CRX.002.068

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TMSIS Dataguide

Medicaid.gov

Version 3.36.0

WAIVER-TYPE

Data Element

DE Number

CRX068

System DE Number

CRX.002.068

File Name

CRX - CLAIM PHARMACY

File Segment Number

File Segment Name

CLAIM-HEADER-RECORD-RX

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	455
FLF Stop Position	456
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. Value must have a corresponding value in Waive ID (CRX.002.069) 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-1816	If the program type is HCBS on a non-denied claim from an RX 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-1838	If the waiver type is populated on a non-denied claim from an RX file, then the waiver type reported must be found in the list of valid values.
RULE-6708	If a claim is a non-denied claim from an RX file, then the waiver type value reported must be compatible with specified T-MSIS picture format: X(2).
RULE-7773	If a claim is a non-denied claim from an RX file, and the waiver type is populated, and the claim prescription fill date 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
COT110	COT.002.110	WAIVER-TYPE	COT00002	CLAIM-HEADER-RECORD-OT
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	CRX.002.068	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. Value must have a corresponding value in Waive ID (CRX.002.069)5. 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. Value must have a corresponding value in Waive ID (CRX.002.069)5. 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