FTX.003.099

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TMSIS Dataguide

Medicaid.gov

Version:

SPA-NUMBER

Data Element

DE Number

FTX099

System DE Number

FTX.003.099

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	State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where: SS = State (use the two character postal abbreviation for your state); YY = Calendar Year (last two characters of the calendar year of the state plan amendment); NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions. xxxx = Optional, 1 to 4 characters alpha/numeric modifier (Suffix) States should use the specific SPA that covered the services rendered.
Size	X(15)
FLF Start Position	737
FLF Stop Position	751
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be 15 characters or less 2. 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-8096	If a financial transaction is from an FTX file, then the SPA number value reported must be compatible with specified T-MSIS picture format: X(15).

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
FTX055	FTX.002.055	SPA-NUMBER	FTX00002	INDIVIDUAL-CAPITATION-PMPM
FTX143	FTX.004.143	SPA-NUMBER	FTX00004	GROUP-INSURANCE-PREMIUM-PAYMENT
FTX186	FTX.005.186	SPA-NUMBER	FTX00005	COST-SHARING-OFFSET
FTX228	FTX.006.228	SPA-NUMBER	FTX00006	VALUE-BASED-PAYMENT
FTX272	FTX.007.272	SPA-NUMBER	FTX00007	STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM
FTX312	FTX.008.312	SPA-NUMBER	FTX00008	COST-SETTLEMENT-PAYMENT
FTX351	FTX.009.351	SPA-NUMBER	FTX00009	FQHC-WRAP-PAYMENT
FTX400	FTX.095.400	SPA-NUMBER	FTX00095	MISCELLANEOUS-PAYMENT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
12/19/2024	4.0.1	FTX.003.099	UPDATE	Definition	State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where: SS = State (use the two character postal abbreviation for your state); YY = Calendar Year (last two characters of the calendar year of the state plan amendment); NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions. The system will not permit reuse of a previously used SPA ID for a package that has been formally = an Situational entry for specific SPA types	State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where: SS = State (use the two character postal abbreviation for your state); YY = Calendar Year (last two characters of the calendar year of the state plan amendment); NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions. xxxx = Optional, 1 to 4 characters alpha/numeric modifier (Suffix) States should use the specific SPA that covered the services rendered.
09/16/2024	4.0.0	FTX.003.099	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.099	ADD	N/A		Created