Military Health System

One (1) alphanumeric character.

Code to indicate the type of record.

Institutional

Non-Institutional

N/A

Two (2) alphanumeric character.

Region Indicator is the region of the contractor responsible for the care provided.

Blank

North Contract

Overseas Contract

South Contract

West Contract

East Contract 2017

West Contract 2017

N/A

Four (4) alphanumeric characters.

Code which identifies revenue categories associated with the type of service rendered. Like revenue codes must be combined to one occurrence for reporting on the TED record. Like denied revenue codes with the same Adjustment/Denial Reason Code must be combined to one occurrence for reporting on the TED record. Denied and non-denied revenue codes cannot be reported on the same occurrence. Room and board revenue codes must be combined if the code and rate are the same.

Use UB-04/UB-92 revenue codes (see Addendum H).

N/A

Seven (7) alphanumeric characters.

Codes identifying the procedures, other than the principal procedure, performed during the period reported on the TED record. The secondary OP/NSP code(s) shall not duplicate the primary OP/NSP code. Do not duplicate secondary OP/NSP codes.

Use the most current procedure code edition (ICD-9-CM or ICD-10-PCS) as directed by DHA. Must code the most detailed procedure. Do not code the decimal point.

N/A

Eight (8) alphanumeric characters.

Secondary Treatment Diagnosis: Code corresponding to additional conditions that co-exist at the time of admission or during the treatment encounter. The secondary treatment diagnosis code(s) shall not duplicate the primary treatment diagnosis code. Do not duplicate secondary treatment diagnosis codes.

POA Indicator: Diagnosis present at the time the order for inpatient admission occurs.

Secondary Treatment Diagnosis (Positions 1 through 7): Use the most current diagnoses edition (ICD-9-CM or ICD-10-CM) as directed by DHA. Must code the most detailed procedure. Do not code decimal point.

POA Indicator (Position 8):

Valid POA values are:

Not reported

Unreported/Not Used - Exempt from POA reporting

No - Not present at time of admission

Unknown - Documentation insufficient to determine if the condition was present at time of admission

Clinically Undetermined - The provider is unable to clinically determine if the condition was present at time of admission

Yes - Present at time of admission

N/A

Seven (7) alphanumeric characters.

A sequential number assigned by the contractor to identify the individual claim. Once assigned, the sequence number cannot be re-used with the same Filing Date and Filing State/Country.

The sequential identifying number assigned by the contractor.

N/A

One (1) alphanumeric character.

The code that represents the branch classification of service with which the sponsor is affiliated. Download field from DEERS.

Foreign Army

Foreign Navy

Foreign Marine Corps

Foreign Air Force

Army

Coast Guard

Office of the Secretary of Defense

Air Force

Public Health Service

Marine Corps

Navy

NOAA

Not applicable1

Not provided from DEERS

N/A

Nine (9) signed numeric digits including two (2) decimal places.

Amount the SCH would be allowed if reimbursed under DRG based payment system.

N/A

N/A

Three (3) alphanumeric characters.

Number identifying the DRG classification used to determine the SCH DRG CALCULATION.

N/A

N/A

Four occurrences of two (2) alphanumeric characters per occurrence/line item for non-institutional.

Code indicating care that requires special processing.

Hospice non-affiliated provider

Medicaid

Allogeneic bone marrow recipient (Wilford Hall referred only prior to 10/01/1997 and PCM/HCF referred after 12/31/2002)

Allogeneic bone marrow donor (Wilford Hall referred only prior to 10/01/1997 and PCM/HCF referred after 12/31/2002)

Liver transplant (effective for care before 03/01/1997, or between 02/20/1998 and 08/31/1999 and after 05/31/2003)

HHC (non-institutional only)

Heart Transplant

Active duty cost-share ambulatory surgery taken from professional claim

Hospice

Capitated Arrangements

BMTs - DHA approved

Ambulatory Surgery Facility charge

VHA medical provider claim (care rendered by a VHA provider)

Hospital reimbursement reduced by manufacturer credit/replacement of device during warranty period

Hospital reimbursement reduced by manufacturer credit/recalled device

Partnership Program (internal providers with signed agreements)

HHC/CM Demonstration (After 03/15/1999, grandfathered into the Individual Case Management Program (ICMP))2

Active Duty Delayed Deductible

Medicare/TRICARE Dual Entitlement First Payor - not a Medicare Benefit (Effective 10/01/2001)

Resource Sharing - External

Medicare/TRICARE Dual Entitlement (formally normal COB processing (Effective 10/01/2001 process as Second Payor))

BRAC Medicare Pharmacy (Section 702) claim (Terminated 04/01/2001)

Financially underwritten payment by contractor

Non-financially underwritten payment by financially underwritten contractor

Partial hospitalization - provider not contracted with or employed by the PHP billing for psychotherapy services in a PHP

Heart-lung transplant

Kidney transplant

Abused dependent of discharged or dismissed member (Effective 07/28/1999)

Access To Care (ATC) Demonstration (South Region only)

Foreign active duty claims (Effective 06/30/1996)

Abortion performed due to rape

Abortion performed due to incest

Abortion performed due to life endangering physical condition

SHCP - Non-MTF/eMSM-Referred Care (Effective 10/01/1999 through 05/31/2004)

Applied Behavior Analysis (ABA) Pilot

SHCP - MTF/eMSM Referred Care (Effective 10/01/1999 through 05/31/2004)

Comprehensive Autism Care Demonstration

Autism Demonstration (Effective 03/15/2008)3

Applied Behavior Analysis (ABA) (Interim Benefit)

Bosnia Deductible (Effective 12/08/1995)

Civil Action Payment (Effective 07/01/1999)

SHCP - CCEP (Effective 10/01/1999)

Clinical Trials Demonstration (Enrollment Effective 03/17/2003 through 03/31/2008)

ICMP claims (Effective 03/15/1999)

Cancer Clinical Trials (Enrollment Effective on or after 04/01/2008)

CCTP (Effective 12/28/2001)

Digital Breast Tomosynthesis (DBT)

DCPE-DVA/VHA - C&P exams used to determine fit for duty

TDRL physical exams (Effective 03/30/2009)

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)

Emergency services rendered by an unauthorized provider (Effective 06/01/1999)

TFL (First Payor - Not A Medicare Benefit) (Effective 10/01/2001)

TFL (First Payor - No TRICARE Provider Certification, i.e., Medicare benefits have been exhausted) (Effective 10/01/2001)

TFL (Second Payor) (Effective 10/01/2001)

TPR for eligible ADFM residing with a TPR Eligible Service Member (Effective 10/30/2000 through 08/31/2002)

Service member enrolled in TPR (Effective 10/01/1999)

Good Faith Payment Debt Transfer5

Good Faith Payment

Allied Forces - Kosovo (Effective 06/01/1999)

Laboratory Developed Tests (LDTs) Demonstration

Non-FDA Approved LDTs Demonstration

Platelet Rich Plasma Injections for the treatment of Musculoskeletal Conditions

Mental Health Active Duty Cost- Share

Maryland Multi-Payer Patient-Centered Medical Home Program (MMPCMHP)

TSP (Non-Network) (Effective 01/01/1998 through 12/31/2001)

TSP (Network) (Effective 01/01/1998 through 12/31/2001)

Operation Noble Eagle/Operation Enduring Freedom Demonstration (Reservists called to active duty under Executive Order 13223) (Effective 09/14/2001 through 10/31/2009)

Provisional Coverage for Emerging Services and Supplies

Pharmacy Redesign Pilot Program (Effective 07/01/2000 through 04/01/2001)

ECHO (formerly PFPWD)

Philippines Demonstration Project (Expired)

TRICARE Prime - Point of Service (POS)

Specialty Pharmacy Service (MOP Only)

Retail Network Pharmacy Services for DVA/VHA Beneficiaries (TPharm Retail Pharmacies Only)

Respite Benefit for Seriously Injured or Ill ADSMs4

Rare Diseases

Resource Sharing - Internal

Medicare/TRICARE Dual Entitlement (First Payor - No TRICARE Provider Certification, i.e., Medicare benefits have been exhausted) (Effective 10/01/2001)

SHCP Gamete Handling/Transportation

SHCP Portable CPAP Device

SHCP - Non-TRICARE Eligible (Effective 10/01/1999)

SHCP - TRICARE Eligible (Effective 10/01/1999)

SHCP - Emergency (Effective 10/01/1999)

TSS (Non-Network) (Effective 04/01/2000 through 12/31/2002)

Special/Emergent Care (Effective 06/01/1999)

TSS (Network) (Effective 04/01/2000 through 12/31/2002)

Specialized Treatment (Effective 03/01/1997 through 05/31/2003)

Urgent Care Pilot (Expired)

Mental Health Wraparound Demonstration (Effective 01/01/1998 through 06/30/2001)

N/A