The unique code that identifies the line of business, a high-level payer, or funding source such as Medicaid.

The type of financial entity that can make payments and/or receive payments.

Examples: Provider, Member, Carrier

The code associated with the type of payee/payer.

Defaults: If the Payee/Payer Type is Provider, then the Payee/Payer ID Type Code is Medicaid. If the Payee/Payer Type is Member, then the Payee/Payer ID Type Code is Medicaid ID. If the Payee/Payer Type is Carrier, then the Payee/Payer ID Type is Carrier ID.

Unique identifier of the payee/payer.

The name of the payee/payer. Dependent upon the Payee/Payer Type Code and Payee/Payer ID on file in ND MMIS.

The financial control number (FCN) assigned to the write-off. The FCN consists of the date it was received, the media source (how it was received), and a document number.

Format: YYYYMMDDMNNNNN

Links to appropriate Accounts Receivable page for the receivable.

The transaction control number (TCN) of the financial transaction (FT) created to record the creation of an account receivable (AR) write-off during Claims Processing. When the FT contains a negative reimbursement amount that is equal to the original AR amount then it is a history only transaction.

Links to the Claims Inquiry page for the claim associated with the control number, if you have access.

Unique code representing a logical grouping for financial reason codes.

The amount of the original account receivable.

Format: Displayed as currency with $ symbol left of the value and two digits to the right of the decimal.

Display Example: $9999999.99

The code indicating why the transaction was added.

The current balance amount of the account receivable transaction.

Sum of the revised account receivable amount, revised interest, revised penalty, and revised fees.

The date that the original account receivable was created.

The account receivable letter aging status.

The Member ID of the member on whose behalf this financial action was created.

The amount of interest accruals on the account receivable. An interest charge is imposed on the remaining balance when the account receivable is not exempted from interest charges.

The type of Alternate ID being used as the Member ID.

Examples: Medicaid, SPED, Voc Rehab

The amount of penalty accrued on the account receivable. A penalty charge is imposed when payment has not been received on time. This occurs when the account receivable is not exempt from penalties.

The name of person associated with the member ID.