ALL-34-001-1

An official website of the United States government

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS
A lock () or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

TMSIS Dataguide

Medicaid.gov

Version:

ALL-34-001-1

Data Quality Measure

Last updated

Key Information

Measure Name	% of claim lines with non-missing HCBS Service Code that have missing HCBS Taxonomy
File Type	COT
Measure ID	ALL-34-001-1
Measure Type	Claims Percentage
Content area	ALL

Validation

Validation Type	Inferential

Measure Priority

Measure Priority	Medium
Focus Area	N/A
Category	Utilization

Claim Information

Claim Type	Medicaid,FFS or Medicaid,Enc
Adjustment Type	Original and Replacement
Crossover Type	All Indicators

Thresholds

Minimum	0
Maximum	0.01
TA Minimun	0
TA Maximum	0.01
Longitudinal Threshold	N/A
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

Data Elements

DD Data Element	HCBS-TAXONOMY • HCBS-SERVICE-CODE
DD Data Element Number	COT188 • COT187

Annotation	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
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
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