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TRICARE Systems Manual 7950.4-M

Each TRICARE Manual posted on the website incorporates all published changes. Although changes are published, they are not implemented by the contractors until they receive direction to do so by the Contracting Officer. Each TRICARE Manual on the web incorporates all changes by the date of publication. Although changes are published, they may not be implemented by the contractor until directed to do so by the Contracting Officer.
The TRICARE Systems Manual (TSM) is incorporated by reference in the Managed Care Support Contracts (MCSCs) and is the primary vehicle for systems requirements and instructions. The TSM provides a mechanism for keeping the contracts current by clarifying or modifying existing contractual requirements, adding new specifications/requirements and deleting obsolete information. The TRICARE Systems Manual (TSM), 7950.4-M, defines contractor responsibilities for automated processing of health care information, reporting and transmission of relevant data between the contractor and the Defense Health Agency (DHA). The manual also provides requirements for TRICARE contractors to interface with the Defense Enrollment Eligibility Reporting System (DEERS) for obtaining beneficiary eligibility verifications from DEERS and performing TRICARE Prime enrollments onto DEERS. Requirements for the TRICARE Encounter Data (TED) and the TRICARE Duplicate Claims System (DCS) – TRICARE Encounter Data (TED) Version are located in this manual.
  • April 6, 2021 Edition
    Last Updated: December 5, 2022
    Most Recent Change Number: Baseline
    These manuals are applicable to the T-5 East and West Regional Managed Care Support Contracts (MCSCs) (HT940223C0001 and HT940223C0002). Upon direction of the respective Contracting Officer (CO), all or portions of these manuals may also apply to other TRICARE contracts.
    All future changes will be published to this edition.

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    This is the baseline version of the April 2021 TRICARE System Manual (TSM).
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