FFS-26-009-9

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Measure Name	% of claim headers without a valid Adjustment Indicator (ADJ-IND is 2, 3, 9, other invalid value, or missing)
File Type	CIP
Measure ID	FFS-26-009-9
Measure Type	Claims percentage
Content area	FFS

Validation Type	Inferential

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

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

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

DD Data Element	ADJUSTMENT-IND
DD Data Element Number	CIP026

Annotation	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
11/20/2025	4.0.22	FFS-26-009-9	UPDATE	Annotation	Calculate the percentage of unique header records associated with S-CHIP FFS: original and adjustment, paid IP claims with an invalid or missing adjustment indicator value	N/A
11/20/2025	4.0.22	FFS-26-009-9	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP 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: S-CHIP 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 = "A"STEP 3: Total CountOf the claims that meet the criteria from STEP 2, count the number of unique header records. STEP 4: Count invalid adjustment indicatorsFrom the records from STEP 2, count unique header records with ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missingSTEP 5: PercentageDivide the count of unique header records from STEP 4 by the count in STEP 3	N/A
04/24/2025	4.0.7	FFS-26-009-9	ADD	N/A		Created

FFS-26-009-9

Key Information

Validation

Measure Priority

Claim Information

Thresholds

Data Elements