TRICARE Encounter Data (TED)
Chapter 2
Section 2.1
Data Requirements - Overview
Revision:
1.0 This chapter
covers the Defense Health Agency (DHA) requirements for the presentation
of data submitted by the contractor. It specifies the structure
of files and records to be sent to DHA for editing and processing.
It also gives a complete definition of each data element included
in these records. The data element definitions are in alphabetical
order by data element name. Data element definition forms, used
for consistent presentation of each element, include element characteristics
and parameters needed by the contractor for accurate submission
of data required by DHA. Every data element is assigned an Element
Locator Number (ELN) according to the following structure:
• One
Digit Record Type (followed by a hyphen)
• 0 - Batch Header (includes
vouchers for ELN assignment)
• 1 - Institutional
• 2 - Non-Institutional
• 3 - Provider
• Three
Digit Element Locator Number For A Given Record Category
2.0 A Batch
Header record is to be used as the first record in each batch/voucher
of Institutional, Non-Institutional, and Provider records. Contractors
use Batch Header records for Provider records and Batch/Voucher
Header records for Institutional and Non-Institutional TRICARE Encounter
Data (TED) records.
3.0 The Institutional
record category is to be used primarily only when there is an inpatient admission
to the institution. The Non-Institutional record category is to
be used for submission of all other TED records, including outpatient
maternity care rendered in an institution (cost-shared on an inpatient
basis). The Provider record category is to be used to submit information
for each provider who rendered care to TRICARE beneficiaries.
4.0 A data
element “FILLER” has been included in all Record Layouts to provide
for future expansion of data elements.
5.0 The following
editing rules will apply to all data elements unless the Data Element
Definition contains different instructions. Edits will be applied
to all TED and Provider records.
5.1 All numeric fields (including
monetary fields) must be right-justified and zero-filled. Non-numeric
values are not permitted. All numeric fields which do not contain
data must be completely zero-filled. Fields identified as signed
numeric fields will be processed by DHA as positive values unless the
low-order position of the field indicates it contains a negative
value. All money fields are signed numeric containing dollars and
cents without the decimal point.
5.2 All alphabetic fields must
be left-justified and blank-filled. A HEX 40 must be used to represent
a blank. All alphabetic fields which do not contain data must be
completely blank-filled.
5.3 All alphanumeric fields must
be left-justified and blank-filled. A HEX 40 must be used to represent
a blank. All alphanumeric fields which do not contain data must
be completely blank-filled.
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