FTX.003.070

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TMSIS Dataguide

Medicaid.gov

Version:

ADJUSTMENT-IND

Data Element

DE Number

FTX070

System DE Number

FTX.003.070

File Name

FTX - FINANCIAL TRANSACTION

File Segment Number

File Segment Name

INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	Indicates the type of adjustment record.
Size	X(1)
FLF Start Position	122
FLF Stop Position	122
Segment Key Field Identifier	4
Coding Requirements	1. Value must be 1 character 2. Value must be in Adjustment Indicator List (VVL) 3. 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-8067	If a financial transaction is from an FTX file, then the adjustment indicator value reported must be compatible with specified T-MSIS picture format: X(1).
RULE-8425	If the adjustment indicator is populated on the Individual Health Insurance Premium Payment Transaction from a FTX file, then the adjustment indicator reported must be found in the list of valid values.
RULE-8630	If the Insurance Premium Payment Transaction segment is populated from a FTX file, then the adjustment-ind must be populated
RULE-8711	If a financial transaction is from an FTX file Individual Health Insurance Premium Payment segment, then submitting state, original ICN, adjustment ICN, payment or recoupemnt date, and adjustment indicator values reported must be unique across all financial transactions in Individual Health Insurance Premium Payment segment.

Measure ID	Measure Name
EXP-23-002-1	Average absolute value of Payment or Recoupment Amount
EXP-25-002-1	Average absolute value of Payment or Recoupment Amount
MCR-28-001-1	% of plan IDs with capitation payment ratios <0.9 or >1.1 (non-PCCM)
MCR-32-005-5	% of capitation payments without a valid Adjustment Indicator (ADJ-IND is 2, 3, 9, other invalid value, or missing)
MCR-32-015-15	% of capitation payments without a valid Adjustment Indicator (ADJ-IND is 2, 3, 9, other invalid value, or missing)
MCR-35-001-1	Adjustment Indicator values
MCR-45-001-1	Adjustment Indicator values
RULE-8425	% of records with an invalid Adjustment Indicator (ADJUSTMENT-IND is 2, 3, 9, other invalid value)
RULE-8630	% of records with a missing Adjustment Indicator

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP026	CIP.002.026	ADJUSTMENT-IND	CIP00002	CLAIM-HEADER-RECORD-IP
CIP327	CIP.004.327	ADJUSTMENT-IND	CIP00004	CLAIM-DX-IP
CLT025	CLT.002.025	ADJUSTMENT-IND	CLT00002	CLAIM-HEADER-RECORD-LT
CLT273	CLT.004.273	ADJUSTMENT-IND	CLT00004	CLAIM-DX-LT
COT025	COT.002.025	ADJUSTMENT-IND	COT00002	CLAIM-HEADER-RECORD-OT
COT279	COT.004.279	ADJUSTMENT-IND	COT00004	CLAIM-DX-OT
CRX025	CRX.002.025	ADJUSTMENT-IND	CRX00002	CLAIM-HEADER-RECORD-RX
CRX201	CRX.004.201	ADJUSTMENT-IND	CRX00004	CLAIM-DX-RX
FTX023	FTX.002.023	ADJUSTMENT-IND	FTX00002	INDIVIDUAL-CAPITATION-PMPM
FTX111	FTX.004.111	ADJUSTMENT-IND	FTX00004	GROUP-INSURANCE-PREMIUM-PAYMENT
FTX155	FTX.005.155	ADJUSTMENT-IND	FTX00005	COST-SHARING-OFFSET
FTX198	FTX.006.198	ADJUSTMENT-IND	FTX00006	VALUE-BASED-PAYMENT
FTX242	FTX.007.242	ADJUSTMENT-IND	FTX00007	STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM
FTX285	FTX.008.285	ADJUSTMENT-IND	FTX00008	COST-SETTLEMENT-PAYMENT
FTX324	FTX.009.324	ADJUSTMENT-IND	FTX00009	FQHC-WRAP-PAYMENT
FTX363	FTX.095.363	ADJUSTMENT-IND	FTX00095	MISCELLANEOUS-PAYMENT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/16/2024	4.0.0	FTX.003.070	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.070	ADD	N/A		Created