ALL-7-001-1

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Measure Name	% of claim headers that are crossover claims
File Type	CLT
Measure ID	ALL-7-001-1
Measure Type	Claims Percentage
Content area	ALL

Validation Type	Inferential

Measure Priority	Medium
Focus Area	N/A
Category	Expenditures

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

Minimum	0.001
Maximum	0.35
TA Minimun	0.001
TA Maximum	0.35
Longitudinal Threshold	0.1
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

DD Data Element	CROSSOVER-INDICATOR
DD Data Element Number	CLT023

Annotation	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
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

ALL-7-001-1

Key Information

Validation

Measure Priority

Claim Information

Thresholds

Data Elements