Records/Locator Numbers
|
Record Name
|
Locator#
|
Occurrences
|
Required
|
Institutional
Non-Institutional
|
1-185
2-305
|
4
4/Up
to 99
|
Yes1
Yes1
|
Primary Picture
(Format)
|
Four occurrences
of two (2) alphanumeric characters per occurrence/line item for
non-institutional.
|
Definition
|
Code indicating
care that requires special processing.
|
Code/Value Specifications
|
0
|
Hospice non-affiliated
provider
|
|
1
|
Medicaid
|
|
3
|
Allogeneic bone
marrow recipient (Wilford Hall referred only prior to 10/01/1997
and PCM/HCF referred after 12/31/2002)
|
|
4
|
Allogeneic bone
marrow donor (Wilford Hall referred only prior to 10/01/1997 and
PCM/HCF referred after 12/31/2002)
|
|
5
|
Liver transplant
(effective for care before 03/01/1997, or between 02/20/1998 and
08/31/1999 and after 05/31/2003)
|
|
6
|
HHC (non-institutional
only)
|
|
7
|
Heart Transplant
|
|
10
|
Active duty
cost-share ambulatory surgery taken from professional claim
|
|
11
|
Hospice
|
|
12
|
Capitated Arrangements
|
|
14
|
BMTs - DHA approved
|
|
16
|
Ambulatory Surgery
Facility charge
|
|
17
|
VHA medical
provider claim (care rendered by a VHA provider)
|
|
49
|
Hospital reimbursement
reduced by manufacturer credit/replacement of device during warranty
period
|
|
50
|
Hospital reimbursement
reduced by manufacturer credit/recalled device
|
|
A
|
Partnership
Program (internal providers with signed agreements)
|
|
E
|
HHC/CM Demonstration
(After 03/15/1999, grandfathered into the Individual Case Management
Program (ICMP))2
|
|
Q
|
Active Duty
Delayed Deductible
|
|
R
|
Medicare/TRICARE
Dual Entitlement First Payer - Not a Medicare Benefit (Effective
10/01/2001)
|
|
S
|
Resource Sharing
- External
|
|
T
|
Medicare/TRICARE
Dual Entitlement (formally normal COB processing (Effective 10/01/2001
process as Second Payer))
|
|
U
|
BRAC Medicare
Pharmacy (Section 702) claim (Terminated
04/01/2001)
|
|
V
|
Financially
underwritten payment by contractor
|
|
W
|
Non-financially
underwritten payment by financially underwritten contractor
|
|
X
|
Partial hospitalization
- provider not contracted with or employed by the PHP billing for
psychotherapy services in a PHP
|
|
Y
|
Heart-lung transplant
|
|
Z
|
Kidney transplant
|
|
AB
|
Abused dependent
of discharged or dismissed member (Effective 07/28/1999)
|
|
AC
|
Access To Care
(ATC) Demonstration (South Region only)
|
|
AD
|
Foreign active
duty claims (Effective 06/30/1996)
|
|
AE
|
Abortion performed
due to rape
|
|
AF
|
Abortion performed
due to incest
|
|
AG
|
Abortion performed
due to life endangering physical condition
|
|
AN
|
SHCP - Non-MTF/eMSM-Referred
Care (Effective 10/01/1999 through 05/31/2004)
|
|
AP
|
Applied Behavior
Analysis (ABA) Pilot
|
|
AR
|
SHCP - MTF/eMSM
Referred Care (Effective 10/01/1999 through 05/31/2004)
|
|
AS
|
Comprehensive
Autism Care Demonstration
|
|
AU
|
Autism Demonstration
(Effective 03/15/2008)3
|
|
A1
|
ACO Pilot for
Part A services rendered by KP owned providers
|
|
A2
|
ACO Pilot for
Part A services rendered by KP contracted providers
|
|
A3
|
ACO Pilot for
Part A services rendered by non-KP providers (HGB Network and other
providers)6
|
|
BA
|
Applied Behavior
Analysis (ABA) (Interim Benefit)
|
|
BD
|
Bosnia Deductible
(Effective 12/08/1995)
|
|
BH
|
IOP Behavioral
Health Sequelae of Sexual Trauma Pilot (Effective 09/01/2020)
|
|
B1
|
ACO Pilot for
Part B services rendered by KP owned providers
|
|
B2
|
ACO Pilot for
Part B services rendered by KP contracted providers
|
|
B3
|
ACO Pilot for
Part B services rendered by non-KP providers (HGB Network and other
providers)6
|
|
CA
|
Civil Action
Payment (Effective 07/01/1999)
|
|
CC
|
Cost-Share,
Co-Pay, Deductible Amount Reported-Waived (Effective 11/01/2019)7
|
|
CE
|
SHCP - CCEP
(Effective 10/01/1999)
|
|
CL
|
Clinical Trials
Demonstration (Enrollment Effective
03/17/2003 through 03/31/2008)
|
|
CM
|
ICMP claims
(Effective 03/15/1999)
|
|
CO
|
NIAID COVID-19
Clinical Trials (Effective 10/30/2020)
|
|
CP
|
Cancer Clinical
Trials (Enrollment Effective on or after
04/01/2008)
|
|
CT
|
CCTP (Effective
12/28/2001)
|
|
CV
|
COVID-19
Services-Care for COVID-19 Patients (Effective
11/01/2019)
|
|
DB
|
Digital Breast
Tomosynthesis (DBT)
|
|
DC
|
DCPE-DVA/VHA
- C&P exams used to determine fit for duty
|
|
DE
|
TDRL physical
exams (Effective 03/30/2009)
|
|
D1
|
ACO Pilot for
Part D services rendered by KP Pharmacies
|
|
D2
|
ACO Pilot for
Part D services rendered by non-KP Pharmacies6
|
|
EF
|
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)
|
|
EU
|
Emergency services
rendered by an unauthorized provider (Effective 06/01/1999)
|
|
FF
|
TFL (First Payer
- Not A Medicare Benefit) (Effective
10/01/2001)
|
|
FG
|
TFL (First Payer
- No TRICARE Provider Certification, i.e., Medicare benefits have
been exhausted) (Effective
10/01/2001)
|
|
FS
|
TFL (Second
Payer) (Effective 10/01/2001)
|
|
GF
|
TPR for eligible
ADFM residing with a TPR Eligible Service Member (Effective 10/30/2000
through 08/31/2002)
|
|
GU
|
Service member
enrolled in TPR (Effective 10/01/1999)
|
|
G1
|
Good Faith Payment
Debt Transfer5
|
|
G2
|
Good Faith Payment
|
|
HH
|
Home Health
Value-Based Purchasing (HHVBP) Demonstration (Effective 01/01/2020)
|
|
KO
|
Allied Forces
- Kosovo (Effective 06/01/1999)
|
|
LB
|
Low Back Pain
Demonstration (Effective 01/01/2021 through 12/31/2023)
|
|
LD
|
Laboratory Developed
Tests (LDTs) Demonstration
|
|
L2
|
Non-FDA Approved
LDTs Demonstration
|
|
MC
|
Platelet Rich
Plasma Injections for the treatment of Musculoskeletal Conditions
(Effective 10/01/2019)
|
|
MH
|
Mental Health
Active Duty Cost- Share
|
|
MM
|
Maryland Multi-Payer
Patient-Centered Medical Home Program (MMPCMHP)
|
|
MN
|
TSP (Non-Network)
(Effective 01/01/1998 through
12/31/2001)
|
|
MS
|
TSP (Network)
(Effective 01/01/1998 through 12/31/2001)
|
|
NE
|
Operation Noble
Eagle/Operation Enduring Freedom Demonstration (Reservists called
to active duty under Executive Order 13223) (Effective 09/14/2001
through
10/31/2009)
|
|
PC
|
Provisional
Coverage for Emerging Services and Supplies
|
|
PD
|
Pharmacy Redesign
Pilot Program (Effective 07/01/2000 through 04/01/2001)
|
|
PF
|
ECHO (formerly
PFPWD)
|
|
PH
|
Philippines
Demonstration Project (Expired)
|
|
PO
|
TRICARE Prime
- Point of Service (POS)
|
|
PS
|
Specialty Pharmacy
Service (MOP Only)
|
|
PV
|
Retail Network
Pharmacy Services for DVA/VHA Beneficiaries (TPharm Retail Pharmacies
Only)
|
|
RB
|
Respite Benefit
for Seriously Injured or Ill ADSMs4
|
|
RD
|
Rare Diseases
|
|
RI
|
Resource Sharing
- Internal
|
|
RS
|
Medicare/TRICARE
Dual Entitlement (First Payer - No TRICARE Provider Certification,
i.e., Medicare benefits have been exhausted) (Effective 10/01/2001)
|
|
SA
|
SHCP Gamete
Handling/Transportation
|
|
SB
|
SHCP Portable
CPAP Device
|
|
SC
|
SHCP - Non-TRICARE
Eligible (Effective 10/01/1999)
|
|
SE
|
SHCP - TRICARE
Eligible (Effective 10/01/1999)
|
|
SM
|
SHCP - Emergency
(Effective 10/01/1999)
|
|
SN
|
TSS (Non-Network)
(Effective 04/01/2000 through
12/31/2002)
|
|
SP
|
Special/Emergent
Care (Effective 06/01/1999)
|
|
SS
|
TSS (Network)
(Effective 04/01/2000 through 12/31/2002)
|
|
ST
|
Specialized
Treatment (Effective 03/01/1997 through
05/31/2003)
|
|
UC
|
Urgent Care
Pilot (Expired)
|
|
WR
|
Mental Health
Wraparound Demonstration (Effective
01/01/1998 through 06/30/2001)
|
Algorithm
|
N/A
|
Subordinate
And/Or Group Elements
|
Subordinate
|
Group
|
N/A
|
PROCESSING INFORMATION
|