Type : FT1.CONTENT |
Definition |
Segment Description: |
Elements | |||
FT1.1_Set_ID_-_FT1 | Parent Segment: FT1 Sequential Number: 1 Description: Set ID - FT1 Data Type: SI Item ID: 355 |
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FT1.2_Transaction_ID | Parent Segment: FT1 Sequential Number: 2 Description: Transaction ID Data Type: ST Item ID: 356 |
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FT1.3_Transaction_Batch_ID | Parent Segment: FT1 Sequential Number: 3 Description: Transaction Batch ID Data Type: ST Item ID: 357 |
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![]() | Parent Segment: FT1 Sequential Number: 4 Description: Transaction Date Data Type: DR Item ID: 358 |
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FT1.5_Transaction_Posting_Date | Parent Segment: FT1 Sequential Number: 5 Description: Transaction Posting Date Data Type: DTM Item ID: 359 |
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![]() | Parent Segment: FT1 Sequential Number: 6 Description: Transaction Type Data Type: CWE Item ID: 360 Table: 0017 |
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![]() | Parent Segment: FT1 Sequential Number: 7 Description: Transaction Code Data Type: CWE Item ID: 361 Table: 0132 |
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FT1.10_Transaction_Quantity | Parent Segment: FT1 Sequential Number: 10 Description: Transaction Quantity Data Type: NM Item ID: 364 |
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FT1.11_Transaction_Amount_-_Extended | Parent Segment: FT1 Sequential Number: 11 Description: Transaction Amount - Extended Data Type: CP Item ID: 365 |
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FT1.12_Transaction_amount_-_unit | Parent Segment: FT1 Sequential Number: 12 Description: Transaction amount - unit Data Type: CP Item ID: 366 |
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FT1.13_Department_Code | Parent Segment: FT1 Sequential Number: 13 Description: Department Code Data Type: CWE Item ID: 367 Table: 0049 |
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FT1.14_Health_Plan_ID | Parent Segment: FT1 Sequential Number: 14 Description: Health Plan ID Data Type: CWE Item ID: 368 Table: 0072 |
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FT1.15_Insurance_Amount | Parent Segment: FT1 Sequential Number: 15 Description: Insurance Amount Data Type: CP Item ID: 369 |
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FT1.16_Assigned_Patient_Location | Parent Segment: FT1 Sequential Number: 16 Description: Assigned Patient Location Data Type: PL Item ID: 133 |
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FT1.17_Fee_Schedule | Parent Segment: FT1 Sequential Number: 17 Description: Fee Schedule Data Type: CWE Item ID: 370 Table: 0024 |
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FT1.18_Patient_Type | Parent Segment: FT1 Sequential Number: 18 Description: Patient Type Data Type: CWE Item ID: 148 Table: 0018 |
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![]() | Parent Segment: FT1 Sequential Number: 19 Description: Diagnosis Code - FT1 Data Type: CWE Item ID: 371 Table: 0051 |
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![]() | Parent Segment: FT1 Sequential Number: 20 Description: Performed By Code Data Type: XCN Item ID: 372 Table: 0084 |
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![]() | Parent Segment: FT1 Sequential Number: 21 Description: Ordered By Code Data Type: XCN Item ID: 373 |
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FT1.22_Unit_Cost | Parent Segment: FT1 Sequential Number: 22 Description: Unit Cost Data Type: CP Item ID: 374 |
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FT1.23_Filler_Order_Number | Parent Segment: FT1 Sequential Number: 23 Description: Filler Order Number Data Type: EI Item ID: 217 |
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![]() | Parent Segment: FT1 Sequential Number: 24 Description: Entered By Code Data Type: XCN Item ID: 765 |
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FT1.25_Procedure_Code | Parent Segment: FT1 Sequential Number: 25 Description: Procedure Code Data Type: CNE Item ID: 393 Table: 0088 |
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![]() | Parent Segment: FT1 Sequential Number: 26 Description: Procedure Code Modifier Data Type: CNE Item ID: 1316 Table: 0340 |
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FT1.27_Advanced_Beneficiary_Notice_Code | Parent Segment: FT1 Sequential Number: 27 Description: Advanced Beneficiary Notice Code Data Type: CWE Item ID: 1310 Table: 0339 |
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FT1.28_Medically_Necessary_Duplicate_Procedure_Reason | Parent Segment: FT1 Sequential Number: 28 Description: Medically Necessary Duplicate Procedure Reason Data Type: CWE Item ID: 1646 Table: 0476 |
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FT1.29_NDC_Code | Parent Segment: FT1 Sequential Number: 29 Description: NDC Code Data Type: CWE Item ID: 1845 Table: 0549 |
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FT1.30_Payment_Reference_ID | Parent Segment: FT1 Sequential Number: 30 Description: Payment Reference ID Data Type: CX Item ID: 1846 |
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![]() | Parent Segment: FT1 Sequential Number: 31 Description: Transaction Reference Key Data Type: SI Item ID: 1847 |
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![]() | Parent Segment: FT1 Sequential Number: 32 Description: Performing Facility Data Type: XON Item ID: 2361 |
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FT1.33_Ordering_Facility | Parent Segment: FT1 Sequential Number: 33 Description: Ordering Facility Data Type: XON Item ID: 2362 |
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FT1.34_Item_Number | Parent Segment: FT1 Sequential Number: 34 Description: Item Number Data Type: CWE Item ID: 2363 |
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FT1.35_Model_Number | Parent Segment: FT1 Sequential Number: 35 Description: Model Number Data Type: ST Item ID: 2364 |
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![]() | Parent Segment: FT1 Sequential Number: 36 Description: Special Processing Code Data Type: CWE Item ID: 2365 |
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FT1.37_Clinic_Code | Parent Segment: FT1 Sequential Number: 37 Description: Clinic Code Data Type: CWE Item ID: 2366 |
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FT1.38_Referral_Number | Parent Segment: FT1 Sequential Number: 38 Description: Referral Number Data Type: CX Item ID: 2367 |
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FT1.39_Authorization_Number | Parent Segment: FT1 Sequential Number: 39 Description: Authorization Number Data Type: CX Item ID: 2368 |
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FT1.40_Service_Provider_Taxonomy_Code | Parent Segment: FT1 Sequential Number: 40 Description: Service Provider Taxonomy Code Data Type: CWE Item ID: 2369 |
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FT1.41_Revenue_Code | Parent Segment: FT1 Sequential Number: 41 Description: Revenue Code Data Type: CWE Item ID: 1600 Table: 0456 |
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FT1.42_Prescription_Number | Parent Segment: FT1 Sequential Number: 42 Description: Prescription Number Data Type: ST Item ID: 325 |
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FT1.43_NDC_Qty_and_UOM | Parent Segment: FT1 Sequential Number: 43 Description: NDC Qty and UOM Data Type: CQ Item ID: 2370 |
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