Fixed Payment Indicator

SAS Name

This indicator indicates that the reimbursement amount included on the claim is for a fixed payment


Fixed payments are made by the state to insurers or providers for premiums or eligible coverage, not for a particular service. For example, some states have Primary Care Case Management (PCCM) programs where the state pays providers a monthly patient management fee of $3.50 for each eligible participant under their care. This fee is considered a fixed payment.

It is very important for states to correctly identify fixed payments. Fixed payments do not have a defined “medical record” associated with the payment; therefore, fixed payments are not subject to medical record request and medical record review.

SOURCE: T-MSIS Analytic File (TAF) Claims

Code Code value
0 Not Fixed Payment
1 Fee-for-service (FFS) Fixed Payment
Null/missing source value is missing or unknown