FT1
Financial Transaction
The FT1 segment contains the detail data necessary to post charges, payments, adjustments, etc., to patient accounting records.
RRequiredOOptionalCConditionalWWithdrawn|#Date/Time*Backward compat.+Filler
43
| C.Len | Element | v2.6 | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 1..4 | - | SI | O | 1 | - | 00355 | FT1-1 | Set ID - FT1 | Min Length |
| 2 | 1..12 | - | ST | O | 1 | - | 00356 | FT1-2 | Transaction ID | Min Length |
| 3 | 1..10 | - | ST | O | 1 | - | 00357 | FT1-3 | Transaction Batch ID | Min Length |
| 4 | - | - | DR | R | 1 | - | 00358 | FT1-4 | Transaction Date | Length |
| 5 | - | - | DTM | O | 1 | - | 00359 | FT1-5 | Transaction Posting Date | Length |
| 6 | - | - | CWE | R | 1 | 0017 | 00360 | FT1-6 | Transaction Type | 2 |
| 7 | - | - | CWE | R | 1 | 0132 | 00361 | FT1-7 | Transaction Code | Length |
| 8 | - | - | - | W | 1 | - | 00362 | FT1-8 | Transaction Description | |
| 9 | - | - | - | W | 1 | - | 00363 | FT1-9 | Transaction Description - Alt | |
| 10 | - | 6= | NM | O | 1 | - | 00364 | FT1-10 | Transaction Quantity | 2 |
| 11 | - | - | CP | O | 1 | - | 00365 | FT1-11 | Transaction Amount - Extended | Length |
| 12 | - | - | CP | O | 1 | - | 00366 | FT1-12 | Transaction amount - unit | Length |
| 13 | - | - | CWE | O | 1 | 0049 | 00367 | FT1-13 | Department Code | Length |
| 14 | - | - | CWE | O | 1 | 0072 | 00368 | FT1-14 | Health Plan ID | 2 |
| 15 | - | - | CP | O | 1 | - | 00369 | FT1-15 | Insurance Amount | Length |
| 16 | - | - | PL | O | 1 | - | 00133 | FT1-16 | Assigned Patient Location | Length |
| 17 | - | - | CWE | O | 1 | 0024 | 00370 | FT1-17 | Fee Schedule | 2 |
| 18 | - | - | CWE | O | 1 | 0018 | 00148 | FT1-18 | Patient Type | 2 |
| 19 | - | - | CWE | O | * | 0051 | 00371 | FT1-19 | Diagnosis Code - FT1 | Length |
| 20 | - | - | XCN | O | * | 0084 | 00372 | FT1-20 | Performed By Code | Length |
| 21 | - | - | XCN | O | * | - | 00373 | FT1-21 | Ordered By Code | Length |
| 22 | - | - | CP | O | 1 | - | 00374 | FT1-22 | Unit Cost | Length |
| 23 | - | - | EI | O | 1 | - | 00217 | FT1-23 | Filler Order Number | Length |
| 24 | - | - | XCN | O | * | - | 00765 | FT1-24 | Entered By Code | Length |
| 25 | - | - | CNE | O | 1 | 0088 | 00393 | FT1-25 | Procedure Code | Length |
| 26 | - | - | CNE | O | * | 0340 | 01316 | FT1-26 | Procedure Code Modifier | Length |
| 27 | - | - | CWE | O | 1 | 0339 | 01310 | FT1-27 | Advanced Beneficiary Notice Code | Length |
| 28 | - | - | CWE | O | 1 | 0476 | 01646 | FT1-28 | Medically Necessary Duplicate Procedure Reason | Length |
| 29 | - | - | CWE | O | 1 | 0549 | 01845 | FT1-29 | NDC Code | Length |
| 30 | - | - | CX | O | 1 | - | 01846 | FT1-30 | Payment Reference ID | Length |
| 31 | 1..4 | - | SI | O | * | - | 01847 | FT1-31 | Transaction Reference Key | Min Length |
| 32 | - | - | XON | O | * | - | 02361 | FT1-32 | Performing Facility | NEW |
| 33 | - | - | XON | O | 1 | - | 02362 | FT1-33 | Ordering Facility | NEW |
| 34 | - | - | CWE | O | 1 | - | 02363 | FT1-34 | Item Number | NEW |
| 35 | - | 20= | ST | O | 1 | - | 02364 | FT1-35 | Model Number | NEW |
| 36 | - | - | CWE | O | * | - | 02365 | FT1-36 | Special Processing Code | NEW |
| 37 | - | - | CWE | O | 1 | - | 02366 | FT1-37 | Clinic Code | NEW |
| 38 | - | - | CX | O | 1 | - | 02367 | FT1-38 | Referral Number | NEW |
| 39 | - | - | CX | O | 1 | - | 02368 | FT1-39 | Authorization Number | NEW |
| 40 | - | - | CWE | O | 1 | - | 02369 | FT1-40 | Service Provider Taxonomy Code | NEW |
| 41 | - | - | CWE | O | 1 | 0456 | 01600 | FT1-41 | Revenue Code | NEW |
| 42 | - | 20= | ST | O | 1 | - | 00325 | FT1-42 | Prescription Number | NEW |
| 43 | - | - | CQ | O | 1 | - | 02370 | FT1-43 | NDC Qty and UOM | NEW |
13