Military Health System

HPOB

April 1, 2015

The TRICARE Systems Manual (TSM), 7950.3-M, defines the contractor’s responsibilities for automated processing of health care information, reporting and transmission of relevant data between the contractor and the Defense Health Agency (DHA). The manual provides the requirements for the contractors to interface with the Defense Enrollment Eligibility Reporting System (DEERS) for obtaining beneficiary eligibility verifications from DEERS and performing TRICARE Prime enrollments onto DEERS, as well as TRICARE Encounter Data reporting requirements.

The Department of Defense (DoD) has a License Agreement with the American Medical Association (AMA) regarding the use of the Physician’s Current Procedural Terminology (CPT), a coding work of medical nomenclature developed by the AMA. In accordance with the terms of that Agreement, the DoD has agreed to:

1.

Include a Copyright notice in every section that references CPT codes;

2.

Specifically identify procedure codes as CPT procedure codes;

3.

Use only short descriptions with CPT codes and delete all long descriptions; and

4.

Italicize short descriptions wherever they are used.

The TRICARE Manuals provide instructions, guidance and responsibilities in addition to the requirements set forth in the incorporated federal statutes and the regulations and may not be interpreted in contradiction thereto.

Definitions are available in the Apr 2015 TRICARE Operations Manual (TOM), Appendix A.

Acronyms and abbreviations are available at https://manuals.health.mil/pages/v3/DownloadManualFile.aspx?Filename=Acronyms.pdf.