FFS-S-012-10

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 that are original
File Type	CRX
Measure ID	FFS-S-012-10
Measure Type	Claims Percentage
Content area	FFS

Validation Type	Longitudinal and Inferential

Measure Priority	Medium
Focus Area	N/A
Category	Expenditures

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

Minimum	0.26
Maximum	0.9999
TA Minimun	0.26
TA Maximum	0.9999
Longitudinal Threshold	0.75
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

DD Data Element	ADJUSTMENT-IND
DD Data Element Number	CRX025

Annotation	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
11/20/2025	4.0.22	FFS-S-012-10	UPDATE	Annotation	Percentage of Medicaid FFS: original and adjustment, paid RX claims that are original	N/A
11/20/2025	4.0.22	FFS-S-012-10	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 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: Original claimsOf the claims that meet the criteria from STEP 2, select records where 1. ADJUSTMENT-IND = "0"STEP 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-S-012-10	ADD	N/A		Created

FFS-S-012-10

Key Information

Validation

Measure Priority

Claim Information

Thresholds

Data Elements