FFS-52-002-2

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 283Q, 283X, 282E, 31, 32, 385H, or 281P
File Type	CLT
Measure ID	FFS-52-002-2
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	0.02
TA Minimun	0
TA Maximum	0.02
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	CLT132

Annotation	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
11/20/2025	4.0.22	FFS-52-002-2	UPDATE	Annotation	Calculate the percentage Medicaid and S-CHIP FFS: original and adjustment, paid LT claims with billing provider taxonomy codes that do not begin with the characters "283Q" or "283X" or "282E" or "31" or "32" or "385H" or "281P"	N/A
11/20/2025	4.0.22	FFS-52-002-2	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT 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 ("283Q" or "283X" or "282E" or "31" or "32" or "385H" or "281P")Of the claims that meet the criteria from STEP 3, keep claims where BILLING-PROV-TAXONOMY does not begin with ("283Q" or "283X" or "282E" or "31" or "32" or "385H" or "281P")STEP 5: Calculate percentDivide the count of claims from STEP 4 from STEP 3	N/A
04/24/2025	4.0.7	FFS-52-002-2	ADD	N/A		Created

FFS-52-002-2

Key Information

Validation

Measure Priority

Claim Information

Thresholds

Data Elements