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Data Element
FTX095
FTX.003.095
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. |
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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. Conditional |
Valid Value Code Set | Valid Value Code | Valid Value Name | Valid Value Description | Effective Start Date | Effective End Date |
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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 |