Records/Locator Numbers
|
Record
Name
|
Locator#
|
Occurrences
|
Required
|
Institutional
Non-Institutional
|
1-185
2-305
|
4
4/Up to 99
|
Yes1
Yes1
|
Primary
Picture (Format)
|
Four
occurrences of two (2) alphanumeric characters per occurrence/line
item for non-institutional.
|
Definition
|
Code
indicating care that requires special processing.
|
Code/Value
Specifications
|
0
|
Hospice
non-affiliated provider
|
|
1
|
Medicaid
|
|
3
|
Allogeneic
bone marrow recipient (Wilford Hall referred only prior to 10/01/1997
and PCM/HCF referred after 12/31/2002)
|
|
4
|
Allogeneic
bone marrow donor (Wilford Hall referred only prior to 10/01/1997
and PCM/HCF referred after 12/31/2002)
|
|
5
|
Liver
transplant (effective for care before 03/01/1997, or between 02/20/1998
and 08/31/1999 and after 05/31/2003)
|
|
6
|
HHC
(non-institutional only)
|
|
7
|
Heart
Transplant
|
|
10
|
Active
duty cost-share ambulatory surgery taken from professional claim
|
|
11
|
Hospice
|
|
12
|
Capitated
Arrangements
|
|
14
|
BMTs
- DHA approved
|
|
16
|
Ambulatory
Surgery Facility charge
|
|
17
|
VHA
medical provider claim (care rendered by a VHA provider)
|
|
49
|
Hospital
reimbursement reduced by manufacturer credit/replacement of device
during warranty period
|
|
50
|
Hospital
reimbursement reduced by manufacturer credit/recalled device
|
|
A
|
Partnership
Program (internal providers with signed agreements)
|
|
E
|
HHC/CM
Demonstration (After 03/15/1999, grandfathered into the Individual
Case Management Program (ICMP))2
|
|
Q
|
Active
Duty Delayed Deductible
|
|
R
|
Medicare/TRICARE
Dual Entitlement First Payor - not a Medicare Benefit (Effective
10/01/2001)
|
|
S
|
Resource
Sharing - External
|
|
T
|
Medicare/TRICARE
Dual Entitlement (formally normal COB processing (Effective 10/01/2001
process as Second Payor))
|
|
U
|
BRAC
Medicare Pharmacy (Section 702) claim (Terminated
04/01/2001)
|
|
V
|
Financially
underwritten payment by contractor
|
|
W
|
Non-financially
underwritten payment by financially underwritten contractor
|
|
X
|
Partial
hospitalization - provider not contracted with or employed by the
PHP billing for psychotherapy services in a PHP
|
|
Y
|
Heart-lung
transplant
|
|
Z
|
Kidney
transplant
|
|
AB
|
Abused
dependent of discharged or dismissed member (Effective 07/28/1999)
|
|
AC
|
Access
To Care (ATC) Demonstration (South Region only)
|
|
AD
|
Foreign
active duty claims (Effective 06/30/1996)
|
|
AE
|
Abortion
performed due to rape
|
|
AF
|
Abortion
performed due to incest
|
|
AG
|
Abortion
performed due to life endangering physical condition
|
|
AN
|
SHCP
- Non-MTF/eMSM-Referred Care (Effective 10/01/1999 through 05/31/2004)
|
|
AP
|
Applied
Behavior Analysis (ABA) Pilot
|
|
AR
|
SHCP
- MTF/eMSM Referred Care (Effective 10/01/1999 through 05/31/2004)
|
|
AS
|
Comprehensive
Autism Care Demonstration
|
|
AU
|
Autism
Demonstration (Effective 03/15/2008)3
|
|
BA
|
Applied
Behavior Analysis (ABA) (Interim Benefit)
|
|
BD
|
Bosnia
Deductible (Effective 12/08/1995)
|
|
CA
|
Civil
Action Payment (Effective 07/01/1999)
|
|
CE
|
SHCP
- CCEP (Effective 10/01/1999)
|
|
CL
|
Clinical
Trials Demonstration (Enrollment Effective
03/17/2003 through 03/31/2008)
|
|
CM
|
ICMP
claims (Effective 03/15/1999)
|
|
CP
|
Cancer
Clinical Trials (Enrollment Effective on or after
04/01/2008)
|
|
CT
|
CCTP
(Effective 12/28/2001)
|
|
DC
|
DCPE-DVA/VHA -
C&P exams used to determine fit for duty
|
|
DE
|
TDRL
physical exams (Effective 03/30/2009)
|
|
EF
|
TRICARE
Reserve and National Guard Family Member Benefits (Reservists and
National Guard members called to active duty for more than 30 days
in support of a contingency operation) (Effective 11/01/2009)
|
|
EU
|
Emergency
services rendered by an unauthorized provider (Effective 06/01/1999)
|
|
FF
|
TFL
(First Payor - Not A Medicare Benefit) (Effective
10/01/2001)
|
|
FG
|
TFL
(First Payor - No TRICARE Provider Certification, i.e., Medicare
benefits have been exhausted) (Effective
10/01/2001)
|
|
FS
|
TFL
(Second Payor) (Effective 10/01/2001)
|
|
GF
|
TPR
for eligible ADFM residing with a TPR Eligible Service Member (Effective
10/30/2000 through 08/31/2002)
|
|
GU
|
Service
member enrolled in TPR (Effective 10/01/1999)
|
|
G1
|
Good
Faith Payment Debt Transfer5
|
|
G2
|
Good
Faith Payment
|
|
KO
|
Allied
Forces - Kosovo (Effective 06/01/1999)
|
|
LD
|
Laboratory
Developed Tests (LDTs) Demonstration
|
|
L2
|
Non-FDA
Approved LDTs Demonstration
|
|
MH
|
Mental
Health Active Duty Cost- Share
|
|
MM
|
Maryland
Multi-Payer Patient-Centered Medical Home Program (MMPCMHP)
|
|
MN
|
TSP
(Non-Network) (Effective 01/01/1998 through
12/31/2001)
|
|
MS
|
TSP
(Network) (Effective 01/01/1998 through 12/31/2001)
|
|
NE
|
Operation
Noble Eagle/Operation Enduring Freedom Demonstration (Reservists
called to active duty under Executive Order 13223) (Effective 09/14/2001
through
10/31/2009)
|
|
PC
|
Provisional
Coverage for Emerging Services and Supplies
|
|
PD
|
Pharmacy
Redesign Pilot Program (Effective 07/01/2000 through 04/01/2001)
|
|
PF
|
ECHO
(formerly PFPWD)
|
|
PH
|
Philippines
Demonstration Project (Expired)
|
|
PO
|
TRICARE
Prime - Point of Service (POS)
|
|
PS
|
Specialty
Pharmacy Service (MOP Only)
|
|
PV
|
Retail
Network Pharmacy Services for DVA/VHA Beneficiaries (TPharm
Retail Pharmacies Only)
|
|
RB
|
Respite
Benefit for Seriously Injured or Ill ADSMs4
|
|
RD
|
Rare
Diseases
|
|
RI
|
Resource
Sharing - Internal
|
|
RS
|
Medicare/TRICARE
Dual Entitlement (First Payor - No TRICARE Provider Certification,
i.e., Medicare benefits have been exhausted) (Effective 10/01/2001)
|
|
SA
|
SHCP
Gamete Handling/Transportation
|
|
SB
|
SHCP
Portable CPAP Device
|
|
SC
|
SHCP
- Non-TRICARE Eligible (Effective 10/01/1999)
|
|
SE
|
SHCP
- TRICARE Eligible (Effective 10/01/1999)
|
|
SM
|
SHCP
- Emergency (Effective 10/01/1999)
|
|
SN
|
TSS
(Non-Network) (Effective 04/01/2000 through
12/31/2002)
|
|
SP
|
Special/Emergent
Care (Effective 06/01/1999)
|
|
SS
|
TSS
(Network) (Effective 04/01/2000 through 12/31/2002)
|
|
ST
|
Specialized
Treatment (Effective 03/01/1997 through
05/31/2003)
|
|
UC
|
Urgent
Care Pilot (Expired)
|
|
WR
|
Mental
Health Wraparound Demonstration (Effective
01/01/1998 through 06/30/2001)
|
Algorithm
|
N/A
|
Subordinate
And/Or Group Elements
|
Subordinate
|
Group
|
N/A
|
PROCESSING
INFORMATION
|