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TMSIS Dataguide Medicaid.gov

Version:

WAIVER-ID

Data Element

DE Number

FTX094

System DE Number

FTX.003.094

File Segment Number

FTX00003

Last updated

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
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