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TRICARE Systems Manual 7950.3-M, April 1, 2015
TRICARE Encounter Data (TED)
Chapter 2
Section 7.1
Provider Edit Requirements (ELN 000 - 099)
Revision:  C-4, October 20, 2017
ELEMENT NAME:  RECORD TYPE INDICATOR (3-001)
VALIDITY EDITS
3-001-01V
RECORD TYPE INDICATOR MUST =
3
PROVIDER
Relational Edits
NONE
ELEMENT NAME:  PROVIDER TAXPAYER NUMBER (3-005)
VALIDITY EDITS
NONE
Relational Edits
3-005-01R
IF PROVIDER TAXPAYER NUMBER IDENTIFIER =
E
INDICATES EIN OR
S
INDICATES SSN (VALID FOR NON-INSTITUTIONAL ONLY)
THEN PROVIDER TAXPAYER NUMBER MUST BE NUMERIC
3-005-02R
IF PROVIDER TAXPAYER NUMBER IDENTIFIER =
A
ASSIGNED BY CONTRACTOR
•  OUTSIDE CONTRACTOR JURISDICTION
THEN FIRST THREE POSITIONS MUST EQUAL THE PROVIDER STATE/COUNTRY CODE IN THE PROVIDER ADDRESS
AND THE FOURTH POSITION MUST = A
AND THE LAST FIVE POSITIONS MUST BE NUMERIC.
•  INSIDE CONTRACTOR JURISDICTION
THEN FIRST THREE POSITIONS MUST EQUAL THE PROVIDER STATE/COUNTRY CODE IN THE PROVIDER ADDRESS
AND THE LAST SIX POSITIONS MUST BE NUMERIC.
ELEMENT NAME:  PROVIDER SUB-IDENTIFIER (3-010)
VALIDITY EDITS
3-010-01V
LAST TWO DIGITS MUST BE NUMERIC.
Relational Edits
NONE
ELEMENT NAME:  PROVIDER TAXPAYER NUMBER IDENTIFIER (3-015)
VALIDITY EDITS
3-015-01V
MUST BE A VALID PROVIDER TAXPAYER NUMBER IDENTIFIER.
Relational Edits
3-015-01R
IF THIRD POSITION OF PROVIDER STATE/COUNTRY CODE = BLANK (NOT A FOREIGN COUNTRY)
OR PROVIDER STATE/COUNTRY CODE =
PRI
PUERTO RICO
AND INSTITUTIONAL/NON-INSTITUTIONAL INDICATOR =
I
INSTITUTIONAL
THEN PROVIDER TAXPAYER NUMBER IDENTIFIER MUST =
E
INDICATES EIN
ELEMENT NAME:  CONTRACTOR NUMBER (3-020)
VALIDITY EDITS
3-020-01V
MUST BE A VALID CONTRACTOR NUMBER (REFER TO Section 2.10).
Relational Edits
NONE
ELEMENT NAME:  PROVIDER CONTRACT AFFILIATION CODE (3-025)
VALIDITY EDITS
3-025-01V
MUST BE A VALID PROVIDER CONTRACT AFFILIATION CODE (REFER TO Section 2.10).
Relational Edits
3-025-02R
IF PROVIDER CONTRACT AFFILIATION CODE =
5
NON-CERTIFIED PROVIDERS
THEN PROVIDER ACCEPTANCE DATE MUST = ZEROES
AND PROVIDER TERMINATION DATE MUST = ZEROES
ELEMENT NAME:  INSTITUTIONAL/NON-INSTITUTIONAL INDICATOR (3-030)
VALIDITY EDITS
3-030-01V
MUST BE A VALID INSTITUTIONAL/NON-INSTITUTIONAL INDICATOR
Relational Edits
NONE
ELEMENT NAME:  PROVIDER NAME1 (3-035)
1  AN APOSTROPHE IS AN ALLOWED CHARACTER IN PROVIDER’S NAME.
VALIDITY EDITS
3-035-01V
MUST BE LEFT JUSTIFIED AND BLANK FILLED.
MUST NOT BE ALL SPACES.
NO BLANKS IN A ROW ALLOWED UNTIL BLANK FILLING.
Relational Edits
NONE
ELEMENT NAME:  PROVIDER STREET ADDRESS (3-045)
VALIDITY EDITS
3-045-01V
IF THIRD POSITION OF PROVIDER STATE/COUNTRY CODE = BLANK (NOT A FOREIGN COUNTRY)
THEN PROVIDER STREET ADDRESS MUST BE LEFT JUSTIFIED AND BLANK FILLED.
NO BLANKS IN A ROW ALLOWED UNTIL BLANK FILLING.
MUST NOT BE ALL BLANKS.
Relational Edits
NONE
ELEMENT NAME:  PROVIDER CITY (3-050)
VALIDITY EDITS
3-050-01V
MUST BE LEFT JUSTIFIED AND BLANK FILLED.
TWO BLANKS IN A ROW NOT ALLOWED UNTIL BLANK FILLING.
MUST NOT BE ALL BLANKS.
Relational Edits
NONE
ELEMENT NAME:  PROVIDER STATE OR COUNTRY CODE (3-055)
VALIDITY EDITS
3-055-01V
MUST BE A VALID PROVIDER STATE OR COUNTRY CODE IN Addendums A OR B.
Relational Edits
NONE
ELEMENT NAME:  PROVIDER ZIP CODE (3-060)
1  WHEN FOREIGN COUNTRY CODES ARE SUBMITTED, THE FIRST THREE CHARACTERS WILL BE EDITED AGAINST Addendum A.
2  DO NOT PERFORM THIS EDIT IF PROVIDER ZIP CODE IS A THREE CHARACTER COUNTRY CODE (BASED ON THE COUNTRY CODES TABLE).
VALIDITY EDITS
3-060-01V
MUST BE NINE DIGITS OR FIVE DIGITS WITH FOUR BLANKS
MUST BE A VALID ZIP CODE (BASED ON CURRENT SYSTEM DATE) IN THE GOVERNMENT PROVIDED ELECTRONIC ZIP CODE FILE
UNLESS TRANSACTION CODE =
I
INACTIVATE A RECORD OR
M
MODIFY A RECORD
OR MUST BE A THREE CHARACTER FOREIGN COUNTRY CODE (BASED ON THE COUNTRY CODES TABLE1) FOLLOWED BY SIX BLANKS
Relational Edits
3-060-01R
PROVIDER ZIP CODE MUST BE WITHIN THE CONTRACTOR NUMBER AREA OF RESPONSIBILITY (REFER TO Addendum I FOR A LISTING OF VALID STATES FOR EACH CONTRACTOR NUMBER)2.
ELEMENT NAME:  PROVIDER BILLING STREET ADDRESS (3-070)
VALIDITY EDITS
3-070-01V
MUST BE LEFT JUSTIFIED AND BLANK FILLED.
TWO BLANKS IN A ROW NOT ALLOWED UNTIL BLANK FILLING.
Relational Edits
NONE
ELEMENT NAME:  PROVIDER BILLING CITY (3-075)
VALIDITY EDITS
3-075-01V
MUST BE LEFT JUSTIFIED AND BLANK FILLED.
TWO BLANKS IN A ROW NOT ALLOWED UNTIL BLANK FILLING.
Relational Edits
NONE
ELEMENT NAME:  PROVIDER BILLING STATE OR COUNTRY CODE (3-080)
VALIDITY EDITS
3-080-01V
MUST BE ALL BLANKS OR AS LISTED IN Addendums A OR B.
Relational Edits
NONE
ELEMENT NAME:  PROVIDER BILLING ZIP CODE (3-085)
1  WHEN FOREIGN COUNTRY CODES ARE SUBMITTED, THE FIRST THREE CHARACTERS WILL BE EDITED AGAINST Addendum A.
VALIDITY EDITS
3-085-01V
MUST BE 9 BLANKS OR
MUST BE NINE DIGITS OR FIVE DIGITS WITH FOUR BLANKS
MUST BE A VALID ZIP CODE (BASED ON CURRENT SYSTEM DATE) IN THE GOVERNMENT PROVIDED ELECTRONIC ZIP CODE FILE OR
MUST BE A THREE CHARACTER FOREIGN COUNTRY CODE (BASED ON THE COUNTRY CODES TABLE1) FOLLOWED BY SIX BLANKS
Relational Edits
NONE
ELEMENT NAME:  PROVIDER MAJOR SPECIALTY/TYPE OF INSTITUTION (3-090)
VALIDITY EDITS
NONE
Relational Edits
3-090-01R
IF INSTITUTIONAL/NON-INSTITUTIONAL INDICATOR =
I
INSTITUTIONAL
THEN MUST BE VALID PROVIDER MAJOR SPECIALTY/TYPE OF INSTITUTION (REFER TO Addendum D, Figure 2.D-1).
3-090-02R
IF INSTITUTIONAL/NON-INSTITUTIONAL INDICATOR =
N
NON-INSTITUTIONAL
THEN MUST BE A VALID PROVIDER MAJOR SPECIALTY/TYPE OF INSTITUTION (REFER TO HTTP://WWW.WPC-EDI.COM/REFERENCE/).
3-090-03R
IF PROVIDER MAJOR SPECIALTY/TYPE INSTITUTION =
183500000X (PHARMACY SERVICE PROVIDERS/PHARMACIST)
THEN CONTRACTOR NUMBER MUST =
02
TMOP OR
70
TPHARM OR
73
TPHARM
ELEMENT NAME:  TYPE OF INSTITUTION TERM INDICATOR CODE (3-095)
VALIDITY EDITS
3-095-01V
MUST BE A VALID TYPE OF INSTITUTION TERM INDICATOR CODE.
Relational Edits
3-095-01R
IF TYPE OF INSTITUTION CODE TERM INDICATOR =
L
LONG TERM OR
S
SHORT TERM
THEN INSTITUTIONAL/NON-INSTITUTIONAL INDICATOR MUST =
I
INSTITUTIONAL
- END -
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