ELG.012.172

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TMSIS Dataguide

Medicaid.gov

Version 3.36.0

WAIVER-ID

Data Element

DE Number

ELG172

System DE Number

ELG.012.172

File Name

File Segment Number

File Segment Name

WAIVER-PARTICIPATION

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	42
FLF Stop Position	61
Segment Key Field Identifier	3
Coding Requirements	1. Value must have a corresponding value in Waiver Type (ELG.012.173) 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. Mandatory

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

RULE ID	RULE Definition
RULE-2331	If waiver type is populated on a waiver participation segment from an ELG file, then waiver ID must be populated.
RULE-6892	If a segment is a waiver participation segment from an ELG file, then the waiver ID value reported must be compatible with the specified T-MSIS picture format: X(20).
RULE-7458	If a segment is a waiver participation segment from an ELG file, and the MSIS ID is populated, and the waiver participation segment has a waiver type value equal to '01', '21', '22', '23', '24', '25', '26', '27','28', '29', '30', then the waiver id is in the core waiver id (TMSIS only) format.
RULE-7459	If a segment is a waiver participation segment from an ELG file, and the MSIS ID is populated, and the waiver participation segment has a waiver type value equal to '02', '03', '04', '05', '06', '07', '08', '09', '10', '11', '12', '13', '14', '15', '16', '17', '18', '19', '20', '32', '33', then the waiver id is in the core waiver id format.

Measure ID	Measure Name
EL-6-028-28	% of record segments with an invalid waiver ID format for 1115 waivers (WAIVER-TYPE = 01 or 21 - 30)
EL-6-029-29	% of record segments with an invalid waiver ID format for 1915(b) and 1915(c) waivers (WAIVER-TYPE = 02 - 20, 32, or 33)
EL-7-001-1	Enrollment by waiver ID
MIS-1-063-63	% distinct MSIS IDs with only missing values in any active segment: WAIVER-ID (ELG00012)
RULE-7458	% of record segments with an invalid waiver ID format for 1115 waivers (WAIVER-TYPE = 01 or 21 - 30)
RULE-7459	% of record segments with an invalid waiver ID format for 1915(b) and 1915(c) waivers (WAIVER-TYPE = 02 - 20, 32, or 33)

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
COT111	COT.002.111	WAIVER-ID	COT00002	CLAIM-HEADER-RECORD-OT
CRX069	CRX.002.069	WAIVER-ID	CRX00002	CLAIM-HEADER-RECORD-RX
MCR068	MCR.005.068	WAIVER-ID	MCR00005	MANAGED-CARE-OPERATING-AUTHORITY

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/12/2024	3.29.0	ELG.012.172	UPDATE	Coding requirement	1. Value must have a corresponding value in Waiver Type (ELG.012.173)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. (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 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. Mandatory	1. Value must have a corresponding value in Waiver Type (ELG.012.173)2. 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. Mandatory
09/21/2023	3.13.0	ELG.012.172	UPDATE	Segment key field identifier	Not Applicable	3
08/28/2023	3.12.0	ELG.012.172	UPDATE	Coding requirement	1. Value must have a corresponding value in Waiver Type (ELG.012.173)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. (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. Value must have a corresponding value in Waiver Type (ELG.012.173)7. Mandatory	1. Value must have a corresponding value in Waiver Type (ELG.012.173)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. (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 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. Mandatory
08/28/2023	3.12.0	ELG.012.172	UPDATE	Coding requirement	Value must have a corresponding value in Waiver Type (ELG.012.173)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. (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. Value must have a corresponding value in Waiver Type (ELG.012.173)7. Mandatory	1. Value must have a corresponding value in Waiver Type (ELG.012.173)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. (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. Value must have a corresponding value in Waiver Type (ELG.012.173)7. Mandatory
08/28/2023	3.12.0	ELG.012.172	UPDATE	Coding requirement	1. Value must have a corresponding value in Waiver Type (ELG.012.173)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. Value must have a corresponding value in Waiver Type (ELG.012.173)6. Mandatory	Value must have a corresponding value in Waiver Type (ELG.012.173)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. (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. Value must have a corresponding value in Waiver Type (ELG.012.173)7. Mandatory
08/28/2023	3.12.0	ELG.012.172	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. Value must have a corresponding value in Waiver Type (ELG.012.173)6. Mandatory	1. Value must have a corresponding value in Waiver Type (ELG.012.173)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. Value must have a corresponding value in Waiver Type (ELG.012.173)6. Mandatory
08/15/2023	3.12.0	ELG.012.172	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. Value must have a corresponding value in Waiver Type (ELG.012.173)6. Mandatory	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. Value must have a corresponding value in Waiver Type (ELG.012.173)6. Mandatory