FTX.003.094

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TMSIS Dataguide

Medicaid.gov

Version:

WAIVER-ID

Data Element

DE Number

FTX094

System DE Number

FTX.003.094

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	Field specifying the waiver or demonstration which authorized payment. These IDs must be the approved, full federal waiver ID number assigned during the state submission and CMS approval process. Waiver IDs should actually only be the "core" part of the waiver IDs, without including suffixes for renewals or amendments.
Size	X(20)
FLF Start Position	709
FLF Stop Position	728
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be 20 characters or less 2. Value must be associated with a populated Waiver Type 3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30] 4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position 5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33] 6. Conditional

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

RULE ID	RULE Definition
RULE-8091	If a financial transaction is from an FTX file, then the waiver 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
CIP178	CIP.002.178	WAIVER-ID	CIP00002	CLAIM-HEADER-RECORD-IP
CLT129	CLT.002.129	WAIVER-ID	CLT00002	CLAIM-HEADER-RECORD-LT
COT111	COT.002.111	WAIVER-ID	COT00002	CLAIM-HEADER-RECORD-OT
CRX069	CRX.002.069	WAIVER-ID	CRX00002	CLAIM-HEADER-RECORD-RX
ELG172	ELG.012.172	WAIVER-ID	ELG00012	WAIVER-PARTICIPATION
FTX049	FTX.002.049	WAIVER-ID	FTX00002	INDIVIDUAL-CAPITATION-PMPM
FTX138	FTX.004.138	WAIVER-ID	FTX00004	GROUP-INSURANCE-PREMIUM-PAYMENT
FTX180	FTX.005.180	WAIVER-ID	FTX00005	COST-SHARING-OFFSET
FTX222	FTX.006.222	WAIVER-ID	FTX00006	VALUE-BASED-PAYMENT
FTX267	FTX.007.267	WAIVER-ID	FTX00007	STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM
FTX307	FTX.008.307	WAIVER-ID	FTX00008	COST-SETTLEMENT-PAYMENT
FTX346	FTX.009.346	WAIVER-ID	FTX00009	FQHC-WRAP-PAYMENT
FTX394	FTX.095.394	WAIVER-ID	FTX00095	MISCELLANEOUS-PAYMENT
MCR068	MCR.005.068	WAIVER-ID	MCR00005	MANAGED-CARE-OPERATING-AUTHORITY

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
06/05/2025	4.0.10	FTX.003.094	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional
05/29/2025	4.0.9	FTX.003.094	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional
09/16/2024	4.0.0	FTX.003.094	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.094	ADD	N/A		Created