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TMSIS Dataguide Medicaid.gov

Version:

SPA-NUMBER

Data Element

DE Number

FTX099

System DE Number

FTX.003.099

File Segment Number

FTX00003

Last updated

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
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