EXP-22-009-9

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TMSIS Dataguide

Medicaid.gov

Version:

EXP-22-009-9

Data Quality Measure

Last updated

Key Information

Measure Name	% of records with Payment or Recoupment Amount = $0 or missing
File Type	FTX
Measure ID	EXP-22-009-9
Measure Type	Non-Claims Percentage
Content area	EXP
Grace Period Expiration	01/30/2026

Validation

Validation Type	Longitudinal and Inferential

Measure Priority

Measure Priority	High
Focus Area	N/A
Category	Expenditures

Claim Information

Claim Type	N/A
Adjustment Type	Original
Crossover Type	All Indicators

Thresholds

Minimum	0
Maximum	0.05
TA Minimun	0
TA Maximum	0.1
Longitudinal Threshold	0.15
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

Data Elements

DD Data Element	PAYMENT-OR-RECOUPMENT-AMOUNT • PAYMENT-OR-RECOUPMENT-AMOUNT • PAYMENT-AMOUNT
DD Data Element Number	FTX025 • FTX157 • FTX072

Annotation	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
11/20/2025	4.0.22	EXP-22-009-9	UPDATE	Annotation	Calculate the percentage of Medicaid Capitation Payment Financial Transaction records where Payment or Recoupment Amount is equal to $0 or missing	N/A
11/20/2025	4.0.22	EXP-22-009-9	UPDATE	Specification	STEP 1: Active non-duplicate paid capitation payment financial transactions during report monthDefine the FTX universe for the FTX0002, FTX0003, and FTX0005 tables respectively by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Capitation Payment: Original, Paid ClaimsOf the records that meet the criteria from STEP 1, further restrict them by the following criteria:1. MBESCBES-FORM-GROUP = "1" or "2" 2. ADJUSTMENT-IND = "0"STEP 3: Payment or Recoupment Amount $0 or missingOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1a. PAYMENT-OR-RECOUPMENT-AMOUNT = "0" or is missingOR1b. PAYMENT-AMOUNT= "0" or is missingSTEP 4: Calculate the percentage for the measureDivide the count of records from STEP 3 by the count of records from STEP 2	N/A
10/07/2025	4.0.19	EXP-22-009-9	UPDATE	Grace period expiration date	None	2026-01-30
08/13/2025	4.0.16	EXP-22-009-9	UPDATE	Specification	STEP 1: Active non-duplicate paid capitation payment financial transactions during report monthDefine the FTX universe for the FTX0002, FTX0003, and FTX0005 tables respectively by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Capitation Payment: Original, Paid ClaimsOf the records that meet the criteria from STEP 1, further restrict them by the following criteria:1. MBESCBES-FORM-GROUP = "1" or "2"STEP 3: Payment or Recoupment Amount $0 or missingOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1a. PAYMENT-OR-RECOUPMENT-AMOUNT = "0" or is missingOR1b. PAYMENT-AMOUNT= "0" or is missingSTEP 4: Calculate the percentage for the measureDivide the count of records from STEP 3 by the count of records from STEP 2	STEP 1: Active non-duplicate paid capitation payment financial transactions during report monthDefine the FTX universe for the FTX0002, FTX0003, and FTX0005 tables respectively by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Capitation Payment: Original, Paid ClaimsOf the records that meet the criteria from STEP 1, further restrict them by the following criteria:1. MBESCBES-FORM-GROUP = "1" or "2" 2. ADJUSTMENT-IND = "0"STEP 3: Payment or Recoupment Amount $0 or missingOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1a. PAYMENT-OR-RECOUPMENT-AMOUNT = "0" or is missingOR1b. PAYMENT-AMOUNT= "0" or is missingSTEP 4: Calculate the percentage for the measureDivide the count of records from STEP 3 by the count of records from STEP 2
04/24/2025	4.0.7	EXP-22-009-9	ADD	N/A		Created