FFS-52-001-1

An official website of the United States government

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS
A lock () or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

Measure Name	% of claim headers where BILLING-PROV-TAXONOMY does not begin with 27 or 28
File Type	CIP
Measure ID	FFS-52-001-1
Measure Type	Claims Percentage
Content area	FFS

Validation Type	Inferential

Measure Priority	High
Focus Area	N/A
Category	Provider information

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

Minimum	0
Maximum	0.05
TA Minimun	0
TA Maximum	0.05
Longitudinal Threshold	N/A
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

DD Data Element	BILLING-PROV-TAXONOMY
DD Data Element Number	CIP181

Annotation	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
11/20/2025	4.0.22	FFS-52-001-1	UPDATE	Annotation	Calculate the percentage Medicaid and S-CHIP FFS: original and adjustment, paid IP claims with billing provider taxonomy codes that do not begin with the characters "27" or "28"	N/A
11/20/2025	4.0.22	FFS-52-001-1	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 and 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 = "1" or "A"STEP 3: Non-missing billing provider taxonomyOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-TAXONOMYSTEP 4: Billing provider taxonomy does not begin with 27 or 28Of the claims that meet the criteria from STEP 3, keep claims where BILLING-PROV-TAXONOMY does not begin with "27" or "28"STEP 5: Calculate percentDivide the count of claims from STEP 4 from STEP 3	N/A
04/24/2025	4.0.7	FFS-52-001-1	ADD	N/A		Created

FFS-52-001-1

Key Information

Validation

Measure Priority

Claim Information

Thresholds

Data Elements