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VALIDITY EDITS
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Relational Edits
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2-055-11F
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• TPR [SERVICE MEMBER]
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IF HEADER
TYPE INDICATOR =
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5
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VOUCHER HEADER
NON-ADMIN CLAIM RATE-ELIGIBLE OR
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6
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VOUCHER HEADER
ADMIN CLAIM RATE-ELIGIBLE
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AND ENROLLMENT/HEALTH
PLAN CODE =
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W
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TPR SERVICE
MEMBER - USA OR
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WA
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TPR FOREIGN
SERVICE MEMBER
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OR ANY
OCCURRENCE OF SPECIAL PROCESSING CODE =
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GU
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SERVICE MEMBER
ENROLLED IN TPR
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AND TYPE
OF SUBMISSION ≠
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B
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ADJUSTMENT TO
NON-TED RECORD (HCSR) DATA OR
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E
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COMPLETE CANCELLATION
OF NON-TED RECORD (HCSR) DATA
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AND THE
TOTAL OF ALL OCCURRENCES/LINE ITEMS OF AMOUNT PAID BY GOVERNMENT
CONTRACTOR BY PROCEDURE CODE ≠ ZERO
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THEN SERVICE
BRANCH CLASSIFICATION CODE (SPONSOR) MUST =
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A
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ARMY OR
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C
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COAST GUARD OR
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F
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AIR FORCE OR
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H
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PUBLIC HEALTH
SERVICE OR
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M
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MARINES OR
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N
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NAVY OR
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O
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NOAA OR
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Z
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NOT PROVIDED
FROM DEERS
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AND HCC
MEMBER CATEGORY CODE MUST =
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A
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ACTIVE DUTY OR
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G
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NATIONAL GUARD
MEMBER (MOBILIZED OR ON ACTIVE DUTY FOR 31 DAYS OR MORE) OR
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J
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ACADEMY STUDENT OR
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N
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NATIONAL GUARD
(NOT ON ACTIVE DUTY OR ON ACTIVE DUTY FOR 30 DAYS OR LESS) OR
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S
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RESERVE MEMBER
(MOBILIZED OR ON ACTIVE DUTY FOR 31 DAYS OR MORE) OR
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V
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RESERVE MEMBER
(NOT ON ACTIVE DUTY OR ON ACTIVE DUTY FOR 30 DAYS OR LESS) OR
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Z
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UNKNOWN
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AND HCC
MEMBER RELATIONSHIP CODE MUST =
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A
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SELF OR
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Z
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UNKNOWN
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2-055-20F
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• SHCP VOUCHERS (SERVICE MEMBER CLAIMS
ONLY)
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IF ENROLLMENT/HEALTH
PLAN CODE =
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SR
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SHCP - MTF/eMSM
REFERRED CARE (EFFECTIVE 10/01/1999)
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OR ANY
OCCURRENCE OF SPECIAL PROCESSING CODE =
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AR
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SHCP - MTF/eMSM
REFERRED CARE
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OR TYPE
OF SUBMISSION =
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B
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ADJUSTMENT TO
NON-TED RECORD (HCSR) DATA OR
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E
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COMPLETE CANCELLATION
OF NON-TED RECORD (HCSR) DATA
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OR AMOUNT
PAID BY GOVERNMENT CONTRACTOR (TOTAL) = ZERO
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THEN BYPASS
THIS EDIT
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ELSE IF HEADER
TYPE INDICATOR =
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5
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VOUCHER HEADER
NON-ADMIN CLAIM RATE-ELIGIBLE OR
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6
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VOUCHER HEADER
ADMIN CLAIM RATE-ELIGIBLE
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AND ENROLLMENT/HEALTH
PLAN CODE =
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X
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FOREIGN SERVICE
MEMBER OR
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SO
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SHCP - NON-TRICARE
ELIGIBLE OR
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ST
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SHCP - TRICARE
ELIGIBLE OR
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SU
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SHCP - REFERRAL
DESIGNATION UNKNOWN
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OR ANY
OCCURRENCE OF SPECIAL PROCESSING CODE =
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AD
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FOREIGN
ACTIVE DUTY CLAIMS (EFFECTIVE
06/30/1996) OR
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CE
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SHCP - CCEP OR
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SC
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SHCP - NON-TRICARE
ELIGIBLE OR
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SE
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SHCP - TRICARE
ELIGIBLE OR
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SM
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SHCP - EMERGENCY
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THEN SERVICE
BRANCH CLASSIFICATION CODE (SPONSOR) MUST =
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A
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ARMY OR
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C
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COAST GUARD OR
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F
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AIR FORCE OR
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H
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PUBLIC HEALTH
SERVICE OR
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M
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MARINES OR
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N
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NAVY OR
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O
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NOAA OR
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Z
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NOT PROVIDED
FROM DEERS OR
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1
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FOREIGN ARMY
OR
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2
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FOREIGN NAVY
OR
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3
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FOREIGN MARINE
CORPS OR
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4
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FOREIGN AIR
FORCE
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AND HCC
MEMBER CATEGORY CODE MUST =
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A
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ACTIVE DUTY OR
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G
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NATIONAL GUARD
MEMBER (MOBILIZED OR ON ACTIVE DUTY FOR 31 DAYS OR MORE) OR
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J
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ACADEMY STUDENT OR
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N
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NATIONAL GUARD
(NOT ON ACTIVE DUTY OR ON ACTIVE DUTY FOR 30 DAYS OR LESS) OR
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S
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RESERVE MEMBER
(MOBILIZED OR ON ACTIVE DUTY FOR 31 DAYS OR MORE) OR
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T
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FOREIGN MILITARY
MEMBER OR
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V
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RESERVE MEMBER
(NOT ON ACTIVE DUTY OR ON ACTIVE DUTY FOR 30 DAYS OR LESS) OR
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Z
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UNKNOWN
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AND HCC
MEMBER RELATIONSHIP CODE MUST =
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A
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SELF OR
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Z
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UNKNOWN
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2-055-32F
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• SHCP - NON-MTF/eMSM REFERRED VOUCHER
(SERVICE MEMBER CLAIMS ONLY)
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IF TYPE
OF SUBMISSION =
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B
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ADJUSTMENT TO
NON-TED RECORD (HCSR) DATA OR
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E
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COMPLETE CANCELLATION
OF NON-TED RECORD (HCSR) DATA
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OR AMOUNT
PAID BY GOVERNMENT CONTRACTOR (TOTAL) = ZERO
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THEN BYPASS
THIS EDIT
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ELSE IF HEADER
TYPE INDICATOR =
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5
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VOUCHER HEADER
NON-ADMIN CLAIM RATE-ELIGIBLE OR
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6
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VOUCHER HEADER
ADMIN CLAIM RATE ELIGIBLE
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AND ENROLLMENT/HEALTH
PLAN CODE =
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SN
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SHCP - NON-MTF/eMSM
REFERRED CARE
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OR ANY
OCCURRENCE OF SPECIAL PROCESING CODE =
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AN
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SHCP - NON-MTF/eMSM
REFERRED CARE
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THEN SERVICE
BRANCH CLASSIFICATION CODE (SPONSOR) MUST =
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A
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ARMY OR
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C
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COAST GUARD OR
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F
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AIR FORCE OR
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H
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PUBLIC HEALTH
SERVICE OR
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M
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MARINES OR
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N
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NAVY OR
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O
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NOAA OR
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Z
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NOT PROVIDED
FROM DEERS OR
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1
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FOREGIN ARMY OR
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2
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FOREIGN NAVY OR
|
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3
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FOREIGN MARINE
CORPS OR
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4
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FOREIGN AIR
FORCE
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AND HCC
MEMBER RELATIONSHIP CODE MUST =
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A
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SELF OR
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Z
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UNKNOWN
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