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Data Element
FTX189
FTX.005.189
| Definition | This represents any notes from the state's ledger/accounting system associated with the payment/recoupment. | 
|---|---|
| Size | X(500) | 
| FLF Start Position | 1025 | 
| FLF Stop Position | 1524 | 
| Segment Key Field Identifier | Not Applicable | 
| Coding Requirements | 1. Value must be 500 characters or less 2. Situational  | 
                                    
| 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 | 
|---|---|---|---|---|
| FTX061 | FTX.002.061 | MEMO | FTX00002 | INDIVIDUAL-CAPITATION-PMPM | 
| FTX102 | FTX.003.102 | MEMO | FTX00003 | INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT | 
| FTX146 | FTX.004.146 | MEMO | FTX00004 | GROUP-INSURANCE-PREMIUM-PAYMENT | 
| FTX233 | FTX.006.233 | MEMO | FTX00006 | VALUE-BASED-PAYMENT | 
| FTX276 | FTX.007.276 | MEMO | FTX00007 | STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM | 
| FTX315 | FTX.008.315 | MEMO | FTX00008 | COST-SETTLEMENT-PAYMENT | 
| FTX354 | FTX.009.354 | MEMO | FTX00009 | FQHC-WRAP-PAYMENT | 
| FTX404 | FTX.095.404 | MEMO | FTX00095 | MISCELLANEOUS-PAYMENT |