FTX.003.095

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:

WAIVER-TYPE

Data Element

DE Number

FTX095

System DE Number

FTX.003.095

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	A code for specifying waiver type under which the eligible individual is covered during the month and receiving services/under which transaction is submitted.
Size	X(2)
FLF Start Position	729
FLF Stop Position	730
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be 2 characters 2. Value must be in Waiver Type List (VVL) 3. Value must have a corresponding value in Waiver ID 4. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period 5. Situational

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

RULE ID	RULE Definition
RULE-8092	If a financial transaction is from an FTX file, then the waiver type value reported must be compatible with specified T-MSIS picture format: X(2).
RULE-8434	If the waiver type is populated on the Individual Health Insurance Premium Payment Transaction from a FTX file, then the waiver type reported must be found in the list of valid values.

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP177	CIP.002.177	WAIVER-TYPE	CIP00002	CLAIM-HEADER-RECORD-IP
CLT128	CLT.002.128	WAIVER-TYPE	CLT00002	CLAIM-HEADER-RECORD-LT
COT110	COT.002.110	WAIVER-TYPE	COT00002	CLAIM-HEADER-RECORD-OT
CRX068	CRX.002.068	WAIVER-TYPE	CRX00002	CLAIM-HEADER-RECORD-RX
ELG173	ELG.012.173	WAIVER-TYPE	ELG00012	WAIVER-PARTICIPATION
FTX050	FTX.002.050	WAIVER-TYPE	FTX00002	INDIVIDUAL-CAPITATION-PMPM
FTX139	FTX.004.139	WAIVER-TYPE	FTX00004	GROUP-INSURANCE-PREMIUM-PAYMENT
FTX181	FTX.005.181	WAIVER-TYPE	FTX00005	COST-SHARING-OFFSET
FTX223	FTX.006.223	WAIVER-TYPE	FTX00006	VALUE-BASED-PAYMENT
FTX268	FTX.007.268	WAIVER-TYPE	FTX00007	STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM
FTX308	FTX.008.308	WAIVER-TYPE	FTX00008	COST-SETTLEMENT-PAYMENT
FTX347	FTX.009.347	WAIVER-TYPE	FTX00009	FQHC-WRAP-PAYMENT
FTX395	FTX.095.395	WAIVER-TYPE	FTX00095	MISCELLANEOUS-PAYMENT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
07/10/2025	4.0.13	FTX.003.095	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	FTX.003.095	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period5. Conditional	1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period5. Situational
09/16/2024	4.0.0	FTX.003.095	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.095	ADD	N/A		Created