FFS-1-004-28

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TMSIS Dataguide

Medicaid.gov

Version:

FFS-1-004-28

Data Quality Measure

Last updated

Key Information

Measure Name	Average # of diagnoses
File Type	CIP
Measure ID	FFS-1-004-28
Measure Type	Average # Occurrences
Content area	FFS

Validation

Validation Type	Longitudinal and Inferential

Measure Priority

Measure Priority	High
Focus Area	N/A
Category	Utilization

Claim Information

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

Thresholds

Minimum	2
Maximum	37
TA Minimun	2
TA Maximum	37
Longitudinal Threshold	0.15
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

Data Elements

DD Data Element	DIAGNOSIS-CODE
DD Data Element Number	CIP332

Annotation	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
11/20/2025	4.0.22	FFS-1-004-28	UPDATE	Annotation	Average number of diagnosis codes for Medicaid FFS: original, non-crossover, paid IP claims	N/A
11/20/2025	4.0.22	FFS-1-004-28	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria: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.STEP 2: Medicaid FFS: 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"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Non-missing diagnosis codesOf the DX segments that meet the criteria from STEP 3, set Count_Elements equal to the total number of DX segments in STEP 3 where 1. DIAGNOSIS-CODE is not missing2a. DIAGNOSIS-TYPE is not missingAND2b. DIAGNOSIS-TYPE is not equal to ("A")STEP 5: Total number of diagnosesSum Count_Elements for all claims in STEP 4 STEP 6: Calculate the average for measureDivide the sum from STEP 5 by the count of claims from STEP 2	N/A
08/13/2025	4.0.16	FFS-1-004-28	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria: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.STEP 2: Medicaid FFS: 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"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-TYPE-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Non-missing diagnosis codesOf the DX segments that meet the criteria from STEP 3, set Count_Elements equal to the total number of DX segments in STEP 3 where 1. DIAGNOSIS-CODE is not missing2a. DIAGNOSIS-TYPE is not missingAND2b. DIAGNOSIS-TYPE is not equal to ("A")STEP 5: Total number of diagnosesSum Count_Elements for all claims in STEP 4 STEP 6: Calculate the average for measureDivide the sum from STEP 5 by the count of claims from STEP 2	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria: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.STEP 2: Medicaid FFS: 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"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: DX Segments1. Merge DX segments to claims from STEP 2 by header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.STEP 4: Non-missing diagnosis codesOf the DX segments that meet the criteria from STEP 3, set Count_Elements equal to the total number of DX segments in STEP 3 where 1. DIAGNOSIS-CODE is not missing2a. DIAGNOSIS-TYPE is not missingAND2b. DIAGNOSIS-TYPE is not equal to ("A")STEP 5: Total number of diagnosesSum Count_Elements for all claims in STEP 4 STEP 6: Calculate the average for measureDivide the sum from STEP 5 by the count of claims from STEP 2
05/27/2025	4.0.9	FFS-1-004-28	UPDATE	Ta max	12	37
05/27/2025	4.0.9	FFS-1-004-28	UPDATE	Threshold maximum	12	37
04/24/2025	4.0.7	FFS-1-004-28	ADD	N/A		Created