COT.002.110

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TMSIS Dataguide

Medicaid.gov

Version 3.36.0

WAIVER-TYPE

Data Element

DE Number

COT110

System DE Number

COT.002.110

File Name

COT - CLAIM OTHER

File Segment Number

File Segment Name

CLAIM-HEADER-RECORD-OT

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 claim is submitted.
Size	X(2)
FLF Start Position	675
FLF Stop Position	676
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Waiver Type List (VVL) 2. Value must be 2 characters 3. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period (by date of service) 4. When populated, Waiver ID (COT.002.111) must be populated 5. Conditional 6. Value must be in [06,07,08,09,10,11,12,13,14,15,16,17,18,19,20, 33] when associated Program Type equals "07"

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

RULE ID	RULE Definition
RULE-1419	If the program type is HCBS on a non-denied claim from an OT file, then the waiver type value reported must be one of the following: '06', '07', '08', '09', '10', '11', '12', '13', '14', '15', '16', '17', '18', '19', '20', '33'.
RULE-1533	If the waiver type is populated on a non-denied claim from an OT file, then the waiver type reported must be found in the list of valid values.
RULE-6538	If a claim line is a non-denied claim line from an OT file, then the waiver type value reported must be compatible with specified T-MSIS picture format: X(2).
RULE-7772	If a claim is a non-denied claim from an OT file, and the waiver type is populated, and the claim beginning date of service is between the waiver enrollment effective and end dates, then the claim waiver type is equal to the waiver participation waiver type.

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
CRX068	CRX.002.068	WAIVER-TYPE	CRX00002	CLAIM-HEADER-RECORD-RX
ELG173	ELG.012.173	WAIVER-TYPE	ELG00012	WAIVER-PARTICIPATION

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/12/2024	3.29.0	COT.002.110	UPDATE	Coding requirement	1. Value must be in Waiver Type List (VVL)2. Value must be 2 characters3. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period (by date of service)4. When populated, Waiver ID (COT.002.111) must be populated5. Conditional6. Value must be in [ '06', '07', '08', '09', '10', '11', '12', '13', '14', '15', '16', '17', '18', '19', '20', '33'] when associated Program Type equals "07"	1. Value must be in Waiver Type List (VVL)2. Value must be 2 characters3. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period (by date of service)4. When populated, Waiver ID (COT.002.111) must be populated5. Conditional6. Value must be in [06,07,08,09,10,11,12,13,14,15,16,17,18,19,20, 33] when associated Program Type equals "07"
04/17/2024	3.24.0	VV End-Dates for WAIVER-TYPE	Update	Data Dictionary - Valid Values	VV End-Dates for WAIVER-TYPE was 12/31/9999 for the following WAIVER-TYPE Valid Values: 02-19 & 21.	VV End-Dates for WAIVER-TYPE has been updated with ‘10/31/2028’ for the following WAIVER-TYPE Valid Values: 02-19 & 21.
12/04/2020	2.4.0	CIP177-0003, CLT128-0003, COT110-0003, and CRX068-0004	UPDATE	Data Dictionary	coding requirements say: "An ineligible individual cannot have a category for federal reimbursement for Medicaid or CHIP (CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT <> 01,02)"	N/A