TRICARE Encounter Data (TED)
Chapter 2
Section 2.3
Data Requirements - Header Record Data
Revision:
DATA
ELEMENT DEFINITION
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ELEMENT NAME: BATCH/VOUCHER
CLIN/ASAP ACCOUNT NUMBER
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Notes And Special
Instructions:
CLIN based CLIN/ASAP Account Numbers
are used for Invoicing (via the TED record) the Cost Reimbursement
Benefit CLINs (positions 1 through 6 of the CLIN/ASAP Account Number
shall equal the benefit contract CLIN or sub-CLIN you are invoicing),
ASAP based CLIN/ASAP Account Numbers are used for the reporting
of ‘pass-through’ costs.
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Records/Locator Numbers
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Record Name
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Locator#
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Occurrences
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Required
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Header
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0-025
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1
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Yes1
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Primary Picture
(Format)
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Eight (8) alphanumeric
characters.
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Definition
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This field
is used to identify the ASAP Account Number2 the
voucher will be drawn from. Each year when new non-financially underwritten
bank account(s) are setup by the contractor (per the financial provisions
of the contract), DHA will assign an eight digit CLIN/ASAP Account
Number to draw funds from as checks clear the non-financially underwritten
bank account(s).
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Code/Value Specifications
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N/A
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Algorithm
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Section 1.1, paragraph 5.0 provides instructions
on how to assign TED records to the Accrual Fund.
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Subordinate
And/Or Group Elements
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Subordinate
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Group
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N/A
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VOUCHER NUMBER
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DATA
ELEMENT DEFINITION
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ELEMENT NAME: BATCH/VOUCHER
DATE
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Notes And Special
Instructions:
N/A
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Records/Locator Numbers
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Record Name
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Locator#
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Occurrences
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Required
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Header
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0-030
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1
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Yes
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Primary Picture
(Format)
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Seven (7) alphanumeric
characters, YYYYDDD.
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Definition
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Date the
contractor first created the batch/voucher for transmission to DHA.
This date will not change through the resubmission process.
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Code/Value Specifications
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YYYY
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4 digit calendar
year
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DDD
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3 digit Julian
date
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Algorithm
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N/A
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Subordinate
And/Or Group Elements
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Subordinate
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Group
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N/A
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BATCH/VOUCHER
NUMBER
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DATA
ELEMENT DEFINITION
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ELEMENT NAME: BATCH/VOUCHER
IDENTIFIER
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Notes And Special
Instructions:
N/A
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Records/Locator Numbers
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Record Name
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Locator#
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Occurrences
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Required
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Header
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0-015
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1
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Yes
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Primary Picture
(Format)
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One (1) alphanumeric
character.
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Definition
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Identifies the
type of records submitted in the batch/voucher.
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Code/Value Specifications
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3
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Provider (Batch
Only)
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5
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Institutional/Non-Institutional
(Batch/Voucher)
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Algorithm
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N/A
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Subordinate
And/Or Group Elements
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Subordinate
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Group
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N/A
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CONTRACT IDENTIFIER
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DATA
ELEMENT DEFINITION
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ELEMENT NAME: BATCH/VOUCHER
NUMBER
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Notes And Special
Instructions:
N/A
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Records/Locator Numbers
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Record Name
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Locator#
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Occurrences
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Required
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Header
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0-020
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1
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Yes
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Primary Picture
(Format)
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Group
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Definition
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Field containing
multiple elements that uniquely identify the batch/voucher.
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Code/Value Specifications
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N/A
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Algorithm
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N/A
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Subordinate
And/Or Group Elements
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Subordinate
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Group
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BATCH/VOUCHER
ASAP ACCOUNT NUMBER
BATCH/VOUCHER
DATE
BATCH/VOUCHER
SEQUENCE NUMBER
BATCH/VOUCHER
RESUBMISSION NUMBER
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CONTRACT IDENTIFIER
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DATA
ELEMENT DEFINITION
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ELEMENT NAME: BATCH/VOUCHER
RESUBMISSION NUMBER
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Notes And Special
Instructions:
N/A
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Records/Locator Numbers
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Record Name
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Locator#
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Occurrences
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Required
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Header
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0-040
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1
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Yes
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Primary Picture
(Format)
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Two (2) alphanumeric
characters.
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Definition
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Identifies the
number of submissions for the batch/voucher.
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Code/Value Specifications
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N/A
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Algorithm
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Set initial
submission batch/voucher to 00 and increment by one (1) with each resubmission
of rejected TED records. Do not increment if resubmitting
a batch/voucher that failed batch/voucher header edits.
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Subordinate
And/Or Group Elements
|
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Subordinate
|
Group
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N/A
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BATCH/VOUCHER
NUMBER
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DATA
ELEMENT DEFINITION
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ELEMENT NAME: BATCH/VOUCHER
SEQUENCE NUMBER
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Notes And Special
Instructions:
Batch/Voucher
Sequence Number will not be duplicated for that date (i.e., once
sequence number 01 has been assigned to a batch or voucher it cannot
be assigned to any other batch or voucher for that day).
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Records/Locator Numbers
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Record Name
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Locator#
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Occurrences
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Required
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Header
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0-035
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1
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Yes
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Primary Picture
(Format)
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Two (2) alphanumeric
characters.
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Definition
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A sequential
number assigned by the contractor to uniquely identify the batch/voucher. Once
assigned, the number remains with the batch/voucher throughout the resubmission
process if applicable.
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Code/Value Specifications
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N/A
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Algorithm
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Set initial
sequence number to 01 and increment by one (1) for each subsequent
batch/voucher for that date. Do not “reuse” sequence number within
Contract Identifier for that date.
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Subordinate
And/Or Group Elements
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Subordinate
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Group
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N/A
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BATCH/VOUCHER
NUMBER
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DATA
ELEMENT DEFINITION
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ELEMENT NAME: CONTRACT
IDENTIFIER
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Notes And Special
Instructions:
N/A
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Records/Locator Numbers
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Record Name
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Locator#
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Occurrences
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Required
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Header
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0-005
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1
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Yes
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Primary Picture
(Format)
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Group
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Definition
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Field containing
multiple elements that uniquely identify each batch/voucher of records submitted
by the contractor.
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Code/Value Specifications
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N/A
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Algorithm
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N/A
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Subordinate
And/Or Group Elements
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Subordinate
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Group
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CONTRACT NUMBER
BATCH/VOUCHER IDENTIFIER
BATCH/VOUCHER NUMBER
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N/A
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DATA
ELEMENT DEFINITION
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ELEMENT NAME: CONTRACT
NUMBER
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Notes And Special
Instructions:
N/A
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Records/Locator Numbers
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Record Name
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Locator#
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Occurrences
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Required
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Header
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0-010
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1
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Yes
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Primary Picture
(Format)
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Thirteen (13)
alphanumeric characters.
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Definition
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The unique 13
digit contract number assigned to a contract.
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Code/Value Specifications
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N/A
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Algorithm
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N/A
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Subordinate
And/Or Group Elements
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Subordinate
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Group
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N/A
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CONTRACT IDENTIFIER
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DATA
ELEMENT DEFINITION
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ELEMENT NAME: FUND
ACCOUNTING
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Notes And Special
Instructions:
Note: For TMOP records,
the FUND ACCOUNTING must equal the sum of (AMOUNT ALLOWED BY PROCEDURE
CODE minus AMOUNT BILLED BY PROCEDURE CODE) for all included records.
For
TPHARM MOP records, the FUND ACCOUNTING must equal the sum of AMOUNT
ALLOWED BY PROCEDURE CODE for all included records for Batch/Voucher
Dates on or after July 14, 2011. FUND ACCOUNTING must be zero for
Batch/Voucher Dates prior to July 14, 2011.
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Records/Locator Numbers
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Record Name
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Locator#
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Occurrences
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Required
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Header
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0-065
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1
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Yes1
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Primary Picture
(Format)
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Ten (10) signed
numeric digits including two (2) decimal places.
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Definition
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This field contains
the total Government drug cost dollars dispensed by the contractor.
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Code/Value Specifications
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N/A
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Algorithm
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N/A
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Subordinate
And/Or Group Elements
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Subordinate
|
Group
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N/A
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N/A
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DATA
ELEMENT DEFINITION
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ELEMENT NAME: HEADER
TYPE INDICATOR
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Notes And Special
Instructions:
Contractors
are responsible for ensuring claims are submitted under the correct
Header Type Indicator when billing Administrative CLINs on a TED
record. TED records shall be submitted under the correct Header
Type Indicator in order to receive and retain Administrative CLIN
payment(s). Refer to Section G.II of the contract for guidance on
using this field to invoice Administrative CLINs.
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Records/Locator Numbers
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Record Name
|
Locator#
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Occurrences
|
Required
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Header
|
0-001
|
1
|
Yes
|
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Primary Picture
(Format)
|
One (1) alphanumeric
character.
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Definition
|
Code to indicate
whether the record is a batch header or voucher header, and whether
a voucher contains admin rate eligible records.
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Code/Value Specifications
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0
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Batch Header
(used on all provider batches, and for institutional/non-institutional
non-admin claim rate TED records).
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5
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Voucher Header
(used only for institutional/non-institutional non-admin claim rate
eligible TED records).
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6
|
Voucher Header
(used only for institutional/non-institutional admin claim rate
eligible TED records).
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9
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Batch Header
(institutional/non-institutional admin claim rate eligible TED records).
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Algorithm
|
N/A
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Subordinate
And/Or Group Elements
|
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Subordinate
|
Group
|
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N/A
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N/A
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DATA
ELEMENT DEFINITION
|
ELEMENT NAME: INITIAL
TRANSMISSION DATE (DHA DERIVED)
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Notes And Special
Instructions:
|
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Records/Locator Numbers
|
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Record Name
|
Locator#
|
Occurrences
|
Required
|
|
Header
|
0-055
|
1
|
Yes1
|
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Primary Picture
(Format)
|
Eight (8) numeric
digits, YYYYMMDD.
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Definition
|
The Initial
Transmission Date is the date the contractor transmitted the voucher
to DHA.
1. Voucher: Once submission
00 has cleared, the Initial Transmission Received date cannot change,
since this will be the date that DHA obligates the non-financially underwritten
money and the date that will appear on the checks being issued to the
providers/beneficiaries.
2. Batch:
This field will be zero filled.
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Code/Value Specifications
|
YYYY
|
4 digit calendar
year
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MM
|
2 digit calendar
month
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DD
|
2 digit calendar
day
|
|
Algorithm
|
N/A
|
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Subordinate
And/Or Group Elements
|
|
Subordinate
|
Group
|
|
N/A
|
N/A
|
DATA
ELEMENT DEFINITION
|
ELEMENT NAME: DHA
BATCH/VOUCHER PROCESSING DATE (DHA DERIVED)
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Notes And Special
Instructions:
|
|
Records/Locator Numbers
|
|
Record Name
|
Locator#
|
Occurrences
|
Required
|
|
Header
|
0-060
|
1
|
No1
|
|
Primary Picture
(Format)
|
Eight (8) numeric
digits, YYYYMMDD.
|
|
Definition
|
The date the
batch/voucher was processed by DHA.
|
|
Code/Value Specifications
|
YYYY
|
4 digit calendar
year
|
|
|
MM
|
2 digit calendar
month
|
|
|
DD
|
2 digit calendar
day
|
|
Algorithm
|
N/A
|
|
Subordinate
And/Or Group Elements
|
|
Subordinate
|
Group
|
|
N/A
|
N/A
|
DATA
ELEMENT DEFINITION
|
ELEMENT NAME: TOTAL
AMOUNT PAID
|
|
Notes And Special
Instructions:
Note: For MOP Contract
MDA906-02-C-0013 records, the TOTAL AMOUNT PAID must equal AMOUNT
PAID BY GOVERNMENT CONTRACTOR BY PROCEDURE CODE for all included
records.
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|
Records/Locator Numbers
|
|
Record Name
|
Locator#
|
Occurrences
|
Required
|
|
Header
|
0-050
|
1
|
Yes1
|
|
Primary Picture
(Format)
|
Twelve (12)
signed numeric digits including two (2) decimal places.
|
|
Definition
|
This field contains
the total benefit dollars paid by the contractor and the interest
paid for the TED records contained in either the batch or voucher.
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|
Code/Value Specifications
|
N/A
|
|
Algorithm
|
N/A
|
|
Subordinate
And/Or Group Elements
|
|
Subordinate
|
Group
|
|
N/A
|
N/A
|
DATA
ELEMENT DEFINITION
|
ELEMENT NAME: TOTAL
NUMBER OF RECORDS
|
|
Notes And Special
Instructions:
N/A
|
|
Records/Locator Numbers
|
|
Record Name
|
Locator#
|
Occurrences
|
Required
|
|
Header
|
0-045
|
1
|
Yes
|
|
Primary Picture
(Format)
|
Seven (7) numeric
digits.
|
|
Definition
|
Total number
of records submitted in the batch or voucher, exclusive of the header
and trailer records. (Refer to Section 2.2, paragraph 5.0.) |
|
Code/Value Specifications
|
N/A
|
|
Algorithm
|
N/A
|
|
Subordinate
And/Or Group Elements
|
|
Subordinate
|
Group
|
|
N/A
|
N/A
|
- END -