Military Health System

Two (2) alphanumeric characters.

Code indicating whether the patient is enrolled with the contractor (Prime) or not (non-Prime) or a special care program.

TRICARE Standard Program (Terminated 12/31/2017)

TRICARE Prime, Civilian PCM

TRICARE Extra (Terminated 12/31/2017)

TPR Service Member - USA

Foreign Service Member

CHCBP - Non-Network

TRICARE Prime, MTF/eMSM/PCM

CHCBP - Network

TRICARE Select - Active Duty Survivors (Effective 01/01/2018)

TRICARE Select - Active Duty Transitional Survivors (Effective 01/01/2018)

TSP (Effective 10/01/1998 through 12/31/2001)

TFL - Network (Effective 10/01/2001)

TFL - Non-Network (Effective 10/01/2001)

TRICARE Select - Guard/Reserve Survivors (Effective 01/01/2018)

TRICARE Select - Guard/Reserve Transitional Survivors (Effective 01/01/2018)

Medicare/TRICARE Dual Eligible Under 65/Network

Medicare/TRICARE Dual Eligible Under 65/Non-Network

TSRx (Effective 04/01/2001) - Non-Institutional Only

SHCP - Non-MTF/eMSM-Referred Care (Effective 10/01/1999)

SHCP - Non-TRICARE Eligible (Effective 10/01/1999 through 05/31/2004)

SHCP - MTF/eMSM Referred Care (Effective 10/01/1999)

SHCP - TRICARE Eligible (Effective 10/01/1999 through 05/31/2004)

SHCP - Referral Designation Unknown (Effective 03/01/2002) - for Non-Institutional Pharmacy claims only

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

TRICARE Select (Effective 01/01/2018)

TPR Foreign Service Member (Effective 09/01/2003)

TPR for enrolled ADFM Residing with a TPR Eligible Service Member (Effective 09/01/2002)

Includes Transitional Survivors Who Do Not Relocate TPR Foreign ADFM (Effective 09/01/2003)

Foreign ADFM (Effective 09/01/2003)

N/A

Seven (7) alphanumeric characters, YYYYDDD.

Date the request for payment of services rendered was received by the contractor for processing.

4 digit calendar year of receipt

3 digit Julian date of receipt

N/A

Three (3) alphanumeric characters.

Code that indicates the State or Country where the primary care was provided.

Refer to Addendums A1 and B1.

N/A

One (1) alphanumeric character.

Code that describes the frequency of billing from the institution. For filing dates before January 1, 2011 all TED records for interim-interim and interim-final institutional bills must be submitted as an adjustment using the same TRI as the initial submission. Effective with filing dates on or after January 1, 2011 all TED records for interim-interim and interim-final institutional bills with the exception of interim billings reimbursed under the DRG or HHA payment methodology must be submitted as a unique TRI. See Section 1.1, paragraph 7.0.

Non-Payment/Zero Claim

Admit through Discharge TED record

Interim-Initial TED record

Interim-Interim TED record

Interim-Final TED record

Replacement of Prior Claim

Void/Cancel of Prior Claim

Final claim for HHA PPS Episode

N/A

One (1) alphanumeric character.

The code used to identify for each insured in managed care the category of copayment and deductible they must pay based on external forces for a particular health care coverage period. Actual rates depend on HCDP Plan Coverage Code. Download field from DEERS.

Active duty E-4 and below rate

Active duty E-5 and above rate

Retiree rate

Unknown copayment factor

Not applicable

N/A

One (1) alphanumeric character.

The member category code during the Health Care Coverage period. Download field from DEERS.

Transitional compensation not eligible for retirement

Active duty

Presidential Appointee

DoD civil service employee, except Presidential employee

Disabled American veteran

DoD contract employee

Former member (Reserve service, discharged from the Ready Reserve or Standby Reserve following notification of retirement eligibility)

National Guard member (mobilized or on active duty for 31 days or more) Early ID Alert status

Medal of Honor (MOH) recipient

Other Government Agency employee, except Presidential appointee

Academy student (does not include Officer Candidate School or Merchant Marine Academy)

Non-Appropriated Fund DoD employee

Lighthouse service

Non-Government Agency Personnel

National Guard member (not on active duty or on active duty for 30 days or less)

Other Government contract employee

TAMP member

Reserve retiree not yet eligible for retired pay (“gray-area retiree”)

Retired military member eligible for retired pay

Reserve member (mobilized or on active duty for 31 days or more) Early ID Alert status

Foreign military member

DoD OCONUS hires

Reserve member (not on active duty or on active duty for 30 days or less)

DoD beneficiary, a person who receives benefits from the DoD based on prior association, condition or authorization, an example is a former spouse

Service affiliates (including ROTC and Merchant Marines)

Unknown

N/A

One (1) alphanumeric character.

The member relationship code for the HCC period. Download field from DEERS.

Self (i.e., the person and the other person are the same person)

Spouse

Child or stepchild

Pre-adoptive child

Ward (court ordered)

Dependent parent, dependent stepparent, dependent parent-in-law, or dependent stepparent-in-law

Surviving spouse

Former spouse (20/20/20)

Former spouse (20/20/15)

Former spouse (10/20/10)

Former spouse (transitional assistance (composite))

Foster child

Unknown

N/A

Three (3) alphanumeric characters.

The code that represents the plan coverage a family member or sponsor has within a HCDP type. Download field from DEERS.

For valid values refer to Addendum L.

N/A

Two (2) alphanumeric characters.

The code used to identify for each person insured in managed care any special category that they may have been given for copayment and deductible. Download field from DEERS.

Not applicable

Bosnia Participation Special Entitlement (Sponsor Only)

Noble Eagle Participation Special Entitlement (Sponsor Only)

Enduring Freedom Participation Special Entitlement

TA 60 Benefits Period After Special Operation

TA 120 Benefits Period After Special Operation

Kosovo Participation Special Entitlement (Sponsor Only)

Iraqi Freedom Participation Special Entitlement (Sponsor Only)

Special Entitlement for Guard/Reserve on Active Duty more than 30 days (excl. AGR)

TRICARE Senior Pharmacy Exception - Grandfathered Populations before 04/01/2001.

TRICARE Senior Pharmacy Exception - Direct Care (DC) over 65 members with Medicare A and B but no TFL.

N/A

Five (5) alphanumeric characters.

HIPPS rate codes identify specific patient characteristics (or case mix) on which TRICARE SNF and HHA payment determinations are made.

SNF HIPPS codes prior to October 1, 2019: Consists of a three character RUG code plus a two character modifier which is an assessment indicator.

N/A

One (1) alphanumeric character.

Code to indicate the International Classification of Diseases (ICD) version.

ICD-10

ICD-9

N/A

Group

N/A

Refer to subordinate element definitions.

N/A