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Data Element
FTX077
FTX.003.077
Definition | This is a description of what the payer ID represents when the payer ID was reported with a payer type of "Other". |
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Size | X(100) |
FLF Start Position | 199 |
FLF Stop Position | 298 |
Segment Key Field Identifier | Not Applicable |
Coding Requirements | 1. Value must be 100 characters or less 2. Value must be populated when Payer Identifier Type equals "95" 3. Conditional |
Valid Value Code Set | Valid Value Code | Valid Value Name | Valid Value Description | Effective Start Date | Effective End Date |
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DE Number | System DE Number | DE Name | File Segment Number | File Segment Name |
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FTX030 | FTX.002.030 | PAYER-ID-TYPE-OTHER-TEXT | FTX00002 | INDIVIDUAL-CAPITATION-PMPM |
FTX118 | FTX.004.118 | PAYER-ID-TYPE-OTHER-TEXT | FTX00004 | GROUP-INSURANCE-PREMIUM-PAYMENT |
FTX162 | FTX.005.162 | PAYER-ID-TYPE-OTHER-TEXT | FTX00005 | COST-SHARING-OFFSET |
FTX205 | FTX.006.205 | PAYER-ID-TYPE-OTHER-TEXT | FTX00006 | VALUE-BASED-PAYMENT |
FTX249 | FTX.007.249 | PAYER-ID-TYPE-OTHER-TEXT | FTX00007 | STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM |
FTX292 | FTX.008.292 | PAYER-ID-TYPE-OTHER-TEXT | FTX00008 | COST-SETTLEMENT-PAYMENT |
FTX331 | FTX.009.331 | PAYER-ID-TYPE-OTHER-TEXT | FTX00009 | FQHC-WRAP-PAYMENT |
FTX370 | FTX.095.370 | PAYER-ID-TYPE-OTHER-TEXT | FTX00095 | MISCELLANEOUS-PAYMENT |