ALL-5-002-2

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Measure Name	% of duplicate claim headers
File Type	CLT
Measure ID	ALL-5-002-2
Measure Type	Duplicate percentage
Content area	ALL

Validation Type	Inferential

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

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

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

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-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

ALL-5-002-2

Key Information

Validation

Measure Priority

Claim Information

Thresholds

Data Elements