FTX.003.087

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.

TMSIS Dataguide

Medicaid.gov

Version:

MEMBER-ID

Data Element

DE Number

FTX087

System DE Number

FTX.003.087

File Name

FTX - FINANCIAL TRANSACTION

File Segment Number

File Segment Name

INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The subscriber’s identification number or a dependent’s identification number as assigned by the TPL insurance carrier (i.e., the IDs that are on the insurance card issued by the TPL insurance carrier). There should be one FTX00003 segment for each covered life on the policy for which the premium assistance payment is made, regardless of whether that specific covered life is eligible for and enrolled in Medicaid or CHIP. This data element should be populated on each of the FTX000003 segments related to the covered lives on the individual market commercial health insurance policy for the coverage period. The insurance policy and coverage period is identified by the following data elements on the FTX.003 transaction: o SUBMITTING-STATE (FTX.003.065) o INSURANCE-CARRIER-ID-NUM (FTX.003.084) o INSURANCE-PLAN-ID (FTX.003.085) o PREMIUM-PERIOD-START-DATE (FTX.003.088) o PREMIUM-PERIOD-END-DATE (FTX.003.089)
Size	X(20)
FLF Start Position	615
FLF Stop Position	634
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be 20 characters or less 2. Mandatory

Valid Value Code Set	Valid Value Code	Valid Value Name	Valid Value Description	Effective Start Date	Effective End Date

RULE ID	RULE Definition
RULE-8084	If a financial transaction is from an FTX file, then the member id value reported must be compatible with specified T-MSIS picture format: X(20).

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
FTX129	FTX.004.129	MEMBER-ID	FTX00004	GROUP-INSURANCE-PREMIUM-PAYMENT
TPL036	TPL.003.036	MEMBER-ID	TPL00003	TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
10/23/2025	4.0.20	FTX.003.087	UPDATE	Necessity	Situational	Mandatory
10/23/2025	4.0.20	FTX.003.087	UPDATE	Definition	Member identification number as it appears on the card issued by the TPL insurance carrier.	The subscriber’s identification number or a dependent’s identification number as assigned by the TPL insurance carrier (i.e., the IDs that are on the insurance card issued by the TPL insurance carrier). There should be one FTX00003 segment for each covered life on the policy for which the premium assistance payment is made, regardless of whether that specific covered life is eligible for and enrolled in Medicaid or CHIP. This data element should be populated on each of the FTX000003 segments related to the covered lives on the individual market commercial health insurance policy for the coverage period. The insurance policy and coverage period is identified by the following data elements on the FTX.003 transaction: o SUBMITTING-STATE (FTX.003.065) o INSURANCE-CARRIER-ID-NUM (FTX.003.084) o INSURANCE-PLAN-ID (FTX.003.085) o PREMIUM-PERIOD-START-DATE (FTX.003.088) o PREMIUM-PERIOD-END-DATE (FTX.003.089)
10/23/2025	4.0.20	FTX.003.087	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Situational	1. Value must be 20 characters or less2. Mandatory
07/10/2025	4.0.13	FTX.003.087	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.003.087	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Conditional	1. Value must be 20 characters or less2. Situational
09/16/2024	4.0.0	FTX.003.087	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.087	ADD	N/A		Created