ALL-17-006-6

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TMSIS Dataguide

Medicaid.gov

Version:

ALL-17-006-6

Data Quality Measure

Last updated

Key Information

Measure Name	% of claim lines that have no corresponding claim header
File Type	CLT
Measure ID	ALL-17-006-6
Measure Type	Claims Percentage
Content area	ALL

Validation

Validation Type	Inferential

Measure Priority

Measure Priority	N/A
Focus Area	N/A
Category	N/A

Claim Information

Claim Type	Medicaid,FFS or Medicaid,Cap or Medicaid,Enc or Medicaid,Serv or Medicaid,Supp or CHIP,FFS or CHIP,Cap or CHIP,Enc or CHIP,Serv or CHIP,Supp
Adjustment Type	All Adjustment Types
Crossover Type	All Indicators

Thresholds

Minimum	0
Maximum	0.001
TA Minimun
TA Maximum
Longitudinal Threshold	N/A
For TA (for including in compliance training)	No
For TA (Longitudinal)	No

Data Elements

DD Data Element
DD Data Element Number

Annotation	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
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
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