| # | Name | Location | Type | Details | Index | Description |
|---|---|---|---|---|---|---|
| .01 | eft transaction(+) | 0;1 | POINTER | 344.3 | B | This is the pointer to the EFT totals record that this EFT was received in. |
| .02 | payer name | 0;2 | FREE TEXT | This is the insurance co name as reported for the payment on the EFT. | ||
| .03 | payer id | 0;3 | FREE TEXT | This is the payer id as reported for the payment on the EFT. | ||
| .04 | trace # | 0;4 | FREE TEXT | This is the bank trace number assigned to the electronic funds transfer (EFT) by the payer's bank. | ||
| .05 | provider tax id sent | 0;5 | FREE TEXT | This is the tax ID of the Medical Center. The EFT's are routed to the correct site based on this tax ID. If the 'TAX ID CORRECTED' is 'Y', this field will contain the incorrect tax ID as received by the FSC in Austin. | ||
| .06 | tax id correction | 0;6 | SET OF CODES | 0:NO CHANGE E:CHANGE BY EPHRA C:CHANGE BY CLAIM DATA | This field indicates if the tax id was corrected and if so, who did it. | |
| .07 | amount of payment | 0;7 | NUMERIC | This is the amount of the deposit made by the payer into the banking institution. | ||
| .08 | match status | 0;8 | SET OF CODES | -1:MATCHED WITH ERRORS 0:UNMATCHED 1:MATCHED 2:PAPER EOB MATCH | AMATCH | This is the status that indicates whether or not the EFT payment has been matched to an ERA record. If the total amt of the EFT payment does not = the total amount of the ERA payment, the status will be -1 (MATCHED WITH ERRORS). |
| .09 | receipt # | 0;9 | POINTER | 344 | This is the receipt that was created for this EFT record. | |
| .1 | era record | 0;10 | POINTER | 344.4 | AERA | This is the ERA record that contains the detail for this EFT. |
| .11 | eft recorded at site | 0;11 | BOOLEAN | 0:NO 1:YES | This is a flag that indicates the EFT deposit this EFT was received in has been recorded to the FMS system. This locks the record and it cannot be overwritten by another transmission of the same EFT deposit. | |
| .12 | date claims paid | 0;12 | DATE-TIME | This is the date the payer reported the claims were paid. | ||
| .13 | date received | 0;13 | DATE-TIME | ADR | This is the date this record was added to the system. | |
| .14 | transaction # | 0;14 | NUMERIC | This is the transaction # within the receipt for this EFT. | ||
| .15 | ach trace# | 1;1 | FREE TEXT | This is the ACH trace # assigned by the Lockbox banking institution to this EFT detail record. | ||
| .16 | manual tr document | 1;2 | FREE TEXT | This is the TR document that was entered on-line to manually post the EFT detail to the correct accounts and remove them from FUND 5287.4, revenue source code 8NZZ. This is used when a RECEIPT was not used to automatically generate a TR document for the EFT detail record. | ||
| .17 | user who removed eft | 3;1 | POINTER | 200 | This field records the name of the person who is marking the EFT as a duplicate. | |
| .18 | date/time duplicate removed | 3;2 | DATE-TIME | E | This field records the time that the EFT was marked as removed. | |
| .19 | eft removal reason(+) | 3;3 | FREE TEXT | The EFT removal reason is used to record the justification for removing this EFT. | ||
| 2 | error messages | 2;0 | WORD-PROCESSING | This is the record of error messages for the EFT record. |