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Objective: To evaluate the performance of different approaches for identifying live births using Transformed Medicaid Statistical Information System Analytic Files (TAF). Data Sources: The primary data source for this study were TAF inpatient (IP), other services (OT), and demographic and eligibility files. These data contain administrative claims for Medicaid enrollees in all 50 states and the District of Columbia from January 1, 2018 to December 31, 2018. Study Design: We compared five approaches for identifying live birth counts obtained from the TAF IP and OT data with the Centers for Disease Control and Prevention (CDC) Natality data--the gold standard for birth counts at the state level. Data Collection/Extraction Methods: The five approaches used varying combinations of diagnosis and procedure, revenue, and place of service codes to identify live births. Approaches 1 and 2 follow guidance developed by the Centers for Medicare and Medicaid Services (CMS). Approaches 3 and 4 build on the approaches developed by CMS by including all inpatient hospital claims in the OT file and excluding codes related to delivery services for infants, respectively. Approach 5 applied Approach 4 to only the IP file. Principal Findings: Approach 4, which included all inpatient hospital claims in the OT file and excluded codes related to infants to identify deliveries, achieved the best match of birth counts relative to CDC birth record data, identifying 1,656,794 live births--a national overcount of 3.6%. Approaches 1 and 3 resulted in larger overcounts of births (20.5% and 4.5%), while Approaches 2 and 5 resulted in undercounts of births (-3.4% and -6.8%). Conclusions: Including claims from both the IP and OT files, and excluding codes unrelated to the delivery episode and those specific to services rendered to infants improves accuracy of live birth identification in the TAF data. KEYWORDS administrative data uses, maternal and perinatal care and outcomes, Medicaid, obstetrics/gynecology What is known on this topic * No research has evaluated approaches for identifying live births using the newly-available Transformed Medicaid Statistical Information System Analytic Files (TAF), which contain claims from all Medicaid enrollees * Approaches to identify live births in the Medicaid Analytic extract, the prior version of TAF, rely on variables that are not reported or have been re-structured in the TAF * Accurately approximating the date of delivery is critical to measuring maternal health outcomes, which often begin or center around this date What this study adds * Using claims data from both the inpatient and other services TAF files produced the best state-year match to Natality data from the Centers for Disease Control and Prevention * This comparison of different approaches to identify live births using the TAF can help researchers interested in using these data to answer questions related to maternal health decide which approach best fits their needs * The approach used by researchers to identify live births may depend on the states of interest, as performance of each approach varies across states, 1 | INTRODUCTION Improving maternal outcomes has been a long-standing priority in the United States where maternal mortality rates far outpace those identified in peer nations. (1) Further, higher risk [...]