ALL-2-001-1

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TMSIS Dataguide

Medicaid.gov

Version:

ALL-2-001-1

Data Quality Measure

Last updated

Key Information

Measure Name	# of unique HCBS Taxonomy valid values reported
File Type	COT
Measure ID	ALL-2-001-1
Measure Type	Count
Content area	ALL

Validation

Validation Type	Inferential

Measure Priority

Measure Priority	Medium
Focus Area	N/A
Category	Program participation

Claim Information

Claim Type	Medicaid,FFS or Medicaid,Enc
Adjustment Type	Original
Crossover Type	Non-Crossover

Thresholds

Minimum	8
Maximum	104
TA Minimun	8
TA Maximum	104
Longitudinal Threshold	N/A
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

Data Elements

DD Data Element	HCBS-TAXONOMY
DD Data Element Number	COT188

Annotation	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
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
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