPDATE	File segment	None	47
09/16/2024	4.0.0	ELG.004.076	ADD	N/A		Created
09/16/2024	4.0.0	ELG.004.075	UPDATE	File segment	None	47
09/16/2024	4.0.0	ELG.004.075	ADD	N/A		Created
09/16/2024	4.0.0	ELG.004.074	UPDATE	File segment	None	47
09/16/2024	4.0.0	ELG.004.074	ADD	N/A		Created
09/16/2024	4.0.0	ELG.004.073	UPDATE	File segment	None	47
09/16/2024	4.0.0	ELG.004.073	ADD	N/A		Created
09/16/2024	4.0.0	ELG.004.072	UPDATE	File segment	None	47
09/16/2024	4.0.0	ELG.004.072	ADD	N/A		Created
09/16/2024	4.0.0	ELG.004.071	UPDATE	File segment	None	47
09/16/2024	4.0.0	ELG.004.071	ADD	N/A		Created
09/16/2024	4.0.0	ELG.004.070	UPDATE	File segment	None	47
09/16/2024	4.0.0	ELG.004.070	ADD	N/A		Created
09/16/2024	4.0.0	ELG.004.069	UPDATE	File segment	None	47
09/16/2024	4.0.0	ELG.004.069	ADD	N/A		Created
09/16/2024	4.0.0	ELG.004.068	UPDATE	File segment	None	47
09/16/2024	4.0.0	ELG.004.068	ADD	N/A		Created
09/16/2024	4.0.0	ELG.004.067	UPDATE	File segment	None	47
09/16/2024	4.0.0	ELG.004.067	ADD	N/A		Created
09/16/2024	4.0.0	ELG.004.066	UPDATE	File segment	None	47
09/16/2024	4.0.0	ELG.004.066	ADD	N/A		Created
09/16/2024	4.0.0	ELG.004.065	UPDATE	File segment	None	47
09/16/2024	4.0.0	ELG.004.065	ADD	N/A		Created
09/16/2024	4.0.0	ELG.004.064	UPDATE	File segment	None	47
09/16/2024	4.0.0	ELG.004.064	ADD	N/A		Created
09/16/2024	4.0.0	ELG.004.063	UPDATE	File segment	None	47
09/16/2024	4.0.0	ELG.004.063	ADD	N/A		Created
09/16/2024	4.0.0	ELG.004.062	UPDATE	File segment	None	47
09/16/2024	4.0.0	ELG.004.062	ADD	N/A		Created
09/16/2024	4.0.0	ELG.004.061	UPDATE	File segment	None	47
09/16/2024	4.0.0	ELG.004.061	ADD	N/A		Created
09/16/2024	4.0.0	ELG.003.059	UPDATE	File segment	None	46
09/16/2024	4.0.0	ELG.003.059	ADD	N/A		Created
09/16/2024	4.0.0	ELG.003.273	UPDATE	File segment	None	46
09/16/2024	4.0.0	ELG.003.273	ADD	N/A		Created
09/16/2024	4.0.0	ELG.003.269	UPDATE	File segment	None	46
09/16/2024	4.0.0	ELG.003.269	ADD	N/A		Created
09/16/2024	4.0.0	ELG.003.058	UPDATE	File segment	None	46
09/16/2024	4.0.0	ELG.003.058	ADD	N/A		Created
09/16/2024	4.0.0	ELG.003.057	UPDATE	File segment	None	46
09/16/2024	4.0.0	ELG.003.057	ADD	N/A		Created
09/16/2024	4.0.0	ELG.003.054	UPDATE	File segment	None	46
09/16/2024	4.0.0	ELG.003.054	ADD	N/A		Created
09/16/2024	4.0.0	ELG.003.051	UPDATE	File segment	None	46
09/16/2024	4.0.0	ELG.003.051	ADD	N/A		Created
09/16/2024	4.0.0	ELG.003.050	UPDATE	File segment	None	46
09/16/2024	4.0.0	ELG.003.050	ADD	N/A		Created
09/16/2024	4.0.0	ELG.003.049	UPDATE	File segment	None	46
09/16/2024	4.0.0	ELG.003.049	ADD	N/A		Created
09/16/2024	4.0.0	ELG.003.047	UPDATE	File segment	None	46
09/16/2024	4.0.0	ELG.003.047	ADD	N/A		Created
09/16/2024	4.0.0	ELG.003.046	UPDATE	File segment	None	46
09/16/2024	4.0.0	ELG.003.046	ADD	N/A		Created
09/16/2024	4.0.0	ELG.003.045	UPDATE	File segment	None	46
09/16/2024	4.0.0	ELG.003.045	ADD	N/A		Created
09/16/2024	4.0.0	ELG.003.044	UPDATE	File segment	None	46
09/16/2024	4.0.0	ELG.003.044	ADD	N/A		Created
09/16/2024	4.0.0	ELG.003.043	UPDATE	File segment	None	46
09/16/2024	4.0.0	ELG.003.043	ADD	N/A		Created
09/16/2024	4.0.0	ELG.003.042	UPDATE	File segment	None	46
09/16/2024	4.0.0	ELG.003.042	ADD	N/A		Created
09/16/2024	4.0.0	ELG.003.041	UPDATE	File segment	None	46
09/16/2024	4.0.0	ELG.003.041	ADD	N/A		Created
09/16/2024	4.0.0	ELG.003.040	UPDATE	File segment	None	46
09/16/2024	4.0.0	ELG.003.040	ADD	N/A		Created
09/16/2024	4.0.0	ELG.003.039	UPDATE	File segment	None	46
09/16/2024	4.0.0	ELG.003.039	ADD	N/A		Created
09/16/2024	4.0.0	ELG.003.038	UPDATE	File segment	None	46
09/16/2024	4.0.0	ELG.003.038	ADD	N/A		Created
09/16/2024	4.0.0	ELG.003.037	UPDATE	File segment	None	46
09/16/2024	4.0.0	ELG.003.037	ADD	N/A		Created
09/16/2024	4.0.0	ELG.003.036	UPDATE	File segment	None	46
09/16/2024	4.0.0	ELG.003.036	ADD	N/A		Created
09/16/2024	4.0.0	ELG.003.035	UPDATE	File segment	None	46
09/16/2024	4.0.0	ELG.003.035	ADD	N/A		Created
09/16/2024	4.0.0	ELG.003.034	UPDATE	File segment	None	46
09/16/2024	4.0.0	ELG.003.034	ADD	N/A		Created
09/16/2024	4.0.0	ELG.003.033	UPDATE	File segment	None	46
09/16/2024	4.0.0	ELG.003.033	ADD	N/A		Created
09/16/2024	4.0.0	ELG.003.032	UPDATE	File segment	None	46
09/16/2024	4.0.0	ELG.003.032	ADD	N/A		Created
09/16/2024	4.0.0	ELG.003.031	UPDATE	File segment	None	46
09/16/2024	4.0.0	ELG.003.031	ADD	N/A		Created
09/16/2024	4.0.0	ELG.003.030	UPDATE	File segment	None	46
09/16/2024	4.0.0	ELG.003.030	ADD	N/A		Created
09/16/2024	4.0.0	ELG.002.028	UPDATE	File segment	None	45
09/16/2024	4.0.0	ELG.002.028	ADD	N/A		Created
09/16/2024	4.0.0	ELG.002.027	UPDATE	File segment	None	45
09/16/2024	4.0.0	ELG.002.027	ADD	N/A		Created
09/16/2024	4.0.0	ELG.002.026	UPDATE	File segment	None	45
09/16/2024	4.0.0	ELG.002.026	ADD	N/A		Created
09/16/2024	4.0.0	ELG.002.025	UPDATE	File segment	None	45
09/16/2024	4.0.0	ELG.002.025	ADD	N/A		Created
09/16/2024	4.0.0	ELG.002.024	UPDATE	File segment	None	45
09/16/2024	4.0.0	ELG.002.024	ADD	N/A		Created
09/16/2024	4.0.0	ELG.002.023	ADD	N/A		Created
09/16/2024	4.0.0	ELG.002.022	UPDATE	File segment	None	45
09/16/2024	4.0.0	ELG.002.022	ADD	N/A		Created
09/16/2024	4.0.0	ELG.002.021	UPDATE	File segment	None	45
09/16/2024	4.0.0	ELG.002.021	ADD	N/A		Created
09/16/2024	4.0.0	ELG.002.020	UPDATE	File segment	None	45
09/16/2024	4.0.0	ELG.002.020	ADD	N/A		Created
09/16/2024	4.0.0	ELG.002.019	UPDATE	File segment	None	45
09/16/2024	4.0.0	ELG.002.019	ADD	N/A		Created
09/16/2024	4.0.0	ELG.002.018	UPDATE	File segment	None	45
09/16/2024	4.0.0	ELG.002.018	ADD	N/A		Created
09/16/2024	4.0.0	ELG.002.017	UPDATE	File segment	None	45
09/16/2024	4.0.0	ELG.002.017	ADD	N/A		Created
09/16/2024	4.0.0	ELG.002.016	UPDATE	File segment	None	45
09/16/2024	4.0.0	ELG.002.016	ADD	N/A		Created
09/16/2024	4.0.0	ELG.001.014	UPDATE	File segment	None	44
09/16/2024	4.0.0	ELG.001.014	ADD	N/A		Created
09/16/2024	4.0.0	ELG.001.247	UPDATE	File segment	None	44
09/16/2024	4.0.0	ELG.001.247	ADD	N/A		Created
09/16/2024	4.0.0	ELG.001.272	UPDATE	File segment	None	44
09/16/2024	4.0.0	ELG.001.272	ADD	N/A		Created
09/16/2024	4.0.0	ELG.001.013	UPDATE	File segment	None	44
09/16/2024	4.0.0	ELG.001.013	ADD	N/A		Created
09/16/2024	4.0.0	ELG.001.012	UPDATE	File segment	None	44
09/16/2024	4.0.0	ELG.001.012	ADD	N/A		Created
09/16/2024	4.0.0	ELG.001.011	UPDATE	File segment	None	44
09/16/2024	4.0.0	ELG.001.011	ADD	N/A		Created
09/16/2024	4.0.0	ELG.001.010	UPDATE	File segment	None	44
09/16/2024	4.0.0	ELG.001.010	ADD	N/A		Created
09/16/2024	4.0.0	ELG.001.009	UPDATE	File segment	None	44
09/16/2024	4.0.0	ELG.001.009	ADD	N/A		Created
09/16/2024	4.0.0	ELG.001.008	UPDATE	File segment	None	44
09/16/2024	4.0.0	ELG.001.008	ADD	N/A		Created
09/16/2024	4.0.0	ELG.001.007	UPDATE	File segment	None	44
09/16/2024	4.0.0	ELG.001.007	ADD	N/A		Created
09/16/2024	4.0.0	ELG.001.006	UPDATE	File segment	None	44
09/16/2024	4.0.0	ELG.001.006	ADD	N/A		Created
09/16/2024	4.0.0	ELG.001.005	UPDATE	File segment	None	44
09/16/2024	4.0.0	ELG.001.005	ADD	N/A		Created
09/16/2024	4.0.0	ELG.001.004	UPDATE	File segment	None	44
09/16/2024	4.0.0	ELG.001.004	ADD	N/A		Created
09/16/2024	4.0.0	ELG.001.003	UPDATE	File segment	None	44
09/16/2024	4.0.0	ELG.001.003	ADD	N/A		Created
09/16/2024	4.0.0	ELG.001.002	UPDATE	File segment	None	44
09/16/2024	4.0.0	ELG.001.002	ADD	N/A		Created
09/16/2024	4.0.0	ELG.001.001	UPDATE	File segment	None	44
09/16/2024	4.0.0	ELG.001.001	ADD	N/A		Created
09/16/2024	4.0.0	CRX.004.207	UPDATE	File segment	None	42
09/16/2024	4.0.0	CRX.004.207	ADD	N/A		Created
09/16/2024	4.0.0	CRX.004.206	UPDATE	File segment	None	42
09/16/2024	4.0.0	CRX.004.206	ADD	N/A		Created
09/16/2024	4.0.0	CRX.004.205	UPDATE	File segment	None	42
09/16/2024	4.0.0	CRX.004.205	ADD	N/A		Created
09/16/2024	4.0.0	CRX.004.204	UPDATE	File segment	None	42
09/16/2024	4.0.0	CRX.004.204	ADD	N/A		Created
09/16/2024	4.0.0	CRX.004.203	UPDATE	File segment	None	42
09/16/2024	4.0.0	CRX.004.203	ADD	N/A		Created
09/16/2024	4.0.0	CRX.004.202	UPDATE	File segment	None	42
09/16/2024	4.0.0	CRX.004.202	ADD	N/A		Created
09/16/2024	4.0.0	CRX.004.201	UPDATE	File segment	None	42
09/16/2024	4.0.0	CRX.004.201	ADD	N/A		Created
09/16/2024	4.0.0	CRX.004.200	UPDATE	File segment	None	42
09/16/2024	4.0.0	CRX.004.200	ADD	N/A		Created
09/16/2024	4.0.0	CRX.004.199	UPDATE	File segment	None	42
09/16/2024	4.0.0	CRX.004.199	ADD	N/A		Created
09/16/2024	4.0.0	CRX.004.198	UPDATE	File segment	None	42
09/16/2024	4.0.0	CRX.004.198	ADD	N/A		Created
09/16/2024	4.0.0	CRX.004.197	UPDATE	File segment	None	42
09/16/2024	4.0.0	CRX.004.197	ADD	N/A		Created
09/16/2024	4.0.0	CRX.004.196	UPDATE	File segment	None	42
09/16/2024	4.0.0	CRX.004.196	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.153	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.153	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.195	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.195	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.194	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.194	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.193	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.193	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.192	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.192	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.191	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.191	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.190	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.190	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.189	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.189	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.188	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.188	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.187	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.187	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.186	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.186	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.185	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.185	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.184	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.184	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.183	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.183	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.182	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.182	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.180	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.180	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.181	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.181	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.209	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.209	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.179	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.179	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.172	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.172	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.171	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.171	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.170	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.170	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.169	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.169	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.168	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.168	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.167	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.167	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.159	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.159	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.158	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.158	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.157	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.157	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.152	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.152	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.149	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.149	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.146	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.146	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.145	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.145	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.144	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.144	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.143	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.143	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.142	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.142	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.141	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.141	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.140	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.140	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.139	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.139	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.138	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.138	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.137	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.137	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.136	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.136	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.135	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.135	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.134	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.134	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.133	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.133	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.132	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.132	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.131	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.131	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.129	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.129	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.128	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.128	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.127	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.127	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.126	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.126	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.125	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.125	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.124	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.124	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.123	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.123	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.122	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.122	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.121	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.121	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.120	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.120	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.119	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.119	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.118	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.118	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.117	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.117	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.116	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.116	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.115	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.115	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.114	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.114	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.113	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.113	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.112	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.112	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.111	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.111	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.110	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.110	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.109	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.109	ADD	N/A		Created
09/16/2024	4.0.0	CRX.003.108	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.108	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.106	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.106	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.178	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.178	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.177	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.177	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.176	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.176	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.175	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.175	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.174	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.174	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.173	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.173	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.166	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.166	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.165	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.165	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.164	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.164	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.163	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.163	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.162	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.162	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.161	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.161	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.160	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.160	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.156	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.156	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.105	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.105	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.104	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.104	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.102	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.102	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.101	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.101	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.100	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.100	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.099	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.099	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.098	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.098	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.096	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.096	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.095	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.095	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.094	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.094	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.093	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.093	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.092	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.092	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.090	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.090	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.089	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.089	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.088	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.088	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.087	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.087	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.086	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.086	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.085	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.085	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.084	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.084	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.082	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.082	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.081	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.081	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.079	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.079	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.075	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.075	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.074	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.074	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.073	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.073	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.072	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.072	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.071	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.071	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.070	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.070	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.069	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.069	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.068	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.068	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.067	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.067	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.066	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.066	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.065	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.065	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.064	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.064	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.063	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.063	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.062	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.062	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.061	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.061	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.060	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.060	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.059	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.059	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.058	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.058	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.056	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.056	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.055	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.055	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.054	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.054	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.053	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.053	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.052	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.052	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.049	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.049	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.048	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.048	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.047	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.047	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.045	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.045	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.044	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.044	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.043	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.043	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.041	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.041	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.040	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.040	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.039	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.039	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.038	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.038	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.037	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.037	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.036	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.036	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.035	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.035	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.034	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.034	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.033	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.033	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.032	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.032	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.031	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.031	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.030	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.030	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.029	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.029	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.028	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.028	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.027	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.027	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.026	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.026	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.025	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.025	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.024	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.024	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.023	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.023	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.022	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.022	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.021	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.021	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.020	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.020	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.019	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.019	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.018	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.018	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.017	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.017	ADD	N/A		Created
09/16/2024	4.0.0	CRX.002.016	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.016	ADD	N/A		Created
09/16/2024	4.0.0	CRX.001.014	UPDATE	File segment	None	39
09/16/2024	4.0.0	CRX.001.014	ADD	N/A		Created
09/16/2024	4.0.0	CRX.001.155	UPDATE	File segment	None	39
09/16/2024	4.0.0	CRX.001.155	ADD	N/A		Created
09/16/2024	4.0.0	CRX.001.013	UPDATE	File segment	None	39
09/16/2024	4.0.0	CRX.001.013	ADD	N/A		Created
09/16/2024	4.0.0	CRX.001.012	UPDATE	File segment	None	39
09/16/2024	4.0.0	CRX.001.012	ADD	N/A		Created
09/16/2024	4.0.0	CRX.001.011	UPDATE	File segment	None	39
09/16/2024	4.0.0	CRX.001.011	ADD	N/A		Created
09/16/2024	4.0.0	CRX.001.010	UPDATE	File segment	None	39
09/16/2024	4.0.0	CRX.001.010	ADD	N/A		Created
09/16/2024	4.0.0	CRX.001.009	UPDATE	File segment	None	39
09/16/2024	4.0.0	CRX.001.009	ADD	N/A		Created
09/16/2024	4.0.0	CRX.001.008	UPDATE	File segment	None	39
09/16/2024	4.0.0	CRX.001.008	ADD	N/A		Created
09/16/2024	4.0.0	CRX.001.007	UPDATE	File segment	None	39
09/16/2024	4.0.0	CRX.001.007	ADD	N/A		Created
09/16/2024	4.0.0	CRX.001.006	UPDATE	File segment	None	39
09/16/2024	4.0.0	CRX.001.006	ADD	N/A		Created
09/16/2024	4.0.0	CRX.001.005	UPDATE	File segment	None	39
09/16/2024	4.0.0	CRX.001.005	ADD	N/A		Created
09/16/2024	4.0.0	CRX.001.004	UPDATE	File segment	None	39
09/16/2024	4.0.0	CRX.001.004	ADD	N/A		Created
09/16/2024	4.0.0	CRX.001.003	UPDATE	File segment	None	39
09/16/2024	4.0.0	CRX.001.003	ADD	N/A		Created
09/16/2024	4.0.0	CRX.001.002	UPDATE	File segment	None	39
09/16/2024	4.0.0	CRX.001.002	ADD	N/A		Created
09/16/2024	4.0.0	CRX.001.001	UPDATE	File segment	None	39
09/16/2024	4.0.0	CRX.001.001	ADD	N/A		Created
10/08/2024	4.0.0	COT.004.285	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/16/2024	4.0.0	COT.004.285	UPDATE	File segment	None	37
09/16/2024	4.0.0	COT.004.285	ADD	N/A		Created
10/08/2024	4.0.0	COT.004.284	UPDATE	Coding requirement	1. Value must be a minimum of 3 characters2. If associated Diagnosis Code Flag value equals "1" (ICD-9), then value must be in ICD-9 Diagnosis Code List (VVL)3. If associated Diagnosis Code Flag value equals "2" (ICD-10), then value must be in ICD-10 Diagnosis Code List (VVL)4. Value must not contain a decimal point5. Mandatory1. Value must be a minimum of 3 characters2. If associated Diagnosis Code Flag value equals "1" (ICD-9), then value must be in ICD-9 Diagnosis Code List (VVL)3. If associated Diagnosis Code Flag value equals "2" (ICD-10), then value must be in ICD-10 Diagnosis Code List (VVL)4. Value must not contain a decimal point5. Mandatory	1. Value must be a minimum of 3 characters2. If associated Diagnosis Code Flag value equals "1" (ICD-9), then value must be in ICD-9 Diagnosis Code List (VVL)3. If associated Diagnosis Code Flag value equals "2" (ICD-10), then value must be in ICD-10 Diagnosis Code List (VVL)4. Value must not contain a decimal point5. Mandatory
09/16/2024	4.0.0	COT.004.284	UPDATE	File segment	None	37
09/16/2024	4.0.0	COT.004.284	ADD	N/A		Created
10/08/2024	4.0.0	COT.004.283	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Diagnosis Code Flag List (VVL)3. Mandatory1. Value must be 1 character2. Value must be in Diagnosis Code Flag List (VVL)3. Mandatory	1. Value must be 1 character2. Value must be in Diagnosis Code Flag List (VVL)3. Mandatory
09/16/2024	4.0.0	COT.004.283	UPDATE	File segment	None	37
09/16/2024	4.0.0	COT.004.283	ADD	N/A		Created
10/08/2024	4.0.0	COT.004.282	UPDATE	Coding requirement	1. Value must be in [01-24]2. Mandatory1. Value must be in [01-24]2. Mandatory	1. Value must be in [01-24]2. Mandatory
09/16/2024	4.0.0	COT.004.282	UPDATE	File segment	None	37
09/16/2024	4.0.0	COT.004.282	ADD	N/A		Created
10/08/2024	4.0.0	COT.004.281	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Diagnosis Type Code List (VVL)3. Value must be in [P,A,E,O]4. Mandatory1. Value must be 1 character2. Value must be in Diagnosis Type Code List (VVL)3. Value must be in [P,A,E,O]4. Mandatory	1. Value must be 1 character2. Value must be in Diagnosis Type Code List (VVL)3. Value must be in [P,A,E,O]4. Mandatory
09/16/2024	4.0.0	COT.004.281	UPDATE	File segment	None	37
09/16/2024	4.0.0	COT.004.281	ADD	N/A		Created
10/08/2024	4.0.0	COT.004.280	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (COT.001.010)3. Mandatory4. Value should be on or after associated Admission Date value1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (COT.001.010)3. Mandatory4. Value should be on or after associated Admission Date value	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (COT.001.010)3. Mandatory4. Value should be on or after associated Admission Date value
09/16/2024	4.0.0	COT.004.280	UPDATE	File segment	None	37
09/16/2024	4.0.0	COT.004.280	ADD	N/A		Created
10/08/2024	4.0.0	COT.004.279	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Adjustment Indicator List (VVL)3. Value must be in [0,1,4]4. Mandatory5. If value equals "0", then associated Adjustment ICN must not be populated6. Value must equal "1", when associated Claim Status equals "686"7. Value must match the adjustment indicator in the header (COT.002.025)1. Value must be 1 character2. Value must be in Adjustment Indicator List (VVL)3. Value must be in [0,1,4]4. Mandatory5. If value equals "0", then associated Adjustment ICN must not be populated6. Value must equal "1", when associated Claim Status equals "686"7. Value must match the adjustment indicator in the header (COT.002.025)	1. Value must be 1 character2. Value must be in Adjustment Indicator List (VVL)3. Value must be in [0,1,4]4. Mandatory5. If value equals "0", then associated Adjustment ICN must not be populated6. Value must equal "1", when associated Claim Status equals "686"7. Value must match the adjustment indicator in the header (COT.002.025)
09/16/2024	4.0.0	COT.004.279	UPDATE	File segment	None	37
09/16/2024	4.0.0	COT.004.279	ADD	N/A		Created
10/08/2024	4.0.0	COT.004.278	UPDATE	Coding requirement	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated
09/16/2024	4.0.0	COT.004.278	UPDATE	File segment	None	37
09/16/2024	4.0.0	COT.004.278	ADD	N/A		Created
10/08/2024	4.0.0	COT.004.277	UPDATE	Coding requirement	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. Mandatory1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. Mandatory	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. Mandatory
09/16/2024	4.0.0	COT.004.277	UPDATE	File segment	None	37
09/16/2024	4.0.0	COT.004.277	ADD	N/A		Created
10/08/2024	4.0.0	COT.004.276	UPDATE	Coding requirement	1. Value must be 11 digits or less2. Value must be unique within record segment over all records associated with a given Record ID3. Mandatory1. Value must be 11 digits or less2. Value must be unique within record segment over all records associated with a given Record ID3. Mandatory	1. Value must be 11 digits or less2. Value must be unique within record segment over all records associated with a given Record ID3. Mandatory
09/16/2024	4.0.0	COT.004.276	UPDATE	File segment	None	37
09/16/2024	4.0.0	COT.004.276	ADD	N/A		Created
10/08/2024	4.0.0	COT.004.275	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in State Code List (VVL)3. Mandatory4. Value must be the same as Submitting State (COT.001.007)1. Value must be 2 characters2. Value must be in State Code List (VVL)3. Mandatory4. Value must be the same as Submitting State (COT.001.007)	1. Value must be 2 characters2. Value must be in State Code List (VVL)3. Mandatory4. Value must be the same as Submitting State (COT.001.007)
09/16/2024	4.0.0	COT.004.275	UPDATE	File segment	None	37
09/16/2024	4.0.0	COT.004.275	ADD	N/A		Created
10/08/2024	4.0.0	COT.004.274	UPDATE	Coding requirement	1. Value must be 8 characters2. Mandatory3. Value must be in Record ID List (VVL)4. Value must equal "COT00004"1. Value must be 8 characters2. Mandatory3. Value must be in Record ID List (VVL)4. Value must equal "COT00004"	1. Value must be 8 characters2. Mandatory3. Value must be in Record ID List (VVL)4. Value must equal "COT00004"
09/16/2024	4.0.0	COT.004.274	UPDATE	File segment	None	37
09/16/2024	4.0.0	COT.004.274	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.214	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.214	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.273	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.273	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.272	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.272	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.271	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.271	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.270	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.270	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.269	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.269	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.268	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.268	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.267	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.267	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.266	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.266	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.265	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.265	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.264	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.264	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.263	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.263	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.262	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.262	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.261	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.261	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.260	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.260	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.259	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.259	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.258	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.258	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.256	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.256	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.257	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.257	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.290	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.290	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.255	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.255	ADD	N/A		Created
03/14/2025	4.0.4	COT.003.289	UPDATE	Coding requirement	1. Value must be numeric2. Value must not be more than 2 digits long3. Value must be between 1 and 124. Conditional	1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Conditional
09/16/2024	4.0.0	COT.003.289	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.289	ADD	N/A		Created
03/14/2025	4.0.4	COT.003.288	UPDATE	Coding requirement	1. Value must be numeric2. Value must not be more than 2 digits long3. Value must be between 1 and 124. Conditional	1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Conditional
09/16/2024	4.0.0	COT.003.288	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.288	ADD	N/A		Created
03/14/2025	4.0.4	COT.003.287	UPDATE	Coding requirement	1. Value must be numeric2. Value must not be more than 2 digits long3. Value must be between 1 and 124. Conditional	1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Conditional
09/16/2024	4.0.0	COT.003.287	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.287	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.254	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.254	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.234	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.234	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.225	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.225	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.224	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.224	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.223	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.223	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.222	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.222	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.221	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.221	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.219	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.219	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.218	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.218	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.227	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.227	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.217	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.217	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.213	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.213	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.210	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.210	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.208	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.208	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.207	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.207	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.206	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.206	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.205	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.205	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.204	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.204	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.203	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.203	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.202	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.202	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.201	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.201	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.200	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.200	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.199	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.199	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.198	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.198	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.197	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.197	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.196	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.196	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.195	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.195	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.194	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.194	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.193	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.193	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.192	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.192	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.191	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.191	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.190	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.190	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.189	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.189	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.188	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.188	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.187	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.187	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.186	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.186	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.184	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.184	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.183	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.183	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.182	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.182	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.179	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.179	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.178	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.178	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.177	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.177	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.176	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.176	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.175	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.175	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.174	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.174	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.172	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.172	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.171	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.171	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.170	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.170	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.169	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.169	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.168	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.168	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.167	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.167	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.166	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.166	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.165	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.165	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.164	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.164	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.163	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.163	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.162	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.162	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.161	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.161	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.160	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.160	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.159	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.159	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.158	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.158	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.157	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.157	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.156	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.156	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.155	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.155	ADD	N/A		Created
09/16/2024	4.0.0	COT.003.154	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.154	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.152	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.152	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.253	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.253	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.252	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.252	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.251	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.251	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.250	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.250	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.249	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.249	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.248	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.248	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.247	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.247	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.246	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.246	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.245	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.245	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.244	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.244	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.243	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.243	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.242	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.242	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.241	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.241	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.240	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.240	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.239	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.239	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.238	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.238	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.237	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.237	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.236	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.236	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.235	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.235	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.233	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.233	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.232	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.232	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.231	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.231	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.230	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.230	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.226	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.226	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.147	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.147	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.146	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.146	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.143	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.143	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.142	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.142	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.141	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.141	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.140	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.140	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.138	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.138	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.137	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.137	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.136	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.136	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.135	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.135	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.134	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.134	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.133	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.133	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.132	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.132	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.131	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.131	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.130	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.130	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.128	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.128	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.127	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.127	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.126	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.126	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.123	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.123	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.122	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.122	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.118	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.118	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.117	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.117	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.116	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.116	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.115	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.115	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.114	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.114	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.113	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.113	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.112	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.112	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.111	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.111	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.110	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.110	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.109	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.109	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.108	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.108	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.107	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.107	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.106	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.106	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.105	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.105	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.104	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.104	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.103	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.103	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.102	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.102	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.101	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.101	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.100	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.100	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.099	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.099	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.098	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.098	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.097	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.097	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.096	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.096	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.095	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.095	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.094	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.094	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.093	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.093	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.092	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.092	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.091	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.091	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.090	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.090	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.089	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.089	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.088	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.088	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.087	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.087	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.086	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.086	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.085	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.085	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.084	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.084	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.083	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.083	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.082	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.082	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.081	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.081	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.080	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.080	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.079	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.079	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.078	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.078	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.077	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.077	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.076	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.076	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.075	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.075	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.074	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.074	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.073	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.073	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.072	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.072	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.070	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.070	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.069	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.069	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.068	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.068	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.066	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.066	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.065	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.065	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.064	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.064	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.063	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.063	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.062	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.062	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.061	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.061	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.058	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.058	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.057	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.057	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.056	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.056	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.054	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.054	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.053	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.053	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.052	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.052	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.050	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.050	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.049	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.049	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.048	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.048	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.047	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.047	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.046	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.046	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.045	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.045	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.044	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.044	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.043	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.043	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.042	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.042	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.041	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.041	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.040	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.040	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.039	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.039	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.038	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.038	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.037	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.037	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.036	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.036	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.035	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.035	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.034	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.034	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.033	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.033	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.026	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.026	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.025	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.025	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.024	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.024	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.023	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.023	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.022	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.022	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.021	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.021	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.020	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.020	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.019	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.019	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.018	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.018	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.017	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.017	ADD	N/A		Created
09/16/2024	4.0.0	COT.002.016	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.016	ADD	N/A		Created
09/16/2024	4.0.0	COT.001.014	UPDATE	File segment	None	34
09/16/2024	4.0.0	COT.001.014	ADD	N/A		Created
09/16/2024	4.0.0	COT.001.216	UPDATE	File segment	None	34
09/16/2024	4.0.0	COT.001.216	ADD	N/A		Created
09/16/2024	4.0.0	COT.001.013	UPDATE	File segment	None	34
09/16/2024	4.0.0	COT.001.013	ADD	N/A		Created
09/16/2024	4.0.0	COT.001.012	UPDATE	File segment	None	34
09/16/2024	4.0.0	COT.001.012	ADD	N/A		Created
09/16/2024	4.0.0	COT.001.011	UPDATE	File segment	None	34
09/16/2024	4.0.0	COT.001.011	ADD	N/A		Created
09/16/2024	4.0.0	COT.001.010	UPDATE	File segment	None	34
09/16/2024	4.0.0	COT.001.010	ADD	N/A		Created
09/16/2024	4.0.0	COT.001.009	UPDATE	File segment	None	34
09/16/2024	4.0.0	COT.001.009	ADD	N/A		Created
09/16/2024	4.0.0	COT.001.008	UPDATE	File segment	None	34
09/16/2024	4.0.0	COT.001.008	ADD	N/A		Created
09/16/2024	4.0.0	COT.001.007	UPDATE	File segment	None	34
09/16/2024	4.0.0	COT.001.007	ADD	N/A		Created
09/16/2024	4.0.0	COT.001.006	UPDATE	File segment	None	34
09/16/2024	4.0.0	COT.001.006	ADD	N/A		Created
09/16/2024	4.0.0	COT.001.005	UPDATE	File segment	None	34
09/16/2024	4.0.0	COT.001.005	ADD	N/A		Created
09/16/2024	4.0.0	COT.001.004	UPDATE	File segment	None	34
09/16/2024	4.0.0	COT.001.004	ADD	N/A		Created
09/16/2024	4.0.0	COT.001.003	UPDATE	File segment	None	34
09/16/2024	4.0.0	COT.001.003	ADD	N/A		Created
09/16/2024	4.0.0	COT.001.002	UPDATE	File segment	None	34
09/16/2024	4.0.0	COT.001.002	ADD	N/A		Created
09/16/2024	4.0.0	COT.001.001	UPDATE	File segment	None	34
09/16/2024	4.0.0	COT.001.001	ADD	N/A		Created
09/16/2024	4.0.0	CLT.004.280	UPDATE	File segment	None	32
09/16/2024	4.0.0	CLT.004.280	ADD	N/A		Created
09/16/2024	4.0.0	CLT.004.279	UPDATE	File segment	None	32
09/16/2024	4.0.0	CLT.004.279	ADD	N/A		Created
09/16/2024	4.0.0	CLT.004.278	UPDATE	File segment	None	32
09/16/2024	4.0.0	CLT.004.278	ADD	N/A		Created
09/16/2024	4.0.0	CLT.004.277	UPDATE	File segment	None	32
09/16/2024	4.0.0	CLT.004.277	ADD	N/A		Created
09/16/2024	4.0.0	CLT.004.276	UPDATE	File segment	None	32
09/16/2024	4.0.0	CLT.004.276	ADD	N/A		Created
09/16/2024	4.0.0	CLT.004.275	UPDATE	File segment	None	32
09/16/2024	4.0.0	CLT.004.275	ADD	N/A		Created
09/16/2024	4.0.0	CLT.004.274	UPDATE	File segment	None	32
09/16/2024	4.0.0	CLT.004.274	ADD	N/A		Created
09/16/2024	4.0.0	CLT.004.273	UPDATE	File segment	None	32
09/16/2024	4.0.0	CLT.004.273	ADD	N/A		Created
09/16/2024	4.0.0	CLT.004.272	UPDATE	File segment	None	32
09/16/2024	4.0.0	CLT.004.272	ADD	N/A		Created
09/16/2024	4.0.0	CLT.004.271	UPDATE	File segment	None	32
09/16/2024	4.0.0	CLT.004.271	ADD	N/A		Created
09/16/2024	4.0.0	CLT.004.270	UPDATE	File segment	None	32
09/16/2024	4.0.0	CLT.004.270	ADD	N/A		Created
09/16/2024	4.0.0	CLT.004.269	UPDATE	File segment	None	32
09/16/2024	4.0.0	CLT.004.269	ADD	N/A		Created
09/16/2024	4.0.0	CLT.004.268	UPDATE	File segment	None	32
09/16/2024	4.0.0	CLT.004.268	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.226	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.226	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.267	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.267	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.266	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.266	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.265	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.265	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.264	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.264	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.263	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.263	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.261	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.261	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.262	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.262	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.282	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.282	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.260	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.260	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.243	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.243	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.235	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.235	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.234	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.234	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.233	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.233	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.230	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.230	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.229	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.229	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.228	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.228	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.221	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.221	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.219	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.219	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.217	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.217	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.216	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.216	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.215	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.215	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.213	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.213	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.212	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.212	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.211	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.211	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.210	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.210	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.209	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.209	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.208	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.208	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.207	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.207	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.206	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.206	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.205	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.205	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.204	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.204	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.203	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.203	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.202	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.202	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.198	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.198	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.197	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.197	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.196	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.196	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.195	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.195	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.194	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.194	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.193	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.193	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.192	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.192	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.191	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.191	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.190	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.190	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.189	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.189	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.188	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.188	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.187	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.187	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.186	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.186	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.185	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.185	ADD	N/A		Created
09/16/2024	4.0.0	CLT.003.184	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.184	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.173	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.173	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.259	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.259	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.258	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.258	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.257	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.257	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.256	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.256	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.255	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.255	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.254	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.254	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.253	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.253	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.252	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.252	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.251	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.251	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.250	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.250	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.249	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.249	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.248	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.248	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.247	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.247	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.246	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.246	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.245	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.245	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.244	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.244	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.242	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.242	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.241	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.241	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.240	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.240	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.239	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.239	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.237	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.237	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.179	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.179	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.178	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.178	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.177	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.177	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.176	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.176	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.175	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.175	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.174	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.174	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.168	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.168	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.167	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.167	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.166	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.166	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.165	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.165	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.164	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.164	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.163	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.163	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.161	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.161	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.160	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.160	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.159	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.159	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.158	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.158	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.157	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.157	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.156	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.156	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.155	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.155	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.154	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.154	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.153	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.153	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.151	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.151	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.150	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.150	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.149	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.149	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.148	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.148	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.147	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.147	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.145	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.145	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.144	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.144	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.141	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.141	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.140	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.140	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.136	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.136	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.135	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.135	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.134	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.134	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.133	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.133	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.132	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.132	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.131	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.131	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.130	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.130	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.129	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.129	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.128	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.128	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.127	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.127	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.126	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.126	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.125	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.125	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.124	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.124	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.123	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.123	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.122	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.122	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.121	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.121	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.120	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.120	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.119	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.119	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.118	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.118	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.117	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.117	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.116	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.116	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.115	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.115	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.114	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.114	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.113	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.113	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.112	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.112	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.111	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.111	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.110	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.110	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.109	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.109	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.108	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.108	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.107	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.107	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.106	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.106	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.105	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.105	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.104	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.104	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.103	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.103	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.102	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.102	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.101	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.101	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.100	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.100	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.099	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.099	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.098	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.098	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.097	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.097	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.096	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.096	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.095	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.095	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.094	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.094	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.093	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.093	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.092	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.092	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.091	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.091	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.090	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.090	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.087	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.087	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.086	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.086	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.085	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.085	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.084	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.084	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.083	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.083	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.082	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.082	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.080	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.080	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.079	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.079	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.078	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.078	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.077	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.077	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.076	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.076	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.075	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.075	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.072	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.072	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.071	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.071	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.070	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.070	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.069	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.069	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.068	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.068	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.067	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.067	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.065	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.065	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.064	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.064	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.063	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.063	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.062	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.062	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.061	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.061	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.060	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.060	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.059	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.059	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.058	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.058	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.057	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.057	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.056	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.056	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.055	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.055	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.054	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.054	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.053	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.053	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.052	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.052	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.051	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.051	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.050	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.050	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.049	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.049	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.048	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.048	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.047	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.047	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.046	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.046	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.045	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.045	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.044	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.044	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.026	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.026	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.025	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.025	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.024	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.024	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.023	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.023	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.022	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.022	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.021	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.021	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.020	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.020	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.019	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.019	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.018	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.018	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.017	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.017	ADD	N/A		Created
09/16/2024	4.0.0	CLT.002.016	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.016	ADD	N/A		Created
09/16/2024	4.0.0	CLT.001.014	UPDATE	File segment	None	29
09/16/2024	4.0.0	CLT.001.014	ADD	N/A		Created
09/16/2024	4.0.0	CLT.001.227	UPDATE	File segment	None	29
09/16/2024	4.0.0	CLT.001.227	ADD	N/A		Created
09/16/2024	4.0.0	CLT.001.013	UPDATE	File segment	None	29
09/16/2024	4.0.0	CLT.001.013	ADD	N/A		Created
09/16/2024	4.0.0	CLT.001.012	UPDATE	File segment	None	29
09/16/2024	4.0.0	CLT.001.012	ADD	N/A		Created
09/16/2024	4.0.0	CLT.001.011	UPDATE	File segment	None	29
09/16/2024	4.0.0	CLT.001.011	ADD	N/A		Created
09/16/2024	4.0.0	CLT.001.010	UPDATE	File segment	None	29
09/16/2024	4.0.0	CLT.001.010	ADD	N/A		Created
09/16/2024	4.0.0	CLT.001.009	UPDATE	File segment	None	29
09/16/2024	4.0.0	CLT.001.009	ADD	N/A		Created
09/16/2024	4.0.0	CLT.001.008	UPDATE	File segment	None	29
09/16/2024	4.0.0	CLT.001.008	ADD	N/A		Created
09/16/2024	4.0.0	CLT.001.007	UPDATE	File segment	None	29
09/16/2024	4.0.0	CLT.001.007	ADD	N/A		Created
09/16/2024	4.0.0	CLT.001.006	UPDATE	File segment	None	29
09/16/2024	4.0.0	CLT.001.006	ADD	N/A		Created
09/16/2024	4.0.0	CLT.001.005	UPDATE	File segment	None	29
09/16/2024	4.0.0	CLT.001.005	ADD	N/A		Created
09/16/2024	4.0.0	CLT.001.004	UPDATE	File segment	None	29
09/16/2024	4.0.0	CLT.001.004	ADD	N/A		Created
09/16/2024	4.0.0	CLT.001.003	UPDATE	File segment	None	29
09/16/2024	4.0.0	CLT.001.003	ADD	N/A		Created
09/16/2024	4.0.0	CLT.001.002	UPDATE	File segment	None	29
09/16/2024	4.0.0	CLT.001.002	ADD	N/A		Created
09/16/2024	4.0.0	CLT.001.001	UPDATE	File segment	None	29
09/16/2024	4.0.0	CLT.001.001	ADD	N/A		Created
09/16/2024	4.0.0	CIP.004.334	UPDATE	File segment	None	27
09/16/2024	4.0.0	CIP.004.334	ADD	N/A		Created
09/16/2024	4.0.0	CIP.004.333	UPDATE	File segment	None	27
09/16/2024	4.0.0	CIP.004.333	ADD	N/A		Created
09/16/2024	4.0.0	CIP.004.332	UPDATE	File segment	None	27
09/16/2024	4.0.0	CIP.004.332	ADD	N/A		Created
09/16/2024	4.0.0	CIP.004.331	UPDATE	File segment	None	27
09/16/2024	4.0.0	CIP.004.331	ADD	N/A		Created
09/16/2024	4.0.0	CIP.004.330	UPDATE	File segment	None	27
09/16/2024	4.0.0	CIP.004.330	ADD	N/A		Created
09/16/2024	4.0.0	CIP.004.329	UPDATE	File segment	None	27
09/16/2024	4.0.0	CIP.004.329	ADD	N/A		Created
09/16/2024	4.0.0	CIP.004.328	UPDATE	File segment	None	27
09/16/2024	4.0.0	CIP.004.328	ADD	N/A		Created
09/16/2024	4.0.0	CIP.004.327	UPDATE	File segment	None	27
09/16/2024	4.0.0	CIP.004.327	ADD	N/A		Created
09/16/2024	4.0.0	CIP.004.326	UPDATE	File segment	None	27
09/16/2024	4.0.0	CIP.004.326	ADD	N/A		Created
09/16/2024	4.0.0	CIP.004.325	UPDATE	File segment	None	27
09/16/2024	4.0.0	CIP.004.325	ADD	N/A		Created
09/16/2024	4.0.0	CIP.004.324	UPDATE	File segment	None	27
09/16/2024	4.0.0	CIP.004.324	ADD	N/A		Created
09/16/2024	4.0.0	CIP.004.323	UPDATE	File segment	None	27
09/16/2024	4.0.0	CIP.004.323	ADD	N/A		Created
09/16/2024	4.0.0	CIP.004.322	UPDATE	File segment	None	27
09/16/2024	4.0.0	CIP.004.322	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.273	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.273	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.337	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.337	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.336	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.336	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.319	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.319	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.318	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.318	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.317	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.317	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.315	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.315	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.316	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.316	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.340	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.340	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.314	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.314	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.296	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.296	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.288	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.288	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.287	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.287	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.286	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.286	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.285	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.285	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.284	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.284	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.278	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.278	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.272	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.272	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.269	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.269	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.267	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.267	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.266	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.266	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.265	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.265	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.264	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.264	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.263	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.263	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.261	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.261	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.260	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.260	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.257	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.257	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.256	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.256	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.255	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.255	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.254	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.254	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.252	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.252	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.251	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.251	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.250	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.250	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.249	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.249	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.245	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.245	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.244	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.244	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.243	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.243	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.242	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.242	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.241	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.241	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.240	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.240	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.239	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.239	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.238	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.238	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.237	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.237	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.236	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.236	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.235	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.235	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.234	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.234	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.233	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.233	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.232	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.232	ADD	N/A		Created
09/16/2024	4.0.0	CIP.003.231	UPDATE	File segment	None	26
09/16/2024	4.0.0	CIP.003.231	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.229	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.229	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.339	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.339	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.338	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.338	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.311	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.311	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.310	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.310	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.309	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.309	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.308	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.308	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.307	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.307	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.306	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.306	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.305	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.305	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.304	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.304	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.303	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.303	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.302	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.302	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.301	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.301	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.300	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.300	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.299	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.299	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.298	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.298	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.297	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.297	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.295	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.295	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.294	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.294	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.293	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.293	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.292	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.292	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.291	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.291	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.290	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.290	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.289	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.289	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.228	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.228	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.223	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.223	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.222	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.222	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.221	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.221	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.220	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.220	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.219	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.219	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.218	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.218	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.217	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.217	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.216	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.216	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.214	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.214	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.213	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.213	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.212	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.212	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.211	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.211	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.210	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.210	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.209	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.209	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.208	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.208	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.207	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.207	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.206	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.206	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.204	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.204	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.203	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.203	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.202	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.202	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.199	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.199	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.198	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.198	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.197	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.197	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.196	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.196	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.195	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.195	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.194	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.194	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.190	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.190	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.189	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.189	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.188	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.188	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.187	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.187	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.186	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.186	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.185	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.185	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.184	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.184	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.183	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.183	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.182	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.182	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.181	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.181	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.180	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.180	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.179	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.179	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.178	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.178	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.177	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.177	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.176	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.176	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.175	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.175	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.174	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.174	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.173	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.173	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.172	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.172	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.171	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.171	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.170	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.170	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.169	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.169	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.168	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.168	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.167	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.167	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.166	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.166	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.165	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.165	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.164	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.164	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.163	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.163	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.162	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.162	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.161	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.161	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.160	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.160	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.159	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.159	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.158	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.158	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.157	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.157	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.156	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.156	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.155	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.155	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.154	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.154	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.153	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.153	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.152	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.152	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.151	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.151	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.150	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.150	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.149	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.149	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.148	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.148	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.147	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.147	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.146	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.146	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.145	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.145	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.144	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.144	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.143	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.143	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.142	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.142	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.141	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.141	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.140	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.140	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.139	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.139	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.138	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.138	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.137	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.137	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.136	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.136	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.135	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.135	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.134	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.134	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.133	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.133	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.132	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.132	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.130	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.130	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.129	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.129	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.128	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.128	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.127	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.127	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.126	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.126	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.125	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.125	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.122	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.122	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.121	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.121	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.119	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.119	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.118	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.118	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.117	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.117	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.116	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.116	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.114	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.114	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.113	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.113	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.112	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.112	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.111	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.111	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.110	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.110	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.109	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.109	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.108	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.108	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.106	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.106	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.105	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.105	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.104	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.104	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.103	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.103	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.102	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.102	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.101	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.101	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.100	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.100	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.099	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.099	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.098	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.098	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.097	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.097	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.096	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.096	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.095	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.095	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.094	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.094	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.093	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.093	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.092	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.092	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.090	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.090	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.089	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.089	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.088	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.088	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.086	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.086	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.085	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.085	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.084	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.084	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.082	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.082	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.081	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.081	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.080	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.080	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.078	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.078	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.077	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.077	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.076	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.076	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.074	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.074	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.073	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.073	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.072	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.072	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.070	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.070	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.069	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.069	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.068	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.068	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.029	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.029	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.028	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.028	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.027	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.027	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.026	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.026	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.025	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.025	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.024	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.024	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.023	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.023	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.022	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.022	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.021	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.021	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.020	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.020	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.019	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.019	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.018	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.018	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.017	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.017	ADD	N/A		Created
09/16/2024	4.0.0	CIP.002.016	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.016	ADD	N/A		Created
09/16/2024	4.0.0	CIP.001.014	UPDATE	File segment	None	24
09/16/2024	4.0.0	CIP.001.014	ADD	N/A		Created
09/16/2024	4.0.0	CIP.001.275	UPDATE	File segment	None	24
09/16/2024	4.0.0	CIP.001.275	ADD	N/A		Created
09/16/2024	4.0.0	CIP.001.013	UPDATE	File segment	None	24
09/16/2024	4.0.0	CIP.001.013	ADD	N/A		Created
09/16/2024	4.0.0	CIP.001.012	UPDATE	File segment	None	24
09/16/2024	4.0.0	CIP.001.012	ADD	N/A		Created
09/16/2024	4.0.0	CIP.001.011	UPDATE	File segment	None	24
09/16/2024	4.0.0	CIP.001.011	ADD	N/A		Created
09/16/2024	4.0.0	CIP.001.010	UPDATE	File segment	None	24
09/16/2024	4.0.0	CIP.001.010	ADD	N/A		Created
09/16/2024	4.0.0	CIP.001.009	UPDATE	File segment	None	24
09/16/2024	4.0.0	CIP.001.009	ADD	N/A		Created
09/16/2024	4.0.0	CIP.001.008	UPDATE	File segment	None	24
09/16/2024	4.0.0	CIP.001.008	ADD	N/A		Created
09/16/2024	4.0.0	CIP.001.007	UPDATE	File segment	None	24
09/16/2024	4.0.0	CIP.001.007	ADD	N/A		Created
09/16/2024	4.0.0	CIP.001.006	UPDATE	File segment	None	24
09/16/2024	4.0.0	CIP.001.006	ADD	N/A		Created
09/16/2024	4.0.0	CIP.001.005	UPDATE	File segment	None	24
09/16/2024	4.0.0	CIP.001.005	ADD	N/A		Created
09/16/2024	4.0.0	CIP.001.004	UPDATE	File segment	None	24
09/16/2024	4.0.0	CIP.001.004	ADD	N/A		Created
09/16/2024	4.0.0	CIP.001.003	UPDATE	File segment	None	24
09/16/2024	4.0.0	CIP.001.003	ADD	N/A		Created
09/16/2024	4.0.0	CIP.001.002	UPDATE	File segment	None	24
09/16/2024	4.0.0	CIP.001.002	ADD	N/A		Created
09/16/2024	4.0.0	CIP.001.001	UPDATE	File segment	None	24
09/16/2024	4.0.0	CIP.001.001	ADD	N/A		Created
11/05/2024	4.0.0	Data Elements	UPDATE	Icon	None	25
09/16/2024	4.0.0	TPL-ENTITY-CONTACT-INFORMATION	ADD	N/A		Created
09/16/2024	4.0.0	TPL-MEDICAID-ELIGIBLE-OTHER-THIRD-PARTY-COVERAGE-INFORMATION	ADD	N/A		Created
09/16/2024	4.0.0	TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES	ADD	N/A		Created
09/16/2024	4.0.0	TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO	ADD	N/A		Created
09/16/2024	4.0.0	TPL-MEDICAID-ELIGIBLE-PERSON-MAIN	ADD	N/A		Created
09/16/2024	4.0.0	FILE-HEADER-RECORD-TPL	ADD	N/A		Created
09/16/2024	4.0.0	TPL - THIRD-PARTY LIABILITY	UPDATE	Definition	Temporary	Beneficiary level third-party liability (TPL) data and insurance carrier level data.
09/16/2024	4.0.0	TPL - THIRD-PARTY LIABILITY	UPDATE	Overview		Third-Party Liability (TPL) File – TPL Record Segment RelationshipsDescription:Each instance of potential third-party liability for T-MSIS eligibles must have a record in the T-MSIS TPL file. There are two sets of information captured (called “subject areas”) in the TPL file: One set of records captures general information about non-Medicaid, non-Medicare health insurers, while the other set of records captures information about third party sources of funds that individual Medicaid/CHIP eligibles have.TPL Health Insurance Entity Subject AreaTwo types of record segments comprise the “TPL health insurance entity subject area:” the TPL-ENTITY-CONTACT-INFORMATION (TPL00006) and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES (TPL00004) segments. There is a one-to-many relationship between these segment types (one TPL-ENTITY-CONTACT-INFORMATION segment type to many TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES segments). The TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES segment joins to the TPL-ENTITY-CONTACT-INFORMATION segment on two fields:1. SUBMITTING-STATE2. INSURANCE-CARRIER-ID-NUMMedicaid/CHIP Enrollees with TPL Funding Subject AreaThree types of segments make up the “Medicaid/CHIP Enrollees with TPL Funding Subject Area.” The TPL-MEDICAID-ELIGIBLE-PERSON-MAIN(TPL00002) segment type is the parent segment, with TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO (TPL00003) and TPL-MEDICAID-ELIGIBLE-OTHER-THIRD-PARTY-COVERAGE-INFORMATION (TPL00005) being the subordinate segments. The two subordinate segments join to TPL-MEDICAID-ELIGIBLE-PERSON-MAIN (TPL00002) segment on:1. SUBMITTING-STATE2. MSIS-IDENTIFICATION-NUM
09/16/2024	4.0.0	TPL - THIRD-PARTY LIABILITY	ADD	N/A		Created
09/16/2024	4.0.0	PROV-BED-TYPE-INFO	ADD	N/A		Created
09/16/2024	4.0.0	PROV-AFFILIATED-PROGRAMS	ADD	N/A		Created
09/16/2024	4.0.0	PROV-AFFILIATED-GROUPS	ADD	N/A		Created
09/16/2024	4.0.0	PROV-MEDICAID-ENROLLMENT	ADD	N/A		Created
09/16/2024	4.0.0	PROV-TAXONOMY-CLASSIFICATION	ADD	N/A		Created
09/16/2024	4.0.0	PROV-IDENTIFIERS	ADD	N/A		Created
09/16/2024	4.0.0	PROV-LICENSING-INFO	ADD	N/A		Created
09/16/2024	4.0.0	PROV-LOCATION-AND-CONTACT-INFO	ADD	N/A		Created
09/16/2024	4.0.0	PROV-ATTRIBUTES-MAIN	ADD	N/A		Created
09/16/2024	4.0.0	FILE-HEADER-RECORD-PROVIDER	ADD	N/A		Created
09/16/2024	4.0.0	PRV - PROVIDER	UPDATE	Definition	Temporary	Provider enrollment with Medicaid and MCOs including demographics and characteristics data.
09/16/2024	4.0.0	PRV - PROVIDER	UPDATE	Overview		Provider File – Provider Record Segment Relationships Description Each provider in T-MSIS (regardless of whether the provider is a single individual, a group of practitioners, a facility, or a group of facilities) must have a record in the T-MSIS provider’s file. Each provider record is comprised of up to nine different types of record segments. The PROV-ATTRIBUTES-MAIN (PRV00002) segment is the parent segment to five segments: PROV-TAXONOMY-CLASSIFICATION (PRV00006), PROV-MEDICAID-ENROLLMENT (PRV00007), PROV-AFFILIATED-GROUPS (PRV00008), PROV-AFFILIATED-PROGRAMS (PRV00009), and PROV-LOCATION-AND-CONTACT-INFO (PRV00003), all of which join to PROV-ATTRIBUTES-MAIN on the following two data elements: 1. SUBMITTING-STATE2. SUBMITTING-STATE-PROV-IDIn addition, the PROV-LOCATION-AND-CONTACT-INFO (PRV00003) segment is a parent segment to three additional subordinate segments: PROV-IDENTIFIERS (PRV00005), PROV-LICENSING-INFO (PRV00004), PROV-BED-TYPE-INFO (PRV00010). These three segments join to the PROV-LOCATION-AND-CONTACT-INFO segment on:1. SUBMITTING-STATE2. SUBMITTING-STATE-PROV-ID3. PROV-LOCATION-ID
09/16/2024	4.0.0	PRV - PROVIDER	ADD	N/A		Created
12/10/2024	4.0.1	MANAGED-CARE-PLAN-ID	UPDATE	Record segment name	MANAGED-CARE-PLAN-ID	MANAGED-CARE-ID
09/16/2024	4.0.0	MANAGED-CARE-PLAN-ID	ADD	N/A		Created
09/16/2024	4.0.0	MANAGED- CARE-ACCREDITATION-ORGANIZATION	ADD	N/A		Created
09/16/2024	4.0.0	MANAGED-CARE-PLAN-POPULATION-ENROLLED	ADD	N/A		Created
09/16/2024	4.0.0	MANAGED-CARE-OPERATING-AUTHORITY	ADD	N/A		Created
09/16/2024	4.0.0	MANAGED-CARE-SERVICE-AREA	ADD	N/A		Created
09/16/2024	4.0.0	MANAGED-CARE-LOCATION-AND-CONTACT-INFO	ADD	N/A		Created
09/16/2024	4.0.0	MANAGED-CARE-MAIN	ADD	N/A		Created
09/16/2024	4.0.0	FILE-HEADER-RECORD-MANAGED-CARE	ADD	N/A		Created
09/16/2024	4.0.0	MCR - MANAGED CARE PLAN INFORMATION	UPDATE	Definition	Temporary	Managed Care Organizations (MCO) plan level participation and characteristics data.
09/16/2024	4.0.0	MCR - MANAGED CARE PLAN INFORMATION	UPDATE	Overview		Managed Care File – Managed Care Entity Record Segment Relationships Description Each managed care entity in T-MSIS must have a record in the T-MSIS managed care file. Each managed care record is comprised of up to seven different types of record segments. The MANAGED-CARE-MAIN (MCR00002) segment is the parent segment to five segments: MANAGED-CARE-LOCATION-AND-CONTACT-INFO (MCR00003), MANAGED-CARE-SERVICE-AREA (MCR00004), MANAGED-CARE-OPERATING-AUTHORITY (MCR00005), MANAGED-CARE-PLAN-POPULATION-ENROLLED (MCR00006), MANAGED-CARE-ACCREDITATION-ORGANIZATION (MCR00007) and MANAGED-CARE-PLAN-ID (MCR00010) all of which join to MANAGED-CARE-MAIN and to each other on the following two data elements: 1. SUBMITTING-STATE2. STATE-PLAN-ID-NUM
09/16/2024	4.0.0	MCR - MANAGED CARE PLAN INFORMATION	ADD	N/A		Created
09/16/2024	4.0.0	MISCELLANEOUS-PAYMENT	ADD	N/A		Created
09/16/2024	4.0.0	FQHC-WRAP-PAYMENT	ADD	N/A		Created
09/16/2024	4.0.0	COST-SETTLEMENT-PAYMENT	ADD	N/A		Created
10/16/2024	4.0.0	STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM	UPDATE	Record segment definition	A record segment to capture State Directed Payment Separate Payment Term payments.	A record segment to capture State Directed Payments which are made under separate payment terms.
09/16/2024	4.0.0	STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM	ADD	N/A		Created
09/16/2024	4.0.0	VALUE-BASED-PAYMENT	ADD	N/A		Created
09/16/2024	4.0.0	COST-SHARING-OFFSET	ADD	N/A		Created
09/16/2024	4.0.0	GROUP-INSURANCE-PREMIUM-PAYMENT	ADD	N/A		Created
09/16/2024	4.0.0	INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT	ADD	N/A		Created
09/16/2024	4.0.0	INDIVIDUAL-CAPITATION-PMPM	ADD	N/A		Created
09/16/2024	4.0.0	FILE-HEADER-RECORD-FTX	ADD	N/A		Created
09/16/2024	4.0.0	FTX - FINANCIAL TRANSACTION	UPDATE	Definition	Temporary	Information about financial transactions.
09/16/2024	4.0.0	FTX - FINANCIAL TRANSACTION	UPDATE	Overview		Financial Transactions File – FTX Record Segment Relationships Description Unlike the other T-MSIS file types, the Financial Transactions file does not contain relationships among the segments. Each segment in this file represents a different type of financial transaction, except for the “miscellaneous” segment which can represent multiple types of financial transactions. The purpose of the “miscellaneous” segment is to represent financial transactions which are not common across states and/or occur in relatively low volumes within most states, as well as to provide a flexible mechanism for CMS and/or states to add new financial transactions in a much shorter time cycle than would be possible by adding an entirely new segment. The “miscellaneous” segment utilizes a generalized set of data elements and an expandable valid value list to distinguish different types of financial transactions from one another.
09/16/2024	4.0.0	FTX - FINANCIAL TRANSACTION	ADD	N/A		Created
09/16/2024	4.0.0	SOGI	ADD	N/A		Created
09/16/2024	4.0.0	ELG-IDENTIFIERS	ADD	N/A		Created
09/16/2024	4.0.0	ENROLLMENT-TIME-SPAN-SEGMENT	ADD	N/A		Created
09/16/2024	4.0.0	HCBS-CHRONIC-CONDITIONS-NON-HEALTH-HOME	ADD	N/A		Created
09/16/2024	4.0.0	1115A-DEMONSTRATION-INFORMATION	ADD	N/A		Created
09/16/2024	4.0.0	DISABILITY-INFORMATION	ADD	N/A		Created
09/16/2024	4.0.0	RACE-INFORMATION	ADD	N/A		Created
09/16/2024	4.0.0	ETHNICITY-INFORMATION	ADD	N/A		Created
09/16/2024	4.0.0	MANAGED-CARE-PARTICIPATION	ADD	N/A		Created
09/16/2024	4.0.0	LTSS-PARTICIPATION	ADD	N/A		Created
09/16/2024	4.0.0	WAIVER-PARTICIPATION	ADD	N/A		Created
09/16/2024	4.0.0	STATE-PLAN-OPTION-PARTICIPATION	ADD	N/A		Created
09/16/2024	4.0.0	MFP-INFORMATION	ADD	N/A		Created
09/16/2024	4.0.0	LOCK-IN-INFORMATION	ADD	N/A		Created
09/16/2024	4.0.0	HEALTH-HOME-CHRONIC-CONDITIONS	ADD	N/A		Created
09/16/2024	4.0.0	HEALTH-HOME-SPA-PROVIDERS	ADD	N/A		Created
09/16/2024	4.0.0	HEALTH-HOME-SPA-PARTICIPATION-INFORMATION	ADD	N/A		Created
09/16/2024	4.0.0	ELIGIBILITY-DETERMINANTS	ADD	N/A		Created
09/16/2024	4.0.0	ELIGIBLE-CONTACT-INFORMATION	ADD	N/A		Created
09/16/2024	4.0.0	VARIABLE-DEMOGRAPHICS-ELIGIBILITY	ADD	N/A		Created
09/16/2024	4.0.0	PRIMARY-DEMOGRAPHICS-ELIGIBILITY	ADD	N/A		Created
09/16/2024	4.0.0	FILE-HEADER-RECORD-ELIGIBILITY	ADD	N/A		Created
09/16/2024	4.0.0	ELG - ELIGIBLE	UPDATE	Definition	Temporary	Enhanced information about beneficiary enrollment and eligibility including person level demographic and eligibility data.
09/16/2024	4.0.0	ELG - ELIGIBLE	UPDATE	Overview		Eligible File – Eligible Person Record Segment RelationshipsDescriptionEach eligible person in T-MSIS has a record in the T-MSIS eligibility file. Each of these records is comprised of up to twenty-one different types of record segments. The PRIMARY-DEMOGRAPHICS-ELIGIBILITY (ELG00002) segment is the parent segment and all other segments, except for the HEALTH-HOME-SPA-PROVIDERS (ELG00007) segment, join to it on the following two data elements:1. SUBMITTING-STATE2. MSIS-IDENTIFICATION-NUMThe exception, the HEALTH-HOME-SPA-PROVIDERS (ELG00007) segment, is a child of the HEALTH-HOME-SPA-PARTICIPATION-INFORMATION (ELG00006) segment and joins to it on:1. SUBMITTING-STATE2. MSIS-IDENTIFICATION-NUM3. HEALTH-HOME-SPA-ID4. HEALTH-HOME-ENTITY-NAME
09/16/2024	4.0.0	ELG - ELIGIBLE	ADD	N/A		Created
09/16/2024	4.0.0	CLAIM-DX-RX	ADD	N/A		Created
09/16/2024	4.0.0	CLAIM-LINE-RECORD-RX	ADD	N/A		Created
09/16/2024	4.0.0	CLAIM-HEADER-RECORD-RX	ADD	N/A		Created
09/16/2024	4.0.0	FILE-HEADER-RECORD-RX	ADD	N/A		Created
09/16/2024	4.0.0	CRX - CLAIM PHARMACY	UPDATE	Definition	Temporary	Pharmacy claims and managed care encounter records.
09/16/2024	4.0.0	CRX - CLAIM PHARMACY	UPDATE	Overview		Claim RX File – Claim Record Segment RelationshipsDescriptionEach claim record in the T-MSIS pharmacy claims file is composed of three types of record segments: One claim header segment, one or more claim diagnosis segments, and one or more claim line segments. Each claim diagnosis segment and claim line segment joins to its corresponding claim header segment on the following five data elements:1. SUBMITTING-STATE2. ICN-ORIG3. ICN-ADJ4. ADJUDICATION-DATE5. ADJUSTMENT-IND (joins to LINE-ADJUSTMENT-IND for claim line segments)
09/16/2024	4.0.0	CRX - CLAIM PHARMACY	ADD	N/A		Created
09/16/2024	4.0.0	CLAIM-DX-OT	ADD	N/A		Created
09/16/2024	4.0.0	CLAIM-LINE-RECORD-OT	ADD	N/A		Created
09/16/2024	4.0.0	CLAIM-HEADER-RECORD-OT	ADD	N/A		Created
09/16/2024	4.0.0	FILE-HEADER-RECORD-OT	ADD	N/A		Created
09/16/2024	4.0.0	COT - CLAIM OTHER	UPDATE	Definition	Temporary	Professional, Dental, Outpatient Institutional claims and encounter, capitation payments and other financial transactions.
09/16/2024	4.0.0	COT - CLAIM OTHER	UPDATE	Overview		Claim OT File – Claim Record Segment RelationshipsDescriptionEach claim record in the T-MSIS other claims file is composed of three types of record segments: One claim header segment, one or more claim diagnosis segments, and one or more claim line segments. Each claim diagnosis segment and claim line segment joins to its corresponding claim header segment on the following five data elements:1. SUBMITTING-STATE2. ICN-ORIG3. ICN-ADJ4. ADJUDICATION-DATE5. ADJUSTMENT-IND (joins to LINE-ADJUSTMENT-IND for claim line segments)
09/16/2024	4.0.0	COT - CLAIM OTHER	ADD	N/A		Created
09/16/2024	4.0.0	CLAIM-DX-LT	ADD	N/A		Created
09/16/2024	4.0.0	CLAIM-LINE-RECORD-LT	ADD	N/A		Created
09/16/2024	4.0.0	CLAIM-HEADER-RECORD-LT	ADD	N/A		Created
09/16/2024	4.0.0	FILE-HEADER-RECORD-LT	ADD	N/A		Created
09/16/2024	4.0.0	CLT - CLAIM LONG-TERM CARE	UPDATE	Definition	Temporary	Institutional long-term care facility claims and managed care encounter records
09/16/2024	4.0.0	CLT - CLAIM LONG-TERM CARE	UPDATE	Overview		Claim LT File – Claim Record Segment RelationshipsDescriptionEach claim record in the T-MSIS long-term care claims file is composed of three types of record segments: One claim header segment, one or more claim diagnosis segments, and one or more claim line segments. Each claim diagnosis segment and claim line segment joins to its corresponding claim header segment on the following five data elements:1. SUBMITTING-STATE2. ICN-ORIG3. ICN-ADJ4. ADJUDICATION-DATE5. ADJUSTMENT-IND (joins to LINE-ADJUSTMENT-IND for claim line segments)
09/16/2024	4.0.0	CLT - CLAIM LONG-TERM CARE	ADD	N/A		Created
04/02/2025	4.0.6	CLAIM-DX-IP	UPDATE	Record segment definition	A record segment to capture data about the diagnosis code(s) associated with a claim.	A record segment to capture data about the diagnosis code(s) associated with a claim. -test
09/16/2024	4.0.0	CLAIM-DX-IP	ADD	N/A		Created
09/16/2024	4.0.0	CLAIM-LINE-RECORD-IP	ADD	N/A		Created
09/16/2024	4.0.0	CLAIM-HEADER-RECORD-IP	ADD	N/A		Created
09/16/2024	4.0.0	FILE-HEADER-RECORD-IP	ADD	N/A		Created
09/16/2024	4.0.0	CIP - CLAIM INPATIENT	UPDATE	Definition	Temporary	Inpatient hospital facility claims and managed care encounter records.
09/16/2024	4.0.0	CIP - CLAIM INPATIENT	UPDATE	Overview		Claim IP File – Claim Record Segment RelationshipsDescriptionEach claim record in the T-MSIS inpatient claims file is composed of three types of record segments: One claim header segment, one or more claim diagnosis segments, and one or more claim line segments. Each claim diagnosis segment and claim line segment joins to its corresponding claim header segment on the following five data elements:1. SUBMITTING-STATE2. ICN-ORIG3. ICN-ADJ4. ADJUDICATION-DATE5. ADJUSTMENT-IND (joins to LINE-ADJUSTMENT-IND for claim line segments)
09/16/2024	4.0.0	CIP - CLAIM INPATIENT	ADD	N/A		Created
09/16/2024	4.0.0	File Segment Layouts	ADD	N/A		Created
09/16/2024	4.0.0	File Segment Layouts	REMOVE	N/A	Removed
09/16/2024	4.0.0	FTX - FINANCIAL TRANSACTIONS	REMOVE	N/A	Removed
09/16/2024	4.0.0	CRX - CLAIM PHARMACY	REMOVE	N/A	Removed
09/16/2024	4.0.0	TPL - THIRD-PARTY LIABILITY	REMOVE	N/A	Removed
09/16/2024	4.0.0	PRV - PROVIDER	REMOVE	N/A	Removed
09/16/2024	4.0.0	MCR - MANAGED CARE PLAN INFORMATION	REMOVE	N/A	Removed
09/16/2024	4.0.0	ELG - ELIGIBLE	REMOVE	N/A	Removed
09/16/2024	4.0.0	CLT - CLAIM LONG-TERM CARE	REMOVE	N/A	Removed
09/16/2024	4.0.0	COT - CLAIM OTHER	REMOVE	N/A	Removed
09/16/2024	4.0.0	CIP - CLAIM INPATIENT	REMOVE	N/A	Removed
09/11/2024	4.0.0	FTX - FINANCIAL TRANSACTIONS	ADD	N/A		Created
09/11/2024	4.0.0	CRX - CLAIM PHARMACY	ADD	N/A		Created
09/11/2024	4.0.0	TPL - THIRD-PARTY LIABILITY	ADD	N/A		Created
09/11/2024	4.0.0	PRV - PROVIDER	ADD	N/A		Created
09/11/2024	4.0.0	MCR - MANAGED CARE PLAN INFORMATION	ADD	N/A		Created
09/11/2024	4.0.0	ELG - ELIGIBLE	ADD	N/A		Created
09/11/2024	4.0.0	CLT - CLAIM LONG-TERM CARE	ADD	N/A		Created
09/11/2024	4.0.0	COT - CLAIM OTHER	ADD	N/A		Created
09/11/2024	4.0.0	CIP - CLAIM INPATIENT	ADD	N/A		Created
11/05/2024	4.0.0	Data Quality Measures	UPDATE	Icon	None	26
09/04/2024	4.0.0	Data Quality Measures	ADD	N/A		Created
09/04/2024	4.0.0	Data Elements	ADD	N/A		Created
09/04/2024	4.0.0	Data Elements	REMOVE	N/A	Removed
09/04/2024	4.0.0	File Segment Layouts	ADD	N/A		Created
09/04/2024	4.0.0	Data Elements	ADD	N/A		Created
07/18/2025	4.0.14	CIP070, CIP074, CIP078, CIP082, CIP086, CIP090, COT169, CRX182	Update	Data Dictionary - Valid Values	ICD-9.psv ICD-10.psv	ICD-9-PROCEDURE-CODE.psv ICD-10-PROCEDURE-CODE.psv
07/03/2025	4.0.12	RULE-9227	Add	Data Dictionary - Validation Rules	N/A	if FILE-HEADER-RECORD-OT.DATA-DICTIONARY-VERSION = 'v4.0.0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM field is populated, then CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: ('1', 'A',' X', '3', 'C', 'W')
07/03/2025	4.0.12	RULE-9228	Add	Data Dictionary - Validation Rules	N/A	if FILE-HEADER-RECORD-RX.DATA-DICTIONARY-VERSION = 'v4.0.0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM field is populated, then CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: ('1', 'A',' X', '3', 'C', 'W')
07/03/2025	4.0.12	RULE-9229	Add	Data Dictionary - Validation Rules	N/A	if FILE-HEADER-RECORD-IP.DATA-DICTIONARY-VERSION = 'v4.0.0' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM field is populated, then CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: ('1', 'A',' X', '3', 'C', 'W')
07/03/2025	4.0.12	RULE-9230	Add	Data Dictionary - Validation Rules	N/A	if FILE-HEADER-RECORD-LT.DATA-DICTIONARY-VERSION = 'v4.0.0' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM field is populated, then CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: ('1', 'A',' X', '3', 'C', 'W')
05/30/2025	4.0.9	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9BASE\|Medical Assistance Expenditures by Type of Service
05/30/2025	4.0.9	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9 WAIVER\|Medical Assistance Expenditures by Type of Service
05/30/2025	4.0.9	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9P\|Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program, Prior Period Adjustment
05/30/2025	4.0.9	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9P Waiver\|Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program, Prior Period Adjustment
05/30/2025	4.0.9	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9 200K\|Medical Assistance Expenditures by Type of Service
05/30/2025	4.0.9	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9P 200K\|Medical Assistance Expenditures by Type of Service for the Medical Assistance Program Prior Period Adjustments in This Quarter
05/30/2025	4.0.9	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9I\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
05/30/2025	4.0.9	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9PI\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
05/30/2025	4.0.9	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9TP\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
05/30/2025	4.0.9	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9TP WAIVER\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
05/30/2025	4.0.9	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9PE\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
05/30/2025	4.0.9	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9PEP\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
05/30/2025	4.0.9	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9PEPWAIV\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
05/30/2025	4.0.9	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9PEWAIV\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
05/30/2025	4.0.9	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9E\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
05/30/2025	4.0.9	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9EP\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
05/30/2025	4.0.9	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9EPWAIV\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
05/30/2025	4.0.9	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9EWAIV\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
05/30/2025	4.0.9	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9VIII\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
05/30/2025	4.0.9	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9VIIIP\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
05/30/2025	4.0.9	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9VIIIP Waiver\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
05/30/2025	4.0.9	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9E\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
05/30/2025	4.0.9	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9EP\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
05/30/2025	4.0.9	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9EPWAIV\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
05/30/2025	4.0.9	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9EWAIV\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
05/30/2025	4.0.9	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9T\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
05/30/2025	4.0.9	MBESCBES-FORMGP-2	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-2\|00010101\|99991231\|CMS 64.21\|Quarterly Medical Assistance Expenditures By Children's Health Insurance Program
05/30/2025	4.0.9	MBESCBES-FORMGP-2	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-2\|00010101\|99991231\|CMS 64.21U\|Child Health Expenditures by Service
05/30/2025	4.0.9	MBESCBES-FORMGP-2	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-2\|00010101\|99991231\|CMS 64.21 WAIVER\|Quarterly Medical Assistance Expenditures By Children's Health Insurance Program
05/30/2025	4.0.9	MBESCBES-FORMGP-2	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-2\|00010101\|99991231\|CMS 64.21U WAIVER\|Quarterly Medical Assistance Expenditures By Children's Health Insurance Program Expenditure Categories
05/30/2025	4.0.9	MBESCBES-FORMGP-2	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-2\|00010101\|99991231\|CMS 64.21P\|Quarterly Medical Assistance Expenditures By Children's Health Insurance Program Prior Period Expenditures
05/30/2025	4.0.9	MBESCBES-FORMGP-2	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-2\|00010101\|99991231\|CMS 64.21P WAIVER\|Quarterly Medical Assistance Expenditures By Children's Health Insurance Program Prior Period Expenditures
05/30/2025	4.0.9	MBESCBES-FORMGP-2	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-2\|00010101\|99991231\|CMS 64.21UP\|Quarterly Medical Assistance Expenditures by Children’s Health Insurance Program expenditure categories
05/30/2025	4.0.9	MBESCBES-FORMGP-2	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-2\|00010101\|99991231\|CMS 64.21UP WAIVER\|Quarterly Medical Assistance Expenditures By Children's Health Insurance Program Prior Period Expenditures
05/30/2025	4.0.9	MBESCBES-FORMGP-3	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-3\|00010101\|99991231\|CMS 21BASE\|Children's Health Expenditures by Type of Service For the Title XXI Program Expenditures in this Quarter
05/30/2025	4.0.9	MBESCBES-FORMGP-3	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-3\|00010101\|99991231\|CMS 21\|Children's Health Expenditures by Type of Service For the Title XXI Program Expenditures in this Quarter
05/30/2025	4.0.9	MBESCBES-FORMGP-3	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-3\|00010101\|99991231\|CMS 21P\|Quarterly Children's Health Insurance Program
05/30/2025	4.0.9	MBESCBES-FORMGP-3	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-3\|00010101\|99991231\|CMS 21 WAIVER\|Children's Health Expenditures by Type of Service For the Title XXI Program Expenditures in this Quarter
05/30/2025	4.0.9	MBESCBES-FORMGP-3	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-3\|00010101\|99991231\|CMS 21PWAIVER\|Children's Health Expenditures by Type of Service For the Title XXI Program Expenditures in this Quarter
06/20/2025	4.0.11	Rule-8569	Update	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and INDIVIDUAL-CAPITATION-PMPM.MBESCBES-FORM-GROUP equals '1' and INDIVIDUAL-CAPITATION-PMPM.MBESCBES-FORM equals '64.9BASE', then the value must be contained in the set of valid values with id: '64.9BASE-FORM' and (if INDIVIDUAL-CAPITATION-PMPM.CAPITATION-PERIOD-END-DATE is non-null then INDIVIDUAL-CAPITATION-PMPM.CAPITATION-PERIOD-END-DATE >= Valid Values Effective-Date and INDIVIDUAL-CAPITATION-PMPM.CAPITATION-PERIOD-END-DATE <= Valid Values End-Date)	If the MBESCBES-CATEGORY-OF-SERVICE field is populated and MBESCBES-FORM-GROUP is equal to '1' and MBESCBES-FORM has non null value then the value must be contained in the set of valid values with id: '64.9COS' and INDIVIDUAL-CAPITATION-PMPM.PREMIUM-PERIOD-END-DATE has non null value and INDIVIDUAL-CAPITATION-PMPM.PREMIUM-PERIOD-END-DATE must be >= Valid Values Effective-Date and INDIVIDUAL-CAPITATION-PMPM.PREMIUM-PERIOD-END-DATE <= Valid Values End-Date
06/20/2025	4.0.11	Rule-8570	Update	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and INDIVIDUAL-CAPITATION-PMPM.MBESCBES-FORM-GROUP equals '2' and INDIVIDUAL-CAPITATION-PMPM.MBESCBES-FORM equals '64.21U', then the value must be contained in the set of valid values with id: '64.21U-FORM' and (if INDIVIDUAL-CAPITATION-PMPM.CAPITATION-PERIOD-END-DATE is non-null then INDIVIDUAL-CAPITATION-PMPM.CAPITATION-PERIOD-END-DATE >= Valid Values Effective-Date and INDIVIDUAL-CAPITATION-PMPM.CAPITATION-PERIOD-END-DATE <= Valid Values End-Date)'	If the MBESCBES-CATEGORY-OF-SERVICE field is populated and MBESCBES-FORM-GROUP is equal to '2' and MBESCBES-FORM has non null value then the value must be contained in the set of valid values with id: '64.21COS' and INDIVIDUAL-CAPITATION-PMPM.PREMIUM-PERIOD-END-DATE has non null value and INDIVIDUAL-CAPITATION-PMPM.PREMIUM-PERIOD-END-DATE must be >= Valid Values Effective-Date and INDIVIDUAL-CAPITATION-PMPM.PREMIUM-PERIOD-END-DATE <= Valid Values End-Date
06/20/2025	4.0.11	Rule-8571	Update	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and INDIVIDUAL-CAPITATION-PMPM.MBESCBES-FORM-GROUP equals '3' and INDIVIDUAL-CAPITATION-PMPM.MBESCBES-FORM equals '21BASE', then the value must be contained in the set of valid values with id: '21BASE-FORM' and (if INDIVIDUAL-CAPITATION-PMPM.CAPITATION-PERIOD-END-DATE is non-null then INDIVIDUAL-CAPITATION-PMPM.CAPITATION-PERIOD-END-DATE >= Valid Values Effective-Date and INDIVIDUAL-CAPITATION-PMPM.CAPITATION-PERIOD-END-DATE <= Valid Values End-Date)'	If the MBESCBES-CATEGORY-OF-SERVICE field is populated and MBESCBES-FORM-GROUP is equal to '3' and MBESCBES-FORM has non null value then the value must be contained in the set of valid values with id: '21COS' and INDIVIDUAL-CAPITATION-PMPM.PREMIUM-PERIOD-END-DATE has non null value and INDIVIDUAL-CAPITATION-PMPM.PREMIUM-PERIOD-END-DATE must be >= Valid Values Effective-Date and INDIVIDUAL-CAPITATION-PMPM.PREMIUM-PERIOD-END-DATE <= Valid Values End-Date
05/30/2025	4.0.9	Rule-8566	Delete	Data Dictionary - Validation Rules	'if the MBESCBES-CATEGORY-OF-SERVICE field is populated and INDIVIDUAL-CAPITATION-PMPM.MBESCBES-FORM-GROUP equals '1' and INDIVIDUAL-CAPITATION-PMPM.MBESCBES-FORM equals '64.9P', then the value must be contained in the set of valid values with id: '64.9P-FORM' and (if INDIVIDUAL-CAPITATION-PMPM.CAPITATION-PERIOD-END-DATE is non-null then INDIVIDUAL-CAPITATION-PMPM.CAPITATION-PERIOD-END-DATE >= Valid Values Effective-Date and INDIVIDUAL-CAPITATION-PMPM.CAPITATION-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	Rule-8567	Delete	Data Dictionary - Validation Rules	'if the MBESCBES-CATEGORY-OF-SERVICE field is populated and INDIVIDUAL-CAPITATION-PMPM.MBESCBES-FORM-GROUP equals '1' and INDIVIDUAL-CAPITATION-PMPM.MBESCBES-FORM equals '64.10BASE', then the value must be contained in the set of valid values with id: '64.10BASE-FORM' and (if INDIVIDUAL-CAPITATION-PMPM.CAPITATION-PERIOD-END-DATE is non-null then INDIVIDUAL-CAPITATION-PMPM.CAPITATION-PERIOD-END-DATE >= Valid Values Effective-Date and INDIVIDUAL-CAPITATION-PMPM.CAPITATION-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	Rule-8568	Delete	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and INDIVIDUAL-CAPITATION-PMPM.MBESCBES-FORM-GROUP equals '1' and INDIVIDUAL-CAPITATION-PMPM.MBESCBES-FORM equals '64.9A', then the value must be contained in the set of valid values with id: '64.9A-FORM' and (if INDIVIDUAL-CAPITATION-PMPM.CAPITATION-PERIOD-END-DATE is non-null then INDIVIDUAL-CAPITATION-PMPM.CAPITATION-PERIOD-END-DATE >= Valid Values Effective-Date and INDIVIDUAL-CAPITATION-PMPM.CAPITATION-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	Rule-8572	Delete	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and INDIVIDUAL-CAPITATION-PMPM.MBESCBES-FORM-GROUP equals '3' and INDIVIDUAL-CAPITATION-PMPM.MBESCBES-FORM equals '21P', then the value must be contained in the set of valid values with id: '21P-FORM' and (if INDIVIDUAL-CAPITATION-PMPM.CAPITATION-PERIOD-END-DATE is non-null then INDIVIDUAL-CAPITATION-PMPM.CAPITATION-PERIOD-END-DATE >= Valid Values Effective-Date and INDIVIDUAL-CAPITATION-PMPM.CAPITATION-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	Rule-8816	Delete	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and INDIVIDUAL-CAPITATION-PMPM.MBESCBES-FORM-GROUP equals '2' and INDIVIDUAL-CAPITATION-PMPM.MBESCBES-FORM equals '64.21UP', then the value must be contained in the set of valid values with id: '64.21UP-FORM' and (if INDIVIDUAL-CAPITATION-PMPM.CAPITATION-PERIOD-END-DATE is non-null then INDIVIDUAL-CAPITATION-PMPM.CAPITATION-PERIOD-END-DATE >= Valid Values Effective-Date and INDIVIDUAL-CAPITATION-PMPM.CAPITATION-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
06/20/2025	4.0.11	Rule-8576	Update	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM-GROUP equals '1' and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM equals '64.9BASE', then the value must be contained in the set of valid values with id: '64.9BASE-FORM' and (if INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE is non-null then INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE >= Valid Values Effective-Date and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE <= Valid Values End-Date)'	If the MBESCBES-CATEGORY-OF-SERVICE field is populated and MBESCBES-FORM-GROUP is equal to '1' and MBESCBES-FORM has non null value then the value must be contained in the set of valid values with id: '64.9COS' and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE has non null value and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD+N20-END-DATE must be >= Valid Values Effective-Date and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE <= Valid Values End-Date
06/20/2025	4.0.11	Rule-8577	Update	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM-GROUP equals '2' and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM equals '64.21U', then the value must be contained in the set of valid values with id: '64.21U-FORM' and (if INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE is non-null then INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE >= Valid Values Effective-Date and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE <= Valid Values End-Date)'	If the MBESCBES-CATEGORY-OF-SERVICE field is populated and MBESCBES-FORM-GROUP is equal to '2' and MBESCBES-FORM has non null value then the value must be contained in the set of valid values with id: '64.21COS' and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE has non null value and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD+N20-END-DATE must be >= Valid Values Effective-Date and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE <= Valid Values End-Date
06/20/2025	4.0.11	Rule-8578	Update	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM-GROUP equals '3' and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM equals '21BASE', then the value must be contained in the set of valid values with id: '21BASE-FORM' and (if INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE is non-null then INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE >= Valid Values Effective-Date and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE <= Valid Values End-Date)'	If the MBESCBES-CATEGORY-OF-SERVICE field is populated and MBESCBES-FORM-GROUP is equal to '3' and MBESCBES-FORM has non null value then the value must be contained in the set of valid values with id: '21COS' and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE has non null value and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD+N20-END-DATE must be >= Valid Values Effective-Date and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE <= Valid Values End-Date
05/30/2025	4.0.9	Rule-8573	Delete	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM-GROUP equals '1' and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM equals '64.9P', then the value must be contained in the set of valid values with id: '64.9P-FORM' and (if INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE is non-null then INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE >= Valid Values Effective-Date and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	Rule-8574	Delete	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM-GROUP equals '1' and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM equals '64.10BASE', then the value must be contained in the set of valid values with id: '64.10BASE-FORM' and (if INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE is non-null then INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE >= Valid Values Effective-Date and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	Rule-8575	Delete	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM-GROUP equals '1' and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM equals '64.9A', then the value must be contained in the set of valid values with id: '64.9A-FORM' and (if INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE is non-null then INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE >= Valid Values Effective-Date and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	Rule-8579	Delete	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM-GROUP equals '3' and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM equals '21P', then the value must be contained in the set of valid values with id: '21P-FORM' and (if INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE is non-null then INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE >= Valid Values Effective-Date and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	Rule-8815	Delete	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM-GROUP equals '2' and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM equals '64.21UP', then the value must be contained in the set of valid values with id: '64.21UP-FORM' and (if INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE is non-null then INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE >= Valid Values Effective-Date and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
06/20/2025	4.0.11	Rule-8583	Update	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and GROUP-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM-GROUP equals '1' and GROUP-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM equals '64.9BASE', then the value must be contained in the set of valid values with id: '64.9BASE-FORM' and (if GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE is non-null then GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE >= Valid Values Effective-Date and GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE <= Valid Values End-Date)'	If the MBESCBES-CATEGORY-OF-SERVICE field is populated and MBESCBES-FORM-GROUP is equal to '1' and MBESCBES-FORM has non null value then the value must be contained in the set of valid values with id: '64.9COS' and GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE has non null value and GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE must be >= Valid Values Effective-Date and GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE <= Valid Values End-Date
06/20/2025	4.0.11	Rule-8584	Update	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and GROUP-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM-GROUP equals '2' and GROUP-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM equals '64.21U', then the value must be contained in the set of valid values with id: '64.21U-FORM' and (if GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE is non-null then GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE >= Valid Values Effective-Date and GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE <= Valid Values End-Date)'	If the MBESCBES-CATEGORY-OF-SERVICE field is populated and MBESCBES-FORM-GROUP is equal to '2' and MBESCBES-FORM has non null value then the value must be contained in the set of valid values with id: '64.21COS' and GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE has non null value and GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE must be >= Valid Values Effective-Date and GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE <= Valid Values End-Date
06/20/2025	4.0.11	Rule-8585	Update	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and GROUP-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM-GROUP equals '3' and GROUP-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM equals '21BASE', then the value must be contained in the set of valid values with id: '21BASE-FORM' and (if GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE is non-null then GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE >= Valid Values Effective-Date and GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE <= Valid Values End-Date)'	If the MBESCBES-CATEGORY-OF-SERVICE field is populated and MBESCBES-FORM-GROUP is equal to '3' and MBESCBES-FORM has non null value then the value must be contained in the set of valid values with id: '21COS' and GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE has non null value and GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE must be >= Valid Values Effective-Date and GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE <= Valid Values End-Date
05/30/2025	4.0.9	Rule-8580	Delete	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and GROUP-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM-GROUP equals '1' and GROUP-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM equals '64.9P', then the value must be contained in the set of valid values with id: '64.9P-FORM' and (if GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE is non-null then GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE >= Valid Values Effective-Date and GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	Rule-8581	Delete	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and GROUP-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM-GROUP equals '1' and GROUP-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM equals '64.10BASE', then the value must be contained in the set of valid values with id: '64.10BASE-FORM' and (if GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE is non-null then GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE >= Valid Values Effective-Date and GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	Rule-8582	Delete	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and GROUP-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM-GROUP equals '1' and GROUP-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM equals '64.9A', then the value must be contained in the set of valid values with id: '64.9A-FORM' and (if GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE is non-null then GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE >= Valid Values Effective-Date and GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	Rule-8586	Delete	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and GROUP-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM-GROUP equals '3' and GROUP-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM equals '21P', then the value must be contained in the set of valid values with id: '21P-FORM' and (if GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE is non-null then GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE >= Valid Values Effective-Date and GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	Rule-8817	Delete	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and GROUP-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM-GROUP equals '2' and GROUP-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM equals '64.21UP', then the value must be contained in the set of valid values with id: '64.21UP-FORM' and (if GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE is non-null then GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE >= Valid Values Effective-Date and GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
06/20/2025	4.0.11	Rule-8590	Update	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and COST-SHARING-OFFSET.MBESCBES-FORM-GROUP equals '1' and COST-SHARING-OFFSET.MBESCBES-FORM equals '64.9BASE', then the value must be contained in the set of valid values with id: '64.9BASE-FORM' and (if COST-SHARING-OFFSET.COVERAGE-PERIOD-END-DATE is non-null then COST-SHARING-OFFSET.COVERAGE-PERIOD-END-DATE >= Valid Values Effective-Date and COST-SHARING-OFFSET.COVERAGE-PERIOD-END-DATE <= Valid Values End-Date)'	If the MBESCBES-CATEGORY-OF-SERVICE field is populated and MBESCBES-FORM-GROUP is equal to '1' and MBESCBES-FORM has non null value then the value must be contained in the set of valid values with id: '64.9COS' and COST-SHARING-OFFSET.COVERAGE-PERIOD-END-DATE has non null value and COST-SHARING-OFFSET.COVERAGE-PERIOD-END-DATE must be >= Valid Values Effective-Date and COST-SHARING-OFFSET.COVERAGE-PERIOD-END-DATE <= Valid Values End-Date
06/20/2025	4.0.11	Rule-8591	Update	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and COST-SHARING-OFFSET.MBESCBES-FORM-GROUP equals '2' and COST-SHARING-OFFSET.MBESCBES-FORM equals '64.21U', then the value must be contained in the set of valid values with id: '64.21U-FORM' and (if COST-SHARING-OFFSET.COVERAGE-PERIOD-END-DATE is non-null then COST-SHARING-OFFSET.COVERAGE-PERIOD-END-DATE >= Valid Values Effective-Date and COST-SHARING-OFFSET.COVERAGE-PERIOD-END-DATE <= Valid Values End-Date)'	If the MBESCBES-CATEGORY-OF-SERVICE field is populated and MBESCBES-FORM-GROUP is equal to '2' and MBESCBES-FORM has non null value then the value must be contained in the set of valid values with id: '64.21COS' and COST-SHARING-OFFSET.COVERAGE-PERIOD-END-DATE has non null value and COST-SHARING-OFFSET.COVERAGE-PERIOD-END-DATE must be >= Valid Values Effective-Date and COST-SHARING-OFFSET.COVERAGE-PERIOD-END-DATE <= Valid Values End-Date
06/20/2025	4.0.11	Rule-8592	Update	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and COST-SHARING-OFFSET.MBESCBES-FORM-GROUP equals '3' and COST-SHARING-OFFSET.MBESCBES-FORM equals '21BASE', then the value must be contained in the set of valid values with id: '21BASE-FORM' and (if COST-SHARING-OFFSET.COVERAGE-PERIOD-END-DATE is non-null then COST-SHARING-OFFSET.COVERAGE-PERIOD-END-DATE >= Valid Values Effective-Date and COST-SHARING-OFFSET.COVERAGE-PERIOD-END-DATE <= Valid Values End-Date)'	If the MBESCBES-CATEGORY-OF-SERVICE field is populated and MBESCBES-FORM-GROUP is equal to '3' and MBESCBES-FORM has non null value then the value must be contained in the set of valid values with id: '21COS' and COST-SHARING-OFFSET.COVERAGE-PERIOD-END-DATE has non null value and COST-SHARING-OFFSET.COVERAGE-PERIOD-END-DATE must be >= Valid Values Effective-Date and COST-SHARING-OFFSET.COVERAGE-PERIOD-END-DATE <= Valid Values End-Date
05/30/2025	4.0.9	Rule-8593	Delete	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and COST-SHARING-OFFSET.MBESCBES-FORM-GROUP equals '3' and COST-SHARING-OFFSET.MBESCBES-FORM equals '21P', then the value must be contained in the set of valid values with id: '21P-FORM' and (if COST-SHARING-OFFSET.COVERAGE-PERIOD-END-DATE is non-null then COST-SHARING-OFFSET.COVERAGE-PERIOD-END-DATE >= Valid Values Effective-Date and COST-SHARING-OFFSET.COVERAGE-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	Rule-8589	Delete	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and COST-SHARING-OFFSET.MBESCBES-FORM-GROUP equals '1' and COST-SHARING-OFFSET.MBESCBES-FORM equals '64.9A', then the value must be contained in the set of valid values with id: '64.9A-FORM' and (if COST-SHARING-OFFSET.COVERAGE-PERIOD-END-DATE is non-null then COST-SHARING-OFFSET.COVERAGE-PERIOD-END-DATE >= Valid Values Effective-Date and COST-SHARING-OFFSET.COVERAGE-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	Rule-8588	Delete	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and COST-SHARING-OFFSET.MBESCBES-FORM-GROUP equals '1' and COST-SHARING-OFFSET.MBESCBES-FORM equals '64.10BASE', then the value must be contained in the set of valid values with id: '64.10BASE-FORM' and (if COST-SHARING-OFFSET.COVERAGE-PERIOD-END-DATE is non-null then COST-SHARING-OFFSET.COVERAGE-PERIOD-END-DATE >= Valid Values Effective-Date and COST-SHARING-OFFSET.COVERAGE-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	Rule-8587	Delete	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and COST-SHARING-OFFSET.MBESCBES-FORM-GROUP equals '1' and COST-SHARING-OFFSET.MBESCBES-FORM equals '64.9P', then the value must be contained in the set of valid values with id: '64.9P-FORM' and (if COST-SHARING-OFFSET.COVERAGE-PERIOD-END-DATE is non-null then COST-SHARING-OFFSET.COVERAGE-PERIOD-END-DATE >= Valid Values Effective-Date and COST-SHARING-OFFSET.COVERAGE-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	Rule-8819	Delete	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and COST-SHARING-OFFSET.MBESCBES-FORM-GROUP equals '2' and COST-SHARING-OFFSET.MBESCBES-FORM equals '64.21UP', then the value must be contained in the set of valid values with id: '64.21UP-FORM' and (if COST-SHARING-OFFSET.COVERAGE-PERIOD-END-DATE is non-null then COST-SHARING-OFFSET.COVERAGE-PERIOD-END-DATE >= Valid Values Effective-Date and COST-SHARING-OFFSET.COVERAGE-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
06/20/2025	4.0.11	Rule-8597	Update	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and VALUE-BASED-PAYMENT.MBESCBES-FORM-GROUP equals '1' and VALUE-BASED-PAYMENT.MBESCBES-FORM equals '64.9BASE', then the value must be contained in the set of valid values with id: '64.9BASE-FORM' and (if VALUE-BASED-PAYMENT.PERFORMANCE-PERIOD-END-DATE is non-null then VALUE-BASED-PAYMENT.PERFORMANCE-PERIOD-END-DATE >= Valid Values Effective-Date and VALUE-BASED-PAYMENT.PERFORMANCE-PERIOD-END-DATE <= Valid Values End-Date)'	If the MBESCBES-CATEGORY-OF-SERVICE field is populated and MBESCBES-FORM-GROUP is equal to '1' and MBESCBES-FORM has non null value then the value must be contained in the set of valid values with id: '64.9COS' and VALUE-BASED-PAYMENT.PERFORMANCE-PERIOD-END-DATE has non null value and VALUE-BASED-PAYMENT.PERFORMANCE-PERIOD-END-DATE must be >= Valid Values Effective-Date and VALUE-BASED-PAYMENT.PERFORMANCE-PERIOD-END-DATE <= Valid Values End-Date
06/20/2025	4.0.11	Rule-8598	Update	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and VALUE-BASED-PAYMENT.MBESCBES-FORM-GROUP equals '2' and VALUE-BASED-PAYMENT.MBESCBES-FORM equals '64.21U', then the value must be contained in the set of valid values with id: '64.21U-FORM' and (if VALUE-BASED-PAYMENT.PERFORMANCE-PERIOD-END-DATE is non-null then VALUE-BASED-PAYMENT.PERFORMANCE-PERIOD-END-DATE >= Valid Values Effective-Date and VALUE-BASED-PAYMENT.PERFORMANCE-PERIOD-END-DATE <= Valid Values End-Date)'	If the MBESCBES-CATEGORY-OF-SERVICE field is populated and MBESCBES-FORM-GROUP is equal to '2' and MBESCBES-FORM has non null value then the value must be contained in the set of valid values with id: '64.21COS' and VALUE-BASED-PAYMENT.PERFORMANCE-PERIOD-END-DATE has non null value and VALUE-BASED-PAYMENT.PERFORMANCE-PERIOD-END-DATE must be >= Valid Values Effective-Date and VALUE-BASED-PAYMENT.PERFORMANCE-PERIOD-END-DATE <= Valid Values End-Date
06/20/2025	4.0.11	Rule-8599	Update	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and VALUE-BASED-PAYMENT.MBESCBES-FORM-GROUP equals '3' and VALUE-BASED-PAYMENT.MBESCBES-FORM equals '21BASE', then the value must be contained in the set of valid values with id: '21BASE-FORM' and (if VALUE-BASED-PAYMENT.PERFORMANCE-PERIOD-END-DATE is non-null then VALUE-BASED-PAYMENT.PERFORMANCE-PERIOD-END-DATE >= Valid Values Effective-Date and VALUE-BASED-PAYMENT.PERFORMANCE-PERIOD-END-DATE <= Valid Values End-Date)'	If the MBESCBES-CATEGORY-OF-SERVICE field is populated and MBESCBES-FORM-GROUP is equal to '3' and MBESCBES-FORM has non null value then the value must be contained in the set of valid values with id: '21COS' and VALUE-BASED-PAYMENT.PERFORMANCE-PERIOD-END-DATE has non null value and VALUE-BASED-PAYMENT.PERFORMANCE-PERIOD-END-DATE must be >= Valid Values Effective-Date and VALUE-BASED-PAYMENT.PERFORMANCE-PERIOD-END-DATE <= Valid Values End-Date
05/30/2025	4.0.9	Rule-8596	Delete	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and VALUE-BASED-PAYMENT.MBESCBES-FORM-GROUP equals '1' and VALUE-BASED-PAYMENT.MBESCBES-FORM equals '64.9A', then the value must be contained in the set of valid values with id: '64.9A-FORM' and (if VALUE-BASED-PAYMENT.PERFORMANCE-PERIOD-END-DATE is non-null then VALUE-BASED-PAYMENT.PERFORMANCE-PERIOD-END-DATE >= Valid Values Effective-Date and VALUE-BASED-PAYMENT.PERFORMANCE-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	Rule-8585	Delete	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and GROUP-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM-GROUP equals '3' and GROUP-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM equals '21BASE', then the value must be contained in the set of valid values with id: '21BASE-FORM' and (if GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE is non-null then GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE >= Valid Values Effective-Date and GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	Rule-8594	Delete	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and VALUE-BASED-PAYMENT.MBESCBES-FORM-GROUP equals '1' and VALUE-BASED-PAYMENT.MBESCBES-FORM equals '64.9P', then the value must be contained in the set of valid values with id: '64.9P-FORM' and (if VALUE-BASED-PAYMENT.PERFORMANCE-PERIOD-END-DATE is non-null then VALUE-BASED-PAYMENT.PERFORMANCE-PERIOD-END-DATE >= Valid Values Effective-Date and VALUE-BASED-PAYMENT.PERFORMANCE-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	Rule-8600	Delete	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and VALUE-BASED-PAYMENT.MBESCBES-FORM-GROUP equals '3' and VALUE-BASED-PAYMENT.MBESCBES-FORM equals '21P', then the value must be contained in the set of valid values with id: '21P-FORM' and (if VALUE-BASED-PAYMENT.PERFORMANCE-PERIOD-END-DATE is non-null then VALUE-BASED-PAYMENT.PERFORMANCE-PERIOD-END-DATE >= Valid Values Effective-Date and VALUE-BASED-PAYMENT.PERFORMANCE-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	Rule-8812	Delete	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and VALUE-BASED-PAYMENT.MBESCBES-FORM-GROUP equals '2' and VALUE-BASED-PAYMENT.MBESCBES-FORM equals '64.21UP', then the value must be contained in the set of valid values with id: '64.21UP-FORM' and (if VALUE-BASED-PAYMENT.PERFORMANCE-PERIOD-END-DATE is non-null then VALUE-BASED-PAYMENT.PERFORMANCE-PERIOD-END-DATE >= Valid Values Effective-Date and VALUE-BASED-PAYMENT.PERFORMANCE-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
06/20/2025	4.0.11	Rule-8611	Update	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and COST-SETTLEMENT-PAYMENT.MBESCBES-FORM-GROUP equals '1' and COST-SETTLEMENT-PAYMENT.MBESCBES-FORM equals '64.9BASE', then the value must be contained in the set of valid values with id: '64.9BASE-FORM' and (if COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE is non-null then COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE >= Valid Values Effective-Date and COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE <= Valid Values End-Date)'	If the MBESCBES-CATEGORY-OF-SERVICE field is populated and MBESCBES-FORM-GROUP is equal to '1' and MBESCBES-FORM has non null value then the value must be contained in the set of valid values with id: '64.9COS' and COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE has non null value and COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE must be >= Valid Values Effective-Date and COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE <= Valid Values End-Date
06/20/2025	4.0.11	Rule-8612	Update	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and COST-SETTLEMENT-PAYMENT.MBESCBES-FORM-GROUP equals '2' and COST-SETTLEMENT-PAYMENT.MBESCBES-FORM equals '64.21U', then the value must be contained in the set of valid values with id: '64.21U-FORM' and (if COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE is non-null then COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE >= Valid Values Effective-Date and COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE <= Valid Values End-Date)'	If the MBESCBES-CATEGORY-OF-SERVICE field is populated and MBESCBES-FORM-GROUP is equal to '2' and MBESCBES-FORM has non null value then the value must be contained in the set of valid values with id: '64.21COS' and COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE has non null value and COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE must be >= Valid Values Effective-Date and COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE <= Valid Values End-Date
06/20/2025	4.0.11	Rule-8613	Update	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and COST-SETTLEMENT-PAYMENT.MBESCBES-FORM-GROUP equals '3' and COST-SETTLEMENT-PAYMENT.MBESCBES-FORM equals '21BASE', then the value must be contained in the set of valid values with id: '21BASE-FORM' and (if COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE is non-null then COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE >= Valid Values Effective-Date and COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE <= Valid Values End-Date)'	If the MBESCBES-CATEGORY-OF-SERVICE field is populated and MBESCBES-FORM-GROUP is equal to '3' and MBESCBES-FORM has non null value then the value must be contained in the set of valid values with id: '21COS' and COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE has non null value and COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE must be >= Valid Values Effective-Date and COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE <= Valid Values End-Date
05/30/2025	4.0.9	Rule-8608	Delete	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and COST-SETTLEMENT-PAYMENT.MBESCBES-FORM-GROUP equals '1' and COST-SETTLEMENT-PAYMENT.MBESCBES-FORM equals '64.9P', then the value must be contained in the set of valid values with id: '64.9P-FORM' and (if COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE is non-null then COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE >= Valid Values Effective-Date and COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	Rule-8609	Delete	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and COST-SETTLEMENT-PAYMENT.MBESCBES-FORM-GROUP equals '1' and COST-SETTLEMENT-PAYMENT.MBESCBES-FORM equals '64.10BASE', then the value must be contained in the set of valid values with id: '64.10BASE-FORM' and (if COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE is non-null then COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE >= Valid Values Effective-Date and COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	Rule-8610	Delete	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and COST-SETTLEMENT-PAYMENT.MBESCBES-FORM-GROUP equals '1' and COST-SETTLEMENT-PAYMENT.MBESCBES-FORM equals '64.9A', then the value must be contained in the set of valid values with id: '64.9A-FORM' and (if COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE is non-null then COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE >= Valid Values Effective-Date and COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	Rule-8614	Delete	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and COST-SETTLEMENT-PAYMENT.MBESCBES-FORM-GROUP equals '3' and COST-SETTLEMENT-PAYMENT.MBESCBES-FORM equals '21P', then the value must be contained in the set of valid values with id: '21P-FORM' and (if COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE is non-null then COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE >= Valid Values Effective-Date and COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	Rule-8820	Delete	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and COST-SETTLEMENT-PAYMENT.MBESCBES-FORM-GROUP equals '2' and COST-SETTLEMENT-PAYMENT.MBESCBES-FORM equals '64.21UP', then the value must be contained in the set of valid values with id: '64.21UP-FORM' and (if COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE is non-null then COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE >= Valid Values Effective-Date and COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	Rule-8615	Delete	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and FQHC-WRAP-PAYMENT.MBESCBES-FORM-GROUP equals '1' and FQHC-WRAP-PAYMENT.MBESCBES-FORM equals '64.9P', then the value must be contained in the set of valid values with id: '64.9P-FORM' and (if FQHC-WRAP-PAYMENT.WRAP-PERIOD-END-DATE is non-null then FQHC-WRAP-PAYMENT.WRAP-PERIOD-END-DATE >= Valid Values Effective-Date and FQHC-WRAP-PAYMENT.WRAP-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	Rule-8616	Delete	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and FQHC-WRAP-PAYMENT.MBESCBES-FORM-GROUP equals '1' and FQHC-WRAP-PAYMENT.MBESCBES-FORM equals '64.10BASE', then the value must be contained in the set of valid values with id: '64.10BASE-FORM' and (if FQHC-WRAP-PAYMENT.WRAP-PERIOD-END-DATE is non-null then FQHC-WRAP-PAYMENT.WRAP-PERIOD-END-DATE >= Valid Values Effective-Date and FQHC-WRAP-PAYMENT.WRAP-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	Rule-8617	Delete	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and FQHC-WRAP-PAYMENT.MBESCBES-FORM-GROUP equals '1' and FQHC-WRAP-PAYMENT.MBESCBES-FORM equals '64.9A', then the value must be contained in the set of valid values with id: '64.9A-FORM' and (if FQHC-WRAP-PAYMENT.WRAP-PERIOD-END-DATE is non-null then FQHC-WRAP-PAYMENT.WRAP-PERIOD-END-DATE >= Valid Values Effective-Date and FQHC-WRAP-PAYMENT.WRAP-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	Rule-8621	Delete	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and FQHC-WRAP-PAYMENT.MBESCBES-FORM-GROUP equals '3' and FQHC-WRAP-PAYMENT.MBESCBES-FORM equals '21P', then the value must be contained in the set of valid values with id: '21P-FORM' and (if FQHC-WRAP-PAYMENT.WRAP-PERIOD-END-DATE is non-null then FQHC-WRAP-PAYMENT.WRAP-PERIOD-END-DATE >= Valid Values Effective-Date and FQHC-WRAP-PAYMENT.WRAP-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	Rule-8818	Delete	Data Dictionary - Validation Rules	if the MBESCBES-CATEGORY-OF-SERVICE field is populated and FQHC-WRAP-PAYMENT.MBESCBES-FORM-GROUP equals '2' and FQHC-WRAP-PAYMENT.MBESCBES-FORM equals '64.21UP', then the value must be contained in the set of valid values with id: '64.21UP-FORM' and (if FQHC-WRAP-PAYMENT.WRAP-PERIOD-END-DATE is non-null then FQHC-WRAP-PAYMENT.WRAP-PERIOD-END-DATE >= Valid Values Effective-Date and FQHC-WRAP-PAYMENT.WRAP-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
06/20/2025	4.0.11	Rule-8625	Update	Data Dictionary - Validation Rules	'if the MBESCBES-CATEGORY-OF-SERVICE field is populated and MISCELLANEOUS-PAYMENT.MBESCBES-FORM-GROUP equals '1' and MISCELLANEOUS-PAYMENT.MBESCBES-FORM equals '64.9BASE', then the value must be contained in the set of valid values with id: '64.9BASE-FORM' and (if MISCELLANEOUS-PAYMENT.PAYMENT-PERIOD-END-DATE is non-null then MISCELLANEOUS-PAYMENT.PAYMENT-PERIOD-END-DATE >= Valid Values Effective-Date and MISCELLANEOUS-PAYMENT.PAYMENT-PERIOD-END-DATE <= Valid Values End-Date)'	If the MBESCBES-CATEGORY-OF-SERVICE field is populated and MBESCBES-FORM-GROUP is equal to '1' and MBESCBES-FORM has non null value then the value must be contained in the set of valid values with id: '64.9COS' and MISCELLANEOUS-PAYMENT.PAYMENT-PERIOD-END-DATE has non null value and MISCELLANEOUS-PAYMENT.PAYMENT-PERIOD-END-DATE must be >= Valid Values Effective-Date and MISCELLANEOUS-PAYMENT.PAYMENT-PERIOD-END-DATE <= Valid Values End-Date
06/20/2025	4.0.11	Rule-8626	Update	Data Dictionary - Validation Rules	'if the MBESCBES-CATEGORY-OF-SERVICE field is populated and MISCELLANEOUS-PAYMENT.MBESCBES-FORM-GROUP equals '2' and MISCELLANEOUS-PAYMENT.MBESCBES-FORM equals '64.21U', then the value must be contained in the set of valid values with id: '64.21U-FORM' and (if MISCELLANEOUS-PAYMENT.PAYMENT-PERIOD-END-DATE is non-null then MISCELLANEOUS-PAYMENT.PAYMENT-PERIOD-END-DATE >= Valid Values Effective-Date and MISCELLANEOUS-PAYMENT.PAYMENT-PERIOD-END-DATE <= Valid Values End-Date)'	If the MBESCBES-CATEGORY-OF-SERVICE field is populated and MBESCBES-FORM-GROUP is equal to '2' and MBESCBES-FORM has non null value then the value must be contained in the set of valid values with id: '64.21COS' and MISCELLANEOUS-PAYMENT.PAYMENT-PERIOD-END-DATE has non null value and MISCELLANEOUS-PAYMENT.PAYMENT-PERIOD-END-DATE must be >= Valid Values Effective-Date and MISCELLANEOUS-PAYMENT.PAYMENT-PERIOD-END-DATE <= Valid Values End-Date
06/20/2025	4.0.11	Rule-8627	Update	Data Dictionary - Validation Rules	'if the MBESCBES-CATEGORY-OF-SERVICE field is populated and MISCELLANEOUS-PAYMENT.MBESCBES-FORM-GROUP equals '3' and MISCELLANEOUS-PAYMENT.MBESCBES-FORM equals '21BASE', then the value must be contained in the set of valid values with id: '21BASE-FORM' and (if MISCELLANEOUS-PAYMENT.PAYMENT-PERIOD-END-DATE is non-null then MISCELLANEOUS-PAYMENT.PAYMENT-PERIOD-END-DATE >= Valid Values Effective-Date and MISCELLANEOUS-PAYMENT.PAYMENT-PERIOD-END-DATE <= Valid Values End-Date)'	If the MBESCBES-CATEGORY-OF-SERVICE field is populated and MBESCBES-FORM-GROUP is equal to '3' and MBESCBES-FORM has non null value then the value must be contained in the set of valid values with id: '21COS' and MISCELLANEOUS-PAYMENT.PAYMENT-PERIOD-END-DATE has non null value and MISCELLANEOUS-PAYMENT.PAYMENT-PERIOD-END-DATE must be >= Valid Values Effective-Date and MISCELLANEOUS-PAYMENT.PAYMENT-PERIOD-END-DATE <= Valid Values End-Date
05/30/2025	4.0.9	Rule-8622	Delete	Data Dictionary - Validation Rules	'if the MBESCBES-CATEGORY-OF-SERVICE field is populated and MISCELLANEOUS-PAYMENT.MBESCBES-FORM-GROUP equals '1' and MISCELLANEOUS-PAYMENT.MBESCBES-FORM equals '64.9P', then the value must be contained in the set of valid values with id: '64.9P-FORM' and (if MISCELLANEOUS-PAYMENT.PAYMENT-PERIOD-END-DATE is non-null then MISCELLANEOUS-PAYMENT.PAYMENT-PERIOD-END-DATE >= Valid Values Effective-Date and MISCELLANEOUS-PAYMENT.PAYMENT-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	Rule-8623	Delete	Data Dictionary - Validation Rules	'if the MBESCBES-CATEGORY-OF-SERVICE field is populated and MISCELLANEOUS-PAYMENT.MBESCBES-FORM-GROUP equals '1' and MISCELLANEOUS-PAYMENT.MBESCBES-FORM equals '64.10BASE', then the value must be contained in the set of valid values with id: '64.10BASE-FORM' and (if MISCELLANEOUS-PAYMENT.PAYMENT-PERIOD-END-DATE is non-null then MISCELLANEOUS-PAYMENT.PAYMENT-PERIOD-END-DATE >= Valid Values Effective-Date and MISCELLANEOUS-PAYMENT.PAYMENT-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	Rule-8624	Delete	Data Dictionary - Validation Rules	'if the MBESCBES-CATEGORY-OF-SERVICE field is populated and MISCELLANEOUS-PAYMENT.MBESCBES-FORM-GROUP equals '1' and MISCELLANEOUS-PAYMENT.MBESCBES-FORM equals '64.9A', then the value must be contained in the set of valid values with id: '64.9A-FORM' and (if MISCELLANEOUS-PAYMENT.PAYMENT-PERIOD-END-DATE is non-null then MISCELLANEOUS-PAYMENT.PAYMENT-PERIOD-END-DATE >= Valid Values Effective-Date and MISCELLANEOUS-PAYMENT.PAYMENT-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	Rule-8628	Delete	Data Dictionary - Validation Rules	'if the MBESCBES-CATEGORY-OF-SERVICE field is populated and MISCELLANEOUS-PAYMENT.MBESCBES-FORM-GROUP equals '3' and MISCELLANEOUS-PAYMENT.MBESCBES-FORM equals '21P', then the value must be contained in the set of valid values with id: '21P-FORM' and (if MISCELLANEOUS-PAYMENT.PAYMENT-PERIOD-END-DATE is non-null then MISCELLANEOUS-PAYMENT.PAYMENT-PERIOD-END-DATE >= Valid Values Effective-Date and MISCELLANEOUS-PAYMENT.PAYMENT-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	Rule-8814	Delete	Data Dictionary - Validation Rules	'if the MBESCBES-CATEGORY-OF-SERVICE field is populated and MISCELLANEOUS-PAYMENT.MBESCBES-FORM-GROUP equals '2' and MISCELLANEOUS-PAYMENT.MBESCBES-FORM equals '64.21UP', then the value must be contained in the set of valid values with id: '64.21UP-FORM' and (if MISCELLANEOUS-PAYMENT.PAYMENT-PERIOD-END-DATE is non-null then MISCELLANEOUS-PAYMENT.PAYMENT-PERIOD-END-DATE >= Valid Values Effective-Date and MISCELLANEOUS-PAYMENT.PAYMENT-PERIOD-END-DATE <= Valid Values End-Date)'	N/A
06/20/2025	4.0.11	Rule-9111	Update	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and the MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-OT.MBESCBES-FORM-GROUP equals '3' and CLAIM-LINE-RECORD-OT.MBESCBES-FORM equals '21BASE', then the value must be contained in the set of valid values with id: '21BASE-FORM' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', and If the CLAIM-LINE-RECORD-OT.MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-OT.MBESCBES-FORM-GROUP is equal to '3' and CLAIM-LINE-RECORD-OT.MBESCBES-FORM has non null value then the value must be contained in the set of valid values with id: '21COS' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)
06/20/2025	4.0.11	Rule-9112	Update	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and the MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-OT.MBESCBES-FORM-GROUP equals '2' and CLAIM-LINE-RECORD-OT.MBESCBES-FORM equals '64.21U', then the value must be contained in the set of valid values with id: '64.21U-FORM' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', and If the CLAIM-LINE-RECORD-OT.MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-OT.MBESCBES-FORM-GROUP is equal to '2' and CLAIM-LINE-RECORD-OT.MBESCBES-FORM has non null value then the value must be contained in the set of valid values with id: '64.21COS' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)
06/20/2025	4.0.11	Rule-9113	Update	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and the MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-OT.MBESCBES-FORM-GROUP equals '1' and CLAIM-LINE-RECORD-OT.MBESCBES-FORM equals '64.9BASE', then the value must be contained in the set of valid values with id: '64.9BASE-FORM' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', and If the CLAIM-LINE-RECORD-OT.MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-OT.MBESCBES-FORM-GROUP is equal to '1' and CLAIM-LINE-RECORD-OT.MBESCBES-FORM has non null value then the value must be contained in the set of valid values with id: '64.9COS' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)
05/30/2025	4.0.9	Rule-9110	Delete	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and the MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-OT.MBESCBES-FORM-GROUP equals '3' and CLAIM-LINE-RECORD-OT.MBESCBES-FORM equals '21P', then the value must be contained in the set of valid values with id: '21P-FORM' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	Rule-9114	Delete	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and the MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-OT.MBESCBES-FORM-GROUP equals '1' and CLAIM-LINE-RECORD-OT.MBESCBES-FORM equals '64.9A', then the value must be contained in the set of valid values with id: '64.9A-FORM' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	Rule-9115	Delete	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and the MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-OT.MBESCBES-FORM-GROUP equals '1' and CLAIM-LINE-RECORD-OT.MBESCBES-FORM equals '64.10BASE', then the value must be contained in the set of valid values with id: '64.10BASE-FORM' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	Rule-9116	Delete	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and the MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-OT.MBESCBES-FORM-GROUP equals '1' and CLAIM-LINE-RECORD-OT.MBESCBES-FORM equals '64.9P', then the value must be contained in the set of valid values with id: '64.9P-FORM' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	Rule-9117	Delete	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and the MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-OT.MBESCBES-FORM-GROUP equals '2' and CLAIM-LINE-RECORD-OT.MBESCBES-FORM equals '64.21UP', then the value must be contained in the set of valid values with id: '64.21UP-FORM' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'	N/A
06/20/2025	4.0.11	Rule-9062	Update	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', and If the CLAIM-LINE-RECORD-IP.MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-IP.MBESCBES-FORM-GROUP is equal to '3' and CLAIM-LINE-RECORD-IP.MBESCBES-FORM is equal to '21BASE' then the value must be contained in the set of valid values with id: '21BASE-FORM' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', and If the CLAIM-LINE-RECORD-IP.MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-IP.MBESCBES-FORM-GROUP is equal to '3' and CLAIM-LINE-RECORD-IP.MBESCBES-FORM has non null value then the value must be contained in the set of valid values with id: '21COS' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)
06/20/2025	4.0.11	Rule-9063	Update	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', and If the CLAIM-LINE-RECORD-IP.MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-IP.MBESCBES-FORM-GROUP is equal to '2' and CLAIM-LINE-RECORD-IP.MBESCBES-FORM is equal to '64.21U' then the value must be contained in the set of valid values with id: '64.21U-FORM' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', and If the CLAIM-LINE-RECORD-IP.MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-IP.MBESCBES-FORM-GROUP is equal to '2' and CLAIM-LINE-RECORD-IP.MBESCBES-FORM has non null value then the value must be contained in the set of valid values with id: '64.21COS' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)
06/20/2025	4.0.11	Rule-9064	Update	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', and If the CLAIM-LINE-RECORD-IP.MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-IP.MBESCBES-FORM-GROUP is equal to '1' and CLAIM-LINE-RECORD-IP.MBESCBES-FORM is equal to '64.9BASE' then the value must be contained in the set of valid values with id: '64.9BASE-FORM' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', and If the CLAIM-LINE-RECORD-IP.MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-IP.MBESCBES-FORM-GROUP is equal to '1' and CLAIM-LINE-RECORD-IP.MBESCBES-FORM has non null value then the value must be contained in the set of valid values with id: '64.9COS' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)
05/30/2025	4.0.9	Rule-9061	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', and If the CLAIM-LINE-RECORD-IP.MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-IP.MBESCBES-FORM-GROUP is equal to '3' and MBESCBES-FORM is equal to '21P' then the value must be contained in the set of valid values with id: '21P-FORM' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)	N/A
05/30/2025	4.0.9	Rule-9065	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', and If the CLAIM-LINE-RECORD-IP.MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-IP.MBESCBES-FORM-GROUP is equal to '1' and CLAIM-LINE-RECORD-IP.MBESCBES-FORM is equal to '64.9A' then the value must be contained in the set of valid values with id: '64.9A-FORM' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)	N/A
05/30/2025	4.0.9	Rule-9066	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', and If the CLAIM-LINE-RECORD-IP.MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-IP.MBESCBES-FORM-GROUP is equal to '1' and CLAIM-LINE-RECORD-IP.MBESCBES-FORM is equal to '64.10BASE' then the value must be contained in the set of valid values with id: '64.10BASE-FORM' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)	N/A
05/30/2025	4.0.9	Rule-9067	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', and If the CLAIM-LINE-RECORD-IP.MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-IP.MBESCBES-FORM-GROUP is equal to '1' and CLAIM-LINE-RECORD-IP.MBESCBES-FORM is equal to '64.9P' then the value must be contained in the set of valid values with id: '64.9P-FORM' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)	N/A
05/30/2025	4.0.9	Rule-9068	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', and If the CLAIM-LINE-RECORD-IP.MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-IP.MBESCBES-FORM-GROUP is equal to '2' and MBESCBES-FORM is equal to '64.21UP' then the value must be contained in the set of valid values with id: '64.21UP-FORM' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)	N/A
06/20/2025	4.0.11	Rule-9086	Update	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', and If the CLAIM-LINE-RECORD-LT.MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-LT.MBESCBES-FORM-GROUP is equal to '3' and CLAIM-LINE-RECORD-LT.MBESCBES-FORM is equal to '21BASE' then the value must be contained in the set of valid values with id: '21BASE-FORM' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', and If the CLAIM-LINE-RECORD-LT.MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-LT.MBESCBES-FORM-GROUP is equal to '3' and CLAIM-LINE-RECORD-LT.MBESCBES-FORM has non null value then the value must be contained in the set of valid values with id: '21COS' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)
06/20/2025	4.0.11	Rule-9087	Update	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', and If the CLAIM-LINE-RECORD-LT.MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-LT.MBESCBES-FORM-GROUP is equal to '2' and CLAIM-LINE-RECORD-LT.MBESCBES-FORM is equal to '64.21U' then the value must be contained in the set of valid values with id: '64.21U-FORM' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', and If the CLAIM-LINE-RECORD-LT.MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-LT.MBESCBES-FORM-GROUP is equal to '2' and CLAIM-LINE-RECORD-LT.MBESCBES-FORM has non null value then the value must be contained in the set of valid values with id: '64.21COS' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)
06/20/2025	4.0.11	Rule-9088	Update	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', and If the CLAIM-LINE-RECORD-LT.MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-LT.MBESCBES-FORM-GROUP is equal to '1' and CLAIM-LINE-RECORD-LT.MBESCBES-FORM is equal to '64.9BASE' then the value must be contained in the set of valid values with id: '64.9BASE-FORM' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', and If the CLAIM-LINE-RECORD-LT.MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-LT.MBESCBES-FORM-GROUP is equal to '1' and CLAIM-LINE-RECORD-LT.MBESCBES-FORM has non null value then the value must be contained in the set of valid values with id: '64.9COS' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)
05/30/2025	4.0.9	Rule-9085	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', and If the CLAIM-LINE-RECORD-LT.MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-LT.MBESCBES-FORM-GROUP is equal to '3' and MBESCBES-FORM is equal to '21P' then the value must be contained in the set of valid values with id: '21P-FORM' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)	N/A
05/30/2025	4.0.9	Rule-9089	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', and If the CLAIM-LINE-RECORD-LT.MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-LT.MBESCBES-FORM-GROUP is equal to '1' and CLAIM-LINE-RECORD-LT.MBESCBES-FORM is equal to '64.9A' then the value must be contained in the set of valid values with id: '64.9A-FORM' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)	N/A
05/30/2025	4.0.9	Rule-9090	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', and If the CLAIM-LINE-RECORD-LT.MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-LT.MBESCBES-FORM-GROUP is equal to '1' and CLAIM-LINE-RECORD-LT.MBESCBES-FORM is equal to '64.10BASE' then the value must be contained in the set of valid values with id: '64.10BASE-FORM' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)	N/A
05/30/2025	4.0.9	Rule-9191	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', and If the CLAIM-LINE-RECORD-LT.MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-LT.MBESCBES-FORM-GROUP is equal to '1' and CLAIM-LINE-RECORD-LT.MBESCBES-FORM is equal to '64.9P' then the value must be contained in the set of valid values with id: '64.9P-FORM' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)	N/A
05/30/2025	4.0.9	Rule-9192	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', and If the CLAIM-LINE-RECORD-LT.MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-LT.MBESCBES-FORM-GROUP is equal to '2' and MBESCBES-FORM is equal to '64.21UP' then the value must be contained in the set of valid values with id: '64.21UP-FORM' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)	N/A
06/20/2025	4.0.11	Rule-9133	Update	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', and If the CLAIM-LINE-RECORD-RX.MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-RX.MBESCBES-FORM-GROUP is equal to '3' and CLAIM-LINE-RECORD-RX.MBESCBES-FORM is equal to '21BASE' then the value must be contained in the set of valid values with id: '21BASE-FORM' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', and If the CLAIM-LINE-RECORD-RX.MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-RX.MBESCBES-FORM-GROUP is equal to '3' and CLAIM-LINE-RECORD-RX.MBESCBES-FORM has non null value then the value must be contained in the set of valid values with id: '21COS' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)
06/20/2025	4.0.11	Rule-9134	Update	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', and If the CLAIM-LINE-RECORD-RX.MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-RX.MBESCBES-FORM-GROUP is equal to '2' and CLAIM-LINE-RECORD-RX.MBESCBES-FORM is equal to '64.21U' then the value must be contained in the set of valid values with id: '64.21U-FORM' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', and If the CLAIM-LINE-RECORD-RX.MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-RX.MBESCBES-FORM-GROUP is equal to '2' and CLAIM-LINE-RECORD-RX.MBESCBES-FORM has non null value then the value must be contained in the set of valid values with id: '64.21COS' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)
06/20/2025	4.0.11	Rule-9135	Update	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', and If the CLAIM-LINE-RECORD-RX.MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-RX.MBESCBES-FORM-GROUP is equal to '1' and CLAIM-LINE-RECORD-RX.MBESCBES-FORM is equal to '64.9BASE' then the value must be contained in the set of valid values with id: '64.9BASE-FORM' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', and If the CLAIM-LINE-RECORD-RX.MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-RX.MBESCBES-FORM-GROUP is equal to '1' and CLAIM-LINE-RECORD-RX.MBESCBES-FORM has non null value then the value must be contained in the set of valid values with id: '64.9COS' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)
05/30/2025	4.0.9	Rule-9132	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', and If the CLAIM-LINE-RECORD-RX.MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-RX.MBESCBES-FORM-GROUP is equal to '3' and MBESCBES-FORM is equal to '21P' then the value must be contained in the set of valid values with id: '21P-FORM' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)	N/A
05/30/2025	4.0.9	Rule-9136	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', and If the CLAIM-LINE-RECORD-RX.MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-RX.MBESCBES-FORM-GROUP is equal to '1' and CLAIM-LINE-RECORD-RX.MBESCBES-FORM is equal to '64.9A' then the value must be contained in the set of valid values with id: '64.9A-FORM' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)	N/A
05/30/2025	4.0.9	Rule-9137	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', and If the CLAIM-LINE-RECORD-RX.MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-RX.MBESCBES-FORM-GROUP is equal to '1' and CLAIM-LINE-RECORD-RX.MBESCBES-FORM is equal to '64.10BASE' then the value must be contained in the set of valid values with id: '64.10BASE-FORM' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)	N/A
05/30/2025	4.0.9	Rule-9138	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', and If the CLAIM-LINE-RECORD-RX.MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-RX.MBESCBES-FORM-GROUP is equal to '1' and CLAIM-LINE-RECORD-RX.MBESCBES-FORM is equal to '64.9P' then the value must be contained in the set of valid values with id: '64.9P-FORM' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)	N/A
05/30/2025	4.0.9	Rule-9139	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', and If the CLAIM-LINE-RECORD-RX.MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-RX.MBESCBES-FORM-GROUP is equal to '2' and MBESCBES-FORM is equal to '64.21UP' then the value must be contained in the set of valid values with id: '64.21UP-FORM' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)	N/A
06/20/2025	4.0.11	Rule-8604	Update	Data Dictionary - Validation Rules	If the MBESCBES-CATEGORY-OF-SERVICE field is populated and MBESCBES-FORM-GROUP is equal to one of the following '3' and MBESCBES-FORM is equal to '21BASE' then the value must be contained in the set of valid values with id: '21BASE-FORM' and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.PAYMENT-PERIOD-END-DATE has non null value and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.PAYMENT-PERIOD-END-DATE must be >= Valid Values Effective-Date and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.PAYMENT-PERIOD-END-DATE <= Valid Values End-Date	If the MBESCBES-CATEGORY-OF-SERVICE field is populated and MBESCBES-FORM-GROUP is equal to '3' and MBESCBES-FORM has non null value then the value must be contained in the set of valid values with id: '21COS' and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.PAYMENT-PERIOD-END-DATE has non null value and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.PAYMENT-PERIOD-END-DATE must be >= Valid Values Effective-Date and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.PAYMENT-PERIOD-END-DATE <= Valid Values End-Date
06/20/2025	4.0.11	Rule-8605	Update	Data Dictionary - Validation Rules	If the MBESCBES-CATEGORY-OF-SERVICE field is populated and MBESCBES-FORM-GROUP is equal to one of the following '2' and MBESCBES-FORM is equal to '64.21U' then the value must be contained in the set of valid values with id: '64.21U-FORM' and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.PAYMENT-PERIOD-END-DATE has non null value and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.PAYMENT-PERIOD-END-DATE must be >= Valid Values Effective-Date and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.PAYMENT-PERIOD-END-DATE <= Valid Values End-Date	If the MBESCBES-CATEGORY-OF-SERVICE field is populated and MBESCBES-FORM-GROUP is equal to '2' and MBESCBES-FORM has non null value then the value must be contained in the set of valid values with id: '64.21COS' and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.PAYMENT-PERIOD-END-DATE has non null value and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.PAYMENT-PERIOD-END-DATE must be >= Valid Values Effective-Date and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.PAYMENT-PERIOD-END-DATE <= Valid Values End-Date
06/20/2025	4.0.11	Rule-8606	Update	Data Dictionary - Validation Rules	If the MBESCBES-CATEGORY-OF-SERVICE field is populated and MBESCBES-FORM-GROUP is equal to one of the following '1' and MBESCBES-FORM is equal to '64.9BASE' then the value must be contained in the set of valid values with id: '64.9BASE-FORM' and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.PAYMENT-PERIOD-END-DATE has non null value and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.PAYMENT-PERIOD-END-DATE must be >= Valid Values Effective-Date and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.PAYMENT-PERIOD-END-DATE <= Valid Values End-Date	If the MBESCBES-CATEGORY-OF-SERVICE field is populated and MBESCBES-FORM-GROUP is equal to '1' and MBESCBES-FORM has non null value then the value must be contained in the set of valid values with id: '64.9COS' and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.PAYMENT-PERIOD-END-DATE has non null value and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.PAYMENT-PERIOD-END-DATE must be >= Valid Values Effective-Date and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.PAYMENT-PERIOD-END-DATE <= Valid Values End-Date
05/30/2025	4.0.9	Rule-8603	Delete	Data Dictionary - Validation Rules	If the MBESCBES-CATEGORY-OF-SERVICE field is populated and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.MBESCBES-FORM-GROUP is equal to one of the following '1' and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.MBESCBES-FORM is equal to '64.9A' then the value must be contained in the set of valid values with id: '64.9A-FORM' and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.PAYMENT-PERIOD-END-DATE has non null value and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.PAYMENT-PERIOD-END-DATE must be >= Valid Values Effective-Date and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.PAYMENT-PERIOD-END-DATE <= Valid Values End-Date	N/A
05/30/2025	4.0.9	Rule-8602	Delete	Data Dictionary - Validation Rules	If the MBESCBES-CATEGORY-OF-SERVICE field is populated and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.MBESCBES-FORM-GROUP is equal to '1' and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.MBESCBES-FORM is equal to '64.10BASE' then the value must be contained in the set of valid values with id: '64.10BASE-FORM' and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.PAYMENT-PERIOD-END-DATE has non null value and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.PAYMENT-PERIOD-END-DATE must be >= Valid Values Effective-Date and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.PAYMENT-PERIOD-END-DATE <= Valid Values End-Date	N/A
05/30/2025	4.0.9	Rule-8601	Delete	Data Dictionary - Validation Rules	If the MBESCBES-CATEGORY-OF-SERVICE field is populated and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.MBESCBES-FORM-GROUP is equal to '1' and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.MBESCBES-FORM is equal to '64.9P' then the value must be contained in the set of valid values with id: '64.9P-FORM' and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.PAYMENT-PERIOD-END-DATE has non null value and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.PAYMENT-PERIOD-END-DATE must be >= Valid Values Effective-Date and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.PAYMENT-PERIOD-END-DATE <= Valid Values End-Date	N/A
05/30/2025	4.0.9	Rule-8607	Delete	Data Dictionary - Validation Rules	If the MBESCBES-CATEGORY-OF-SERVICE field is populated and MBESCBES-FORM-GROUP is equal to one of the following '3' and MBESCBES-FORM is equal to '21P' then the value must be contained in the set of valid values with id: '21P-FORM' and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.PAYMENT-PERIOD-END-DATE has non null value and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.PAYMENT-PERIOD-END-DATE must be >= Valid Values Effective-Date and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.PAYMENT-PERIOD-END-DATE <= Valid Values End-Date	N/A
05/30/2025	4.0.9	Rule-8813	Delete	Data Dictionary - Validation Rules	If the MBESCBES-CATEGORY-OF-SERVICE field is populated and MBESCBES-FORM-GROUP is equal to one of the following '3' and MBESCBES-FORM is equal to '21BASE' then the value must be contained in the set of valid values with id: '21BASE-FORM' and COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE has non null value and COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE must be >= Valid Values Effective-Date and COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE <= Valid Values End-Date	N/A
05/30/2025	4.0.9	RULE-7726	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE'	N/A
05/30/2025	4.0.9	RULE-7725	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE'	N/A
05/30/2025	4.0.9	RULE-7396	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE'	N/A
05/30/2025	4.0.9	RULE-7387	Delete	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM equals '4' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01', then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'	N/A
05/30/2025	4.0.9	RULE-1540	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '2', 'B', 'V' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for BILLING-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-OT, ((there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and (CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE >= PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys and (CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE >= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)))	N/A
05/30/2025	4.0.9	RULE-7646	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1', then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys(ENROLLMENT-TIME-SPAN-SEGMENT[SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM], CLAIM-HEADER-RECORD-OT[SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM])	N/A
05/30/2025	4.0.9	RULE-7702	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', 'V' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys(MANAGED-CARE-MAIN[SUBMITTING-STATE, STATE-PLAN-ID-NUM], CLAIM-HEADER-RECORD-OT[SUBMITTING-STATE, PLAN-ID-NUMBER]) and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE must be in (MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE, MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE)	N/A
05/30/2025	4.0.9	RULE-7836	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then (CLAIM-HEADER-RECORD-IP has a null value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-IP.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-COINS-AMT equals '0.00') and (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')'	N/A
05/30/2025	4.0.9	RULE-7837	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then (CLAIM-HEADER-RECORD-LT has a null value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-LT.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT equals '0.00') and (CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')'	N/A
05/30/2025	4.0.9	RULE-7838	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then (CLAIM-LINE-RECORD-OT has a null value for MEDICARE-PAID-AMT or CLAIM-LINE-RECORD-OT.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT equals '0.00') and (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')'	N/A
05/30/2025	4.0.9	RULE-7839	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then (CLAIM-LINE-RECORD-RX has a null value for MEDICARE-PAID-AMT or CLAIM-LINE-RECORD-RX.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-COINS-AMT equals '0.00') and (CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')'	N/A
05/30/2025	4.0.9	RULE-7840	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then (CLAIM-HEADER-RECORD-IP has a null value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-IP.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-COINS-AMT equals '0.00') and (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')'	N/A
05/30/2025	4.0.9	RULE-7841	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then (CLAIM-HEADER-RECORD-LT has a null value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-LT.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT equals '0.00') and (CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')'	N/A
05/30/2025	4.0.9	RULE-7842	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then (CLAIM-LINE-RECORD-OT has a null value for MEDICARE-PAID-AMT or CLAIM-LINE-RECORD-OT.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT equals '0.00') and (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')'	N/A
05/30/2025	4.0.9	RULE-7843	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then (CLAIM-LINE-RECORD-RX has a null value for MEDICARE-PAID-AMT or CLAIM-LINE-RECORD-RX.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-COINS-AMT equals '0.00') and (CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')'	N/A
05/30/2025	4.0.9	RULE-7392	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE'	N/A
05/30/2025	4.0.9	RULE-7390	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'	N/A
05/30/2025	4.0.9	RULE-7736	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B' and CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT does not equal '0.00', then CLAIM-LINE-RECORD-OT has a non-null value for CATEGORY-FOR-FEDERAL-REIMBURSEMENT'	N/A
05/30/2025	4.0.9	RULE-1343	Delete	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for DIAGNOSIS-CODE-1, then when CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-FLAG-1 is '1', CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-1 should be a valid value in 'ICD-9-DIAGNOSIS-CODE'. when CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-FLAG-1 is '2', CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-1 should be a valid value in 'ICD-10-DIAGNOSIS-CODE'.'	N/A
05/30/2025	4.0.9	RULE-1347	Delete	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT has a non-null value for DIAGNOSIS-CODE-2, then when CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-FLAG-2 is '1', CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-2 should be a valid value in 'ICD-9-DIAGNOSIS-CODE'. when CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-FLAG-2 is '2', CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-2 should be a valid value in 'ICD-10-DIAGNOSIS-CODE'.'	N/A
05/30/2025	4.0.9	RULE-7564	Delete	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and substr(CLAIM-LINE-RECORD-OT.PROCEDURE-CODE, 1, 1) is equal to 'D' and CLAIM-HEADER-RECORD-OT has a non-null value for DIAGNOSIS-CODE-FLAG-1, then CLAIM-HEADER-RECORD-OT has a non-null value for DIAGNOSIS-CODE-1'	N/A
05/30/2025	4.0.9	RULE-7852	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then CLAIM-HEADER-RECORD-IP has a non-null value for ADJUSTMENT-IND'	N/A
05/30/2025	4.0.9	RULE-7853	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then CLAIM-HEADER-RECORD-LT has a non-null value for ADJUSTMENT-IND'	N/A
05/30/2025	4.0.9	RULE-7854	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then CLAIM-HEADER-RECORD-OT has a non-null value for ADJUSTMENT-IND'	N/A
05/30/2025	4.0.9	RULE-7855	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then CLAIM-HEADER-RECORD-RX has a non-null value for ADJUSTMENT-IND'	N/A
05/30/2025	4.0.9	RULE-7856	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then CLAIM-LINE-RECORD-IP has a non-null value for LINE-ADJUSTMENT-IND'	N/A
05/30/2025	4.0.9	RULE-7857	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then CLAIM-LINE-RECORD-LT has a non-null value for LINE-ADJUSTMENT-IND'	N/A
05/30/2025	4.0.9	RULE-7858	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then CLAIM-LINE-RECORD-OT has a non-null value for LINE-ADJUSTMENT-IND'	N/A
05/30/2025	4.0.9	RULE-7859	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then CLAIM-LINE-RECORD-RX has a non-null value for LINE-ADJUSTMENT-IND'	N/A
05/30/2025	4.0.9	RULE-7860	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-IP has a non-null value for ADJUSTMENT-IND'	N/A
05/30/2025	4.0.9	RULE-7861	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-LT has a non-null value for ADJUSTMENT-IND'	N/A
05/30/2025	4.0.9	RULE-7862	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-OT has a non-null value for ADJUSTMENT-IND'	N/A
05/30/2025	4.0.9	RULE-7863	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-RX has a non-null value for ADJUSTMENT-IND'	N/A
05/30/2025	4.0.9	RULE-7864	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-LINE-RECORD-IP has a non-null value for LINE-ADJUSTMENT-IND'	N/A
05/30/2025	4.0.9	RULE-7865	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-LINE-RECORD-LT has a non-null value for LINE-ADJUSTMENT-IND'	N/A
05/30/2025	4.0.9	RULE-7866	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-LINE-RECORD-OT has a non-null value for LINE-ADJUSTMENT-IND'	N/A
05/30/2025	4.0.9	RULE-7867	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-LINE-RECORD-RX has a non-null value for LINE-ADJUSTMENT-IND'	N/A
05/30/2025	4.0.9	RULE-7876	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	RULE-7877	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then If the ADJUSTMENT-IND field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	RULE-7878	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then If the ADJUSTMENT-IND field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	RULE-7879	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then If the ADJUSTMENT-IND field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	RULE-7880	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' and CLAIM-LINE-RECORD-IP has a non-null value for LINE-ADJUSTMENT-IND, then If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	RULE-7881	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' and CLAIM-LINE-RECORD-LT has a non-null value for LINE-ADJUSTMENT-IND, then If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	RULE-7882	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' and CLAIM-LINE-RECORD-OT has a non-null value for LINE-ADJUSTMENT-IND, then If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	RULE-7883	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' and CLAIM-LINE-RECORD-RX has a non-null value for LINE-ADJUSTMENT-IND, then If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	RULE-7884	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	RULE-7885	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then If the ADJUSTMENT-IND field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	RULE-7886	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then If the ADJUSTMENT-IND field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	RULE-7887	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then If the ADJUSTMENT-IND field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	RULE-7888	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' and CLAIM-LINE-RECORD-IP has a non-null value for LINE-ADJUSTMENT-IND, then If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	RULE-7889	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' and CLAIM-LINE-RECORD-LT has a non-null value for LINE-ADJUSTMENT-IND, then If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	RULE-7890	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' and CLAIM-LINE-RECORD-OT has a non-null value for LINE-ADJUSTMENT-IND, then If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'	N/A
05/30/2025	4.0.9	RULE-7891	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' and CLAIM-LINE-RECORD-RX has a non-null value for LINE-ADJUSTMENT-IND, then If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)'	N/A
06/20/2025	4.0.11	NCD-UNIT-OF-MEASURE	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION NDC-UNIT-OF-MEASURE\|00010101\|99991231\|EA\|Each
06/20/2025	4.0.11	NCD-UNIT-OF-MEASURE	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION NDC-UNIT-OF-MEASURE\|00010101\|99991231\|GM\|Grams
06/20/2025	4.0.11	COVERAGE-TYPE	Update	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION COVERAGE-TYPE\|00010101\|99991231\|02\|Professional (Physician) Visit -- Office	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION COVERAGE-TYPE\|00010101\|99991231\|02\|Professional (Physician) Visit-Office
06/20/2025	4.0.11	COVERAGE-TYPE	Update	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION COVERAGE-TYPE\|00010101\|99991231\|12\|Mental health -inpatient	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION COVERAGE-TYPE\|00010101\|99991231\|12\|Mental health-inpatient
06/20/2025	4.0.11	COVERAGE-TYPE	Update	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION COVERAGE-TYPE\|00010101\|99991231\|13\|Psychiatric care- outpatient	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION COVERAGE-TYPE\|00010101\|99991231\|13\|Psychiatric care-outpatient
06/20/2025	4.0.11	COVERAGE-TYPE	Update	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION COVERAGE-TYPE\|00010101\|99991231\|14\|Psychiatric care- inpatient	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION COVERAGE-TYPE\|00010101\|99991231\|14\|Psychiatric care-inpatient
06/20/2025	4.0.11	ACCREDITATION-ORGANIZATION	Update	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ACCREDITATION-ORGANIZATION\|00010101\|99991231\|13\|National committee for quality assurance-- accredited	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ACCREDITATION-ORGANIZATION\|00010101\|99991231\|13\|National committee for quality assurance - accredited
06/20/2025	4.0.11	ACCREDITATION-ORGANIZATION	Update	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ACCREDITATION-ORGANIZATION\|00010101\|99991231\|14\|National committee for quality assurance - interim	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ACCREDITATION-ORGANIZATION\|00010101\|99991231\|14\|National committee for quality assurance - interim
06/20/2025	4.0.11	ACCREDITATION-ORGANIZATION	Update	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ACCREDITATION-ORGANIZATION\|00010101\|99991231\|15\|National committee for quality assurance - denied	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ACCREDITATION-ORGANIZATION\|00010101\|99991231\|15\|National committee for quality assurance - denied
06/20/2025	4.0.11	ELIGIBILITY-GROUP	Update	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ELIGIBILITY-GROUP\|00010101\|99991231\|73\|Adult Group - Individuals at or below 133% FPL Age 19 through 64- not newly eligible for non 1905z(3) states	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ELIGIBILITY-GROUP\|00010101\|99991231\|73\|Adult Group - Individuals at or below 133% FPL Age 19 through 64 - not newly eligible for non 1905z(3) states
06/20/2025	4.0.11	ELIGIBILITY-GROUP	Update	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ELIGIBILITY-GROUP\|00010101\|99991231\|75\|Adult Group - Individuals at or below 133% FPL Age 19 through 64- not newly eligible non-parent/ caretaker-relative(s) in 1905z(3) states	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ELIGIBILITY-GROUP\|00010101\|99991231\|75\|Adult Group - Individuals at or below 133% FPL Age 19 through 64 - not newly eligible non-parent/ caretaker-relative(s) in 1905z(3) states
06/20/2025	4.0.11	TYPE-OF-SERVICE-OT	Update	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION TYPE-OF-SERVICE-OT\|00010101\|99991231\|071\|HCBS - Training for family members	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION TYPE-OF-SERVICE-OT\|00010101\|99991231\|071\|HCBS - Training for family members
06/20/2025	4.0.11	TYPE-OF-SERVICE-OT	Update	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION TYPE-OF-SERVICE-OT\|00010101\|99991231\|072\|HCBS - Minor modification to the home	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION TYPE-OF-SERVICE-OT\|00010101\|99991231\|072\|HCBS - Minor modification to the home
06/20/2025	4.0.11	TYPE-OF-SERVICE	Update	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION TYPE-OF-SERVICE\|00010101\|99991231\|146\|Inpatient Psychiatric Services for beneficiaries between the ages of 22 and 64 who receive services in an institution for mental disease (IMD)	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION TYPE-OF-SERVICE\|00010101\|99991231\|146\|Inpatient Psychiatric Services for beneficiaries between the ages of 21 and 64 who receive services in an institution for mental disease (IMD).
06/20/2025	4.0.11	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9VIII WAIVER\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Prior Period Expenditures
06/20/2025	4.0.11	RULE-1000	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.PROGRAM-TYPE equals '07', then CLAIM-HEADER-RECORD-LT.WAIVER-TYPE is equal to one of the following: '06', '07', '08', '09', '10', '11', '12', '13', '14', '15', '16', '17', '18', '19', '20', '33''	N/A
06/20/2025	4.0.11	RULE-1816	Delete	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.PROGRAM-TYPE equals '07', then CLAIM-HEADER-RECORD-RX.WAIVER-TYPE is equal to one of the following: '06', '07', '08', '09', '10', '11', '12', '13', '14', '15', '16', '17', '18', '19', '20', '33''	N/A
06/20/2025	4.0.11	RULE-561	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.PROGRAM-TYPE equals '07', then CLAIM-HEADER-RECORD-IP.WAIVER-TYPE is equal to one of the following: '06', '07', '08', '09', '10', '11', '12', '13', '14', '15', '16', '17', '18', '19', '20', '33''	N/A
04/25/2025	4.0.7	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9BASE\|Medical Assistance Expenditures by Type of Service
04/25/2025	4.0.7	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9 WAIVER\|Medical Assistance Expenditures by Type of Service
04/25/2025	4.0.7	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9P\|Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program, Prior Period Adjustment
04/25/2025	4.0.7	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9P Waiver\|Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program, Prior Period Adjustment
04/25/2025	4.0.7	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9 200K\|Medical Assistance Expenditures by Type of Service
04/25/2025	4.0.7	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9P 200K\|Medical Assistance Expenditures by Type of Service for the Medical Assistance Program Prior Period Adjustments in This Quarter
04/25/2025	4.0.7	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9I\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
04/25/2025	4.0.7	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9PI\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
04/25/2025	4.0.7	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9TP\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
04/25/2025	4.0.7	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9TP WAIVER\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
04/25/2025	4.0.7	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9PE\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
04/25/2025	4.0.7	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9PEP\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
04/25/2025	4.0.7	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9PEPWAIV\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
04/25/2025	4.0.7	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9PEWAIV\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
04/25/2025	4.0.7	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9E\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
04/25/2025	4.0.7	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9EP\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
04/25/2025	4.0.7	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9EPWAIV\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
04/25/2025	4.0.7	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9EWAIV\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
04/25/2025	4.0.7	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9VIII\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
04/25/2025	4.0.7	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9VIIIP\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
04/25/2025	4.0.7	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9VIIIP Waiver\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
04/25/2025	4.0.7	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9E\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
04/25/2025	4.0.7	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9EP\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
04/25/2025	4.0.7	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9EPWAIV\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
04/25/2025	4.0.7	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9EWAIV\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
04/25/2025	4.0.7	MBESCBES-FORMGP-1	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-1\|00010101\|99991231\|CMS 64.9T\|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter
04/25/2025	4.0.7	MBESCBES-FORMGP-2	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-2\|00010101\|99991231\|CMS 64.21\|Quarterly Medical Assistance Expenditures By Children's Health Insurance Program
04/25/2025	4.0.7	MBESCBES-FORMGP-2	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-2\|00010101\|99991231\|CMS 64.21U\|Child Health Expenditures by Service
04/25/2025	4.0.7	MBESCBES-FORMGP-2	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-2\|00010101\|99991231\|CMS 64.21 WAIVER\|Quarterly Medical Assistance Expenditures By Children's Health Insurance Program
04/25/2025	4.0.7	MBESCBES-FORMGP-2	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-2\|00010101\|99991231\|CMS 64.21U WAIVER\|Quarterly Medical Assistance Expenditures By Children's Health Insurance Program Expenditure Categories
04/25/2025	4.0.7	MBESCBES-FORMGP-2	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-2\|00010101\|99991231\|CMS 64.21P\|Quarterly Medical Assistance Expenditures By Children's Health Insurance Program Prior Period Expenditures
04/25/2025	4.0.7	MBESCBES-FORMGP-2	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-2\|00010101\|99991231\|CMS 64.21P WAIVER\|Quarterly Medical Assistance Expenditures By Children's Health Insurance Program Prior Period Expenditures
04/25/2025	4.0.7	MBESCBES-FORMGP-2	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-2\|00010101\|99991231\|CMS 64.21UP\|Quarterly Medical Assistance Expenditures by Children’s Health Insurance Program expenditure categories
04/25/2025	4.0.7	MBESCBES-FORMGP-2	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-2\|00010101\|99991231\|CMS 64.21UP WAIVER\|Quarterly Medical Assistance Expenditures By Children's Health Insurance Program Prior Period Expenditures
04/25/2025	4.0.7	MBESCBES-FORMGP-3	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-3\|00010101\|99991231\|CMS 21BASE\|Children's Health Expenditures by Type of Service For the Title XXI Program Expenditures in this Quarter
04/25/2025	4.0.7	MBESCBES-FORMGP-3	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-3\|00010101\|99991231\|CMS 21\|Children's Health Expenditures by Type of Service For the Title XXI Program Expenditures in this Quarter
04/25/2025	4.0.7	MBESCBES-FORMGP-3	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-3\|00010101\|99991231\|CMS 21P\|Quarterly Children's Health Insurance Program
04/25/2025	4.0.7	MBESCBES-FORMGP-3	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-3\|00010101\|99991231\|CMS 21 WAIVER\|Children's Health Expenditures by Type of Service For the Title XXI Program Expenditures in this Quarter
04/25/2025	4.0.7	MBESCBES-FORMGP-3	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MBESCBES-FORMGP-3\|00010101\|99991231\|CMS 21PWAIVER\|Children's Health Expenditures by Type of Service For the Title XXI Program Expenditures in this Quarter
03/12/2025	4.0.4	ELIGIBILITY-GROUP (ELG087)	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ELIGIBILITY-GROUP \| 20250301 \| 99991231 \| 77 \| Other optional eligibility for reasonable classifications of children under 21
03/12/2025	4.0.4	ADDR-COUNTY (ELG072)	Delete	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ADDR-COUNTY \| 01/01/0001 \| 12/31/9999 \| 113 \| Shannon County, South Dakota \|	N/A

T-MSIS Data Guide

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