FFS-14-002-7

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Measure Name	% of claim headers with Prescription Fill Date within the past year
File Type	CRX
Measure ID	FFS-14-002-7
Measure Type	Claims Percentage
Content area	FFS

Validation Type	Longitudinal and Inferential

Measure Priority	Medium
Focus Area	N/A
Category	Utilization

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

Minimum	0.95
Maximum	1
TA Minimun	0.95
TA Maximum	1
Longitudinal Threshold	0.15
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

DD Data Element	PRESCRIPTION-FILL-DATE
DD Data Element Number	CRX085

Annotation	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
11/20/2025	4.0.22	FFS-14-002-7	UPDATE	Annotation	Percentage of Medicaid FFS: original, non-crossover, paid RX claims with prescription fill date within the past 12 months	N/A
11/20/2025	4.0.22	FFS-14-002-7	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX 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 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: Fill date in past 12 monthsOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. Claims PRESCRIPTION-FILL-DATE >= Measure_Month_End minus 365STEP 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	FFS-14-002-7	ADD	N/A		Created

FFS-14-002-7

Key Information

Validation

Measure Priority

Claim Information

Thresholds

Data Elements