COT.002.111

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TMSIS Dataguide

Medicaid.gov

Version 3.36.0

WAIVER-ID

Data Element

DE Number

COT111

System DE Number

COT.002.111

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	Field specifying the waiver or demonstration which authorized payment for a claim. These IDs must be the approved, full federal waiver ID number assigned during the state submission and CMS approval process. Waiver IDs should actually only be the "core" part of the waiver IDs, without including suffixes for renewals or amendments.
Size	X(20)
FLF Start Position	677
FLF Stop Position	696
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be associated with a populated Waiver Type 2. Value must be 20 characters or less 3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be "01" or in [21-30] 4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position 5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33] 6. 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-1535	If the waiver type is populated on a non-denied claim from an OT file, then the waiver ID must be populated.
RULE-6539	If a claim line is a non-denied claim line from an OT file, then the waiver identification value reported must be compatible with specified T-MSIS picture format: X(20).
RULE-7460	If a claim is a non-denied, Medicaid-SCHIP, Separate CHIP FFS or Medicaid-SCHIP, Separate CHIP Encounter, original or adjustment paid claim from an OT file, and the claim line hcbs service code is equal to '4', then the claim has a non-null value for waiver id.
RULE-7974	If a claim is a non-denied, Medicaid or Medicaid-CHIP Encounter or Separate CHIP Encounter, original or adjustment paid claim from an OT file, and the claim line hcbs service code is equal to '4', then the claim has a non-null value for waiver id.
RULE-7975	If a claim is a non-denied, Medicaid or Medicaid-CHIP FFS or Separate CHIP FFS, original or adjustment paid claim from an OT file, and the claim line hcbs service code is equal to '4', then the claim has a non-null value for waiver id.

Measure ID	Measure Name
ALL-19-001-1	% of claim headers with HCBS-SERVICE-CODE = 4 that are missing Waiver ID
ALL-2-009-9	% of 1915(c) waiver enrollees (WAIVER-TYPE = 06 - 20 or 33) that do not have any claim headers with the corresponding waiver ID
RULE-7460	% of claim headers with HCBS-SERVICE-CODE = 4 that are missing Waiver ID
RULE-7974	% of claim headers with HCBS-SERVICE-CODE = 4 that are missing Waiver ID
RULE-7975	% of claim headers with HCBS-SERVICE-CODE = 4 that are missing Waiver ID

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP178	CIP.002.178	WAIVER-ID	CIP00002	CLAIM-HEADER-RECORD-IP
CLT129	CLT.002.129	WAIVER-ID	CLT00002	CLAIM-HEADER-RECORD-LT
CRX069	CRX.002.069	WAIVER-ID	CRX00002	CLAIM-HEADER-RECORD-RX
ELG172	ELG.012.172	WAIVER-ID	ELG00012	WAIVER-PARTICIPATION
MCR068	MCR.005.068	WAIVER-ID	MCR00005	MANAGED-CARE-OPERATING-AUTHORITY

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/30/2024	3.30.0	COT.002.111	UPDATE	Coding requirement	1. Value must be associated with a populated Waiver Type2. Value must be 20 characters or less3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be "01" or in [21-30](1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]6. Conditional	1. Value must be associated with a populated Waiver Type2. Value must be 20 characters or less3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be "01" or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]6. Conditional
09/12/2024	3.29.0	COT.002.111	UPDATE	Coding requirement	1. Value must be associated with a populated Waiver Type2. Value must be 20 characters or less3. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by a version number [0-9] in the 12th position 5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]6. Conditional	1. Value must be associated with a populated Waiver Type2. Value must be 20 characters or less3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be "01" or in [21-30](1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]6. Conditional
08/28/2023	3.12.0	COT.002.111	UPDATE	Coding requirement	1. Value must be associated with a populated Waiver Type2. Value must be 20 characters or less3. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]5. Conditional	1. Value must be associated with a populated Waiver Type2. Value must be 20 characters or less3. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by a version number [0-9] in the 12th position 5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]6. Conditional
08/15/2023	3.12.0	COT.002.111	UPDATE	Coding requirement	1. Value must be associated with a populated Waiver Type (CE)2. Value must be 20 characters or less3. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]5. Conditional	1. Value must be associated with a populated Waiver Type2. Value must be 20 characters or less3. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]5. Conditional