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