TRICARE Manuals - Display Chap 2 Sect 6.1 (Change 41, Oct 27, 2020)

TRICARE Encounter Data (TED)

Chapter 2

Section 6.1

Non-Institutional Edit Requirements (ELN 000 - 099)

Revision:

ELEMENT NAME: RECORD TYPE INDICATOR (2-001)
VALIDITY EDITS
2-001-01V	RECORD TYPE INDICATOR MUST =	2	NON-INSTITUTIONAL
Relational Edits
2-001-01R	IF TYPE OF SUBMISSION =	A	ADJUSTMENT OR
		B	ADJUSTMENT TO NON-TED RECORD (HCSR) DATA OR
		C	COMPLETE CANCELLATION OR
		E	COMPLETE CANCELLATION OF NON-TED RECORD (HCSR) DATA
	AND A MATCH IS FOUND ON THE DHA DATABASE
	THEN THE RECORD TYPE FOR THE TED ON THE DATABASE MUST = THE RECORD TYPE ON THE ADJUSTMENT/CANCELLATION TED BEING SUBMITTED.

ELEMENT NAME: FILING DATE (2-015)
VALIDITY EDITS
2-015-01V	MUST BE A VALID JULIAN DATE AND CANNOT BE > DHA CURRENT SYSTEM DATE.
Relational Edits
2-015-01R	FILING DATE MUST BE ≤ DATE TED RECORD PROCESSED TO COMPLETION (PTC)

ELEMENT NAME: FILING STATE/COUNTRY CODE (2-020)
VALIDITY EDITS
2-020-01V	IF TYPE OF SUBMISSION =	D	COMPLETE DENIAL OR
		I	INITIAL SUBMISSION OR
		O	ZERO PAYMENT WITH 100% OHI/TPL OR
		R	RESUBMISSION
	THEN MUST BE A VALID STATE/COUNTRY CODE (REFER TO Addendums A AND B.)
Relational Edits
	NONE

ELEMENT NAME: SEQUENCE NUMBER (2-025)
VALIDITY EDITS
2-025-01V	SEQUENCE NUMBER MUST BE A COMBINATION OF ALPHABETIC OR NUMERIC CHARACTERS, LAST TWO CHARACTERS.
Relational Edits
	NONE

ELEMENT NAME: TIME STAMP (2-030)
VALIDITY EDITS
2-030-01V	MUST BE NUMERIC.
Relational Edits
2-030-01R	IF FILING DATE IS ≥ 02/01/1995
	THEN TIME STAMP MUST BE > ZERO

ELEMENT NAME: ADJUSTMENT KEY (2-035)
VALIDITY EDITS
2-035-01V	MUST BE ALPHA, 0, OR 5.
Relational Edits
	NONE

ELEMENT NAME: DATE TED RECORD PROCESSED TO COMPLETION (2-040)
VALIDITY EDITS
2-040-01V	MUST BE A VALID GREGORIAN DATE AND CANNOT BE > DHA CURRENT SYSTEM DATE.
Relational Edits
2-040-01R	DATE TED RECORD PROCESSED TO COMPLETION (PTC) MUST BE ≤ BATCH/VOUCHER DATE

ELEMENT NAME: DATE ADJUSTMENT IDENTIFIED (2-045)
VALIDITY EDITS
2-045-01V	MUST BE A VALID GREGORIAN DATE OR ALL ZEROES AND CANNOT BE > DHA CURRENT SYSTEM DATE.
2-045-02V	IF TYPE OF SUBMISSION =	D	DENIAL OR
		I	INITIAL SUBMISSION OR
		O	ZERO PAYMENT WITH 100% OHI/TPL OR
		R	RESUBMISSION
	THEN DATE ADJUSTMENT IDENTIFIED MUST BE ALL ZEROES.
2-045-04V	IF TYPE OF SUBMISSION =	A	ADJUSTMENT OR
		B	ADJUSTMENT TO NON-TED RECORD (HCSR) DATA OR
		C	COMPLETE CANCELLATION OR
		E	COMPLETE CANCELLATION OF NON-TED RECORD (HCSR) DATA
	THEN DATE OF ADJUSTMENT IDENTIFIED MUST BE A VALID GREGORIAN DATE
Relational Edits
2-045-03R	IF TYPE OF SUBMISSION =	A	ADJUSTMENT OR
		B	ADJUSTMENT TO NON-TED RECORD (HCSR) DATA OR
		C	COMPLETE CANCELLATION OR
		E	COMPLETE CANCELLATION OF NON-TED RECORD (HCSR) DATA
	THEN DATE ADJUSTMENT IDENTIFIED MUST BE ≤ DATE TED RECORD PROCESSED TO COMPLETION AND ≥ FILING DATE

ELEMENT NAME: PERSON IDENTIFIER (SPONSOR) (2-050)
VALIDITY EDITS
2-050-01V	MUST BE NINE NUMERIC DIGITS (CANNOT BE ALL ZEROES, ALL NINES, OR ALL BLANKS)
Relational Edits
	NONE

ELEMENT NAME: PERSON IDENTIFIER TYPE CODE (SPONSOR) (2-051)
VALIDITY EDITS
2-051-01V	MUST BE A VALID VALUE (REFER TO Section 2.7).
Relational Edits
	NONE

ELEMENT NAME: SERVICE BRANCH CLASSIFICATION CODE (SPONSOR) (2-055)
VALIDITY EDITS
2-055-01V	MUST BE A VALID SERVICE BRANCH CLASSIFICATION CODE (SPONSOR) (REFER TO Section 2.8).
Relational Edits
	REFER TO Section 8.1.

ELEMENT NAME: AGR SERVICE LEGAL AUTHORITY CODE (2-056)
VALIDITY EDITS
2-056-01V	MUST BE VALID AGR SERVICE LEGAL AUTHORITY CODE (REFER TO Section 2.4).
Relational Edits
	REFER TO Section 8.1

ELEMENT NAME: PERSON LAST NAME (PATIENT) (2-061)
VALIDITY EDITS
2-061-01V	MUST BE AT LEAST ONE CHARACTER (LEFT-JUSTIFIED).
Relational Edits
	NONE

ELEMENT NAME: PERSON FIRST NAME (PATIENT) (2-062)
VALIDITY EDITS
	NONE
Relational Edits
	NONE

ELEMENT NAME: PERSON MIDDLE NAME (PATIENT) (2-063)
VALIDITY EDITS
	NONE
Relational Edits
	NONE

ELEMENT NAME: PERSON CADENCY NAME (PATIENT) (2-064)
VALIDITY EDITS
	NONE
Relational Edits
	NONE

ELEMENT NAME: PERSON IDENTIFIER (PATIENT) (2-065)
VALIDITY EDITS
2-065-01V	MUST BE NINE NUMERIC DIGITS AND CANNOT EQUAL ALL BLANKS.
Relational Edits
	NONE

ELEMENT NAME: PERSON IDENTIFIER TYPE CODE (PATIENT) (2-066)
VALIDITY EDITS
2-066-01V	MUST BE A VALID VALUE (REFER TO Section 2.7).
Relational Edits
	NONE

ELEMENT NAME: PERSON BIRTH CALENDAR DATE (PATIENT) (2-070)
1 PATIENT AGE IS CALCULATED BASED ON PERSON BIRTH CALENDAR DATE (PATIENT) AND BEGIN DATE OF CARE.
VALIDITY EDITS
2-070-01V	MUST BE VALID GREGORIAN DATE AND CANNOT BE > DHA CURRENT SYSTEM DATE.
Relational Edits
2-070-01R	PATIENT AGE1 MUST BE < 125 YEARS
2-070-02R	PERSON BIRTH CALENDAR DATE (PATIENT) MUST BE ≤ BEGIN DATE OF CARE.

ELEMENT NAME: DEERS DEPENDENT SUFFIX (2-075)
VALIDITY EDITS
2-075-01V	IF TYPE OF SERVICE (SECOND POSITION) =	M	MOP DRUGS, SUPPLIES, PRESCRIPTION AUTHORIZATIONS, AND REVIEWS
	OR TYPE OF SUBMISSION =	B	ADJUSTMENT OF NON-TED RECORD (HCSR) DATA OR
		E	COMPLETE CANCELLATION OF NON-TED RECORD (HCSR) DATA
	THEN MUST BE A VALID DEERS DEPENDENT SUFFIX OR BLANK (REFER TO Section 2.4) OTHERWISE MUST BE BLANK
Relational Edits
	NONE

ELEMENT NAME: PATIENT IDENTIFIER (DoD) (2-080)
VALIDITY EDITS
2-080-01V	MUST NOT BE BLANK FILLED
2-080-02V	MUST NOT EQUAL ALL ZEROES
	UNLESS TYPE OF SUBMISSION =	D	COMPLETE DENIAL TED RECORD DATA
	OR ALL OCCURRENCES/LINE ITEMS CONTAIN AN ADJUSTMENT/DENIAL REASON CODE (REFER TO Addendum G, Figure 2.G-1 OR Figure 2.G-2).
	AND THE TED RECORD CORRECTION INDICATOR =	1	ADJUSTMENT/CANCELLATION (TYPE OF SUBMISSION A, B, C, OR E) SOLELY TO CORRECT A PROVISIONALLY ACCEPTED TED RECORD OR
		3	ADJUSTMENT/CANCELLATION (TYPE OF SUBMISSION A, B, C, OR E) TO CORRECT BOTH EDIT ERRORS ON A PROVISIONALLY ACCEPTED TED RECORD AND TO CORRECT CLAIM PROCESSING ERRORS OR UPDATE PRIOR DATA WITH MORE CURRENT/ACCURATE INFORMATION
Relational Edits
	NONE

ELEMENT NAME: DEERS IDENTIFIER (PATIENT) (2-082)
VALIDITY EDITS
2-082-01V	POSITIONS 10 AND 11 MUST BE NUMERIC
Relational Edits
	NONE

ELEMENT NAME: PERSON SEX (PATIENT) (2-085)
VALIDITY EDITS
2-085-01V	PERSON SEX (PATIENT) MUST =	F	FEMALE OR
		M	MALE OR
		Z	UNKNOWN
Relational Edits
	NONE

ELEMENT NAME: PATIENT ZIP CODE (2-090)
1 WHEN FOREIGN COUNTRY CODES ARE SUBMITTED, THE FIRST THREE CHARACTERS WILL BE EDITED AGAINST Addendum A.
VALIDITY EDITS
2-090-01V	MUST BE NINE DIGITS OR FIVE DIGITS WITH FOUR BLANKS
	MUST BE A VALID ZIP CODE (BASED ON BEGIN DATE OF CARE) 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: OVERRIDE CODE (2-095)
VALIDITY EDITS
2-095-01V	OCCURRENCE NUMBER 1--MUST BE A VALID OVERRIDE CODE (REFER TO Section 2.6)
2-095-02V	OCCURRENCE NUMBER 2--MUST BE A VALID OVERRIDE CODE (REFER TO Section 2.6)
2-095-03V	OCCURRENCE NUMBER 3--MUST BE A VALID OVERRIDE CODE (REFER TO Section 2.6)
2-095-04V	A VALUE CANNOT BE CODED MORE THAN ONCE (EXCEPT BLANK).
2-095-05V	ALL OCCURRENCES OF OVERRIDE CODE MUST BE BLANK FILLED FOLLOWING THE FIRST OCCURRENCE OF A BLANK FILLED OVERRIDE CODE.
Relational Edits
2-095-11R	IF ANY OCCURRENCE OF OVERRIDE CODE =	NC	NON-CERTIFIED PROVIDER (DOES NOT INCLUDE SANCTIONED/SUSPENDED PROVIDERS)
	THEN ONE OCCURRENCE OF SPECIAL PROCESSING CODE MUST =	AD	FOREIGN ACTIVE DUTY CLAIMS OR
		AN	SHCP - NON-MTF/eMSM REFERRED CARE OR
		AR	SHCP - MTF/eMSM REFERRED CARE OR
		CE	SHCP - CCEP OR
		EU	EMERGENCY SERVICES RENDERED BY AN UNAUTHORIZED PROVIDER OR
		GU	SERVICE MEMBER ENROLLED IN TPR OR
		MN	TSP - NETWORK OR
		MS	TSP - NON-NETWORK OR
		SC	SHCP - NON-TRICARE ELIGIBLE OR
		SE	SHCP - TRICARE ELIGIBLE OR
		SM	SHCP - EMERGENCY
	OR ENROLLMENT/HEALTH PLAN CODE MUST =	SN	SHCP - NON-MTF/eMSM-REFERRED CARE OR
		SR	SHCP - MTF/eMSM REFERRED CARE OR
		SU	SHCP - REFERRAL DESIGNATION UNKNOWN

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