FFS-26-002-2

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TMSIS Dataguide

Medicaid.gov

Version:

FFS-26-002-2

Data Quality Measure

Last updated

Key Information

Measure Name	% of claim lines without a valid Line Adjustment Indicator (LINE-ADJ-IND is 2, 3, 9, other invalid value, or missing)
File Type	CIP
Measure ID	FFS-26-002-2
Measure Type	Claims percentage
Content area	FFS

Validation

Validation Type	Inferential

Measure Priority

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

Claim Information

Claim Type	Medicaid,FFS
Adjustment Type	All Adjustment Types
Crossover Type	All Indicators

Thresholds

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

Data Elements

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	FFS-26-002-2	UPDATE	Annotation	Calculate the percentage of unique line records associated with Medicaid FFS: original and adjustment, paid IP claims with an invalid or missing adjustment indicator value	N/A
11/20/2025	4.0.22	FFS-26-002-2	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers: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.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3	N/A
08/13/2025	4.0.16	FFS-26-002-2	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers: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.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers: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.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique line records.STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique line records from STEP 4 by the count in STEP 3
04/24/2025	4.0.7	FFS-26-002-2	ADD	N/A		Created