FTX.003.072

PAYMENT-AMOUNT

Data Element

DE Number

FTX072

System DE Number

FTX.003.072

File Name

FTX - FINANCIAL TRANSACTION

File Segment Number

FTX00003

File Segment Name

INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The dollar amount being paid to the payee.
Size	S9(11)V99
FLF Start Position	131
FLF Stop Position	143
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be between -99999999999.99 and 99999999999.99 2. Value must be expressed as a number with 2-digit precision (e.g. 100.50) 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-8069	If a financial transaction is from an FTX file, then the payment amount value reported must be compatible with specified T-MSIS picture format: S9(11)V99.
RULE-8702	If the Insurance Premium Payment Transaction segment is populated from a FTX file, then the PAYMENT-AMOUNT must be populated

Measure ID	Measure Name
MCR-54-009-9	# of plans with at least 100 enrollments, capitations, or encounters, that do not have a managed care record
MCR-54-001-1	# of plans with at least 100 enrollments, 0 capitations, 0 encounters
MCR-54-002-2	# of plans with at least 100 enrollments or 100 capitations, 0 encounters
MCR-54-003-3	# of plans with at least 100 enrollments or 100 encounters, 0 capitations
MCR-54-004-4	# of plans with at least 100 enrollments and some capitations that have capitation ratios outside of the expected range (0.7 - 1.3)
MCR-54-005-5	# of plans with at least 100 capitations or 100 encounters, 0 enrollments
MCR-54-006-6	# of plans with at least 100 enrollments and some encounters that have IP ratios outside of the expected range (0.01 - 2)
MCR-54-007-7	# of plans with at least 100 enrollments and some encounters that have OT ratios outside of the expected range (0.1 - 20)
MCR-54-008-8	# of plans with at least 100 enrollments and some encounters that have RX ratios outside of the expected range (0.02 - 5)
MCR-53-003-3	Total # of managed care encounters
MCR-54-010-10	# of plans where MC plan type does not match EL plan type
MCR-54-011-11	# of PCCM plan IDs
MCR-54-012-12	# of PCCM plans with at least 100 enrollments, capitations, or encounters, that do not have a managed care record
MCR-55-001-1	Traditional PCCM capitation ratio
MCR-55-002-2	Enhanced PCCM capitation ratio
MCR-55-003-3	PACE capitation ratio
MCR-55-004-4	Health home capitation ratio
EXP-20-001-1	Sum of Payment or Recoupment Amount for other premium
MCR-53-002-2	Total # of managed care capitations
MCR-53-001-1	Total # of managed care enrollments
EL-8-002-2	Enrollment, capitation payments, capitation ratios, encounters (by claim file type) and encounter ratios (by claim file type) by plan ID with plan ID linking to MC file
EXP-22R-009-9	% of Plan IDs over the threshold for EXP-22P-009-9 (% of records with Payment or Recoupment Amount = $0 or missing, by Plan ID)
EXP-22P-009-9	% of records with Payment or Recoupment Amount = $0 or missing, by Plan ID
EXP-24-009-9	% of records with Payment or Recoupment Amount = $0 or missing
EXP-22-009-9	% of records with Payment or Recoupment Amount = $0 or missing
MCR-28-001-1	% of plan IDs with capitation payment ratios <0.9 or >1.1 (non-PCCM)
EXP-25-002-1	Average absolute value of Payment or Recoupment Amount
EXP-25-001-2	Sum of Payment or Recoupment Amount
EXP-23-002-1	Average absolute value of Payment or Recoupment Amount
EXP-23-001-2	Sum of Payment or Recoupment Amount
EXP-21-002-2	Average Payment or Recoupment Amount for other premium
EXP-21-001-1	Sum of Payment or Recoupment Amount for other premium
EXP-20-002-2	Average Payment or Recoupment Amount for other premium

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
FTX113	FTX.004.113	PAYMENT-AMOUNT	FTX00004	GROUP-INSURANCE-PREMIUM-PAYMENT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/16/2024	4.0.0	FTX.003.072	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.072	ADD	N/A		Created