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TMSIS Dataguide Medicaid.gov

Version:

PAYER-ID-TYPE

Data Element

DE Number

FTX076

System DE Number

FTX.003.076

File Segment Number

FTX00003

Last updated

Definition This is a qualifier that indicates what type of ID the payer ID is. For example, if the payer ID represents the state Medicaid or CHIP agency, then the payer ID type will indicate that the payer ID should be interpreted as a submitting state code.
Size X(2)
FLF Start Position 197
FLF Stop Position 198
Segment Key Field Identifier Not Applicable
Coding Requirements 1. Value must be 2 characters
2. Value must be in Payer ID Type List (VVL)
3. Mandatory
4. When value equals "01" then Payer ID must equal Submitting State (FTX.003.065)
Valid Value Code Set Valid Value Code Valid Value Name Valid Value Description Effective Start Date Effective End Date
DE Number System DE Number DE Name File Segment Number File Segment Name
FTX029 FTX.002.029 PAYER-ID-TYPE FTX00002 INDIVIDUAL-CAPITATION-PMPM
FTX117 FTX.004.117 PAYER-ID-TYPE FTX00004 GROUP-INSURANCE-PREMIUM-PAYMENT
FTX161 FTX.005.161 PAYER-ID-TYPE FTX00005 COST-SHARING-OFFSET
FTX204 FTX.006.204 PAYER-ID-TYPE FTX00006 VALUE-BASED-PAYMENT
FTX248 FTX.007.248 PAYER-ID-TYPE FTX00007 STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM
FTX291 FTX.008.291 PAYER-ID-TYPE FTX00008 COST-SETTLEMENT-PAYMENT
FTX330 FTX.009.330 PAYER-ID-TYPE FTX00009 FQHC-WRAP-PAYMENT
FTX369 FTX.095.369 PAYER-ID-TYPE FTX00095 MISCELLANEOUS-PAYMENT