TRICARE Encounter Data (TED)
Chapter 2
Section 6.1
Non-Institutional Edit Requirements (ELN
000 - 099)
Revision:
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ELEMENT NAME: RECORD
TYPE INDICATOR (2-001)
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VALIDITY EDITS
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2-001-01V
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RECORD TYPE
INDICATOR MUST =
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2
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NON-INSTITUTIONAL
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Relational Edits
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2-001-01R
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IF TYPE OF SUBMISSION
=
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A
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ADJUSTMENT OR
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B
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ADJUSTMENT TO
NON-TED RECORD (HCSR) DATA OR
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C
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COMPLETE CANCELLATION OR
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E
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COMPLETE CANCELLATION
OF NON-TED RECORD (HCSR) DATA
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AND A
MATCH IS FOUND ON THE DHA DATABASE
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THEN THE
RECORD TYPE FOR THE TED ON THE DATABASE MUST = THE RECORD TYPE ON
THE ADJUSTMENT/CANCELLATION TED BEING SUBMITTED.
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ELEMENT NAME: FILING
DATE (2-015)
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VALIDITY EDITS
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2-015-01V
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MUST BE A VALID
JULIAN DATE AND CANNOT BE > DHA CURRENT SYSTEM DATE.
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Relational Edits
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2-015-01R
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FILING DATE
MUST BE ≤ DATE TED RECORD PROCESSED TO COMPLETION (PTC)
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ELEMENT NAME: FILING
STATE/COUNTRY CODE (2-020)
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VALIDITY EDITS
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2-020-01V
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IF TYPE OF SUBMISSION
=
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D
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COMPLETE DENIAL OR
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I
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INITIAL SUBMISSION OR
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O
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ZERO PAYMENT
WITH 100% OHI/TPL OR
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R
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RESUBMISSION
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THEN MUST
BE A VALID STATE/COUNTRY CODE (REFER TO Addendums A AND B.)
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Relational Edits
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NONE
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ELEMENT NAME: SEQUENCE
NUMBER (2-025)
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VALIDITY EDITS
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2-025-01V
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SEQUENCE NUMBER
MUST BE A COMBINATION OF ALPHABETIC OR NUMERIC CHARACTERS, LAST
TWO CHARACTERS.
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Relational Edits
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NONE
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ELEMENT NAME: TIME
STAMP (2-030)
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VALIDITY EDITS
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2-030-01V
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MUST BE NUMERIC.
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Relational Edits
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2-030-01R
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IF FILING DATE
IS ≥ 02/01/1995
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THEN TIME
STAMP MUST BE > ZERO
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ELEMENT NAME: ADJUSTMENT
KEY (2-035)
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VALIDITY EDITS
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2-035-01V
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MUST BE ALPHA,
0, OR 5.
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Relational Edits
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NONE
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ELEMENT NAME: DATE
TED RECORD PROCESSED TO COMPLETION (2-040)
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VALIDITY EDITS
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2-040-01V
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MUST BE A VALID
GREGORIAN DATE AND CANNOT BE > DHA CURRENT SYSTEM DATE.
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Relational Edits
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2-040-01R
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DATE TED RECORD
PROCESSED TO COMPLETION (PTC) MUST BE ≤ BATCH/VOUCHER DATE
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ELEMENT NAME: DATE
ADJUSTMENT IDENTIFIED (2-045)
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VALIDITY EDITS
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2-045-01V
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MUST BE A VALID
GREGORIAN DATE OR ALL ZEROES AND CANNOT BE > DHA CURRENT
SYSTEM DATE.
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2-045-02V
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IF TYPE OF SUBMISSION
=
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D
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DENIAL OR
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I
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INITIAL SUBMISSION OR
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O
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ZERO PAYMENT
WITH 100% OHI/TPL OR
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R
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RESUBMISSION
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THEN DATE
ADJUSTMENT IDENTIFIED MUST BE ALL ZEROES.
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2-045-04V
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IF TYPE OF SUBMISSION
=
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A
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ADJUSTMENT OR
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B
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ADJUSTMENT TO
NON-TED RECORD (HCSR) DATA OR
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C
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COMPLETE CANCELLATION OR
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E
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COMPLETE CANCELLATION
OF NON-TED RECORD (HCSR) DATA
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THEN DATE
OF ADJUSTMENT IDENTIFIED MUST BE A VALID GREGORIAN DATE
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Relational Edits
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2-045-03R
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IF TYPE OF SUBMISSION
=
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A
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ADJUSTMENT OR
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B
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ADJUSTMENT TO
NON-TED RECORD (HCSR) DATA OR
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C
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COMPLETE CANCELLATION OR
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E
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COMPLETE CANCELLATION
OF NON-TED RECORD (HCSR) DATA
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THEN DATE
ADJUSTMENT IDENTIFIED MUST BE ≤ DATE TED RECORD PROCESSED TO COMPLETION AND ≥ FILING
DATE
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ELEMENT NAME: PERSON
IDENTIFIER (SPONSOR) (2-050)
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VALIDITY EDITS
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2-050-01V
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MUST BE NINE
NUMERIC DIGITS (CANNOT BE ALL ZEROES, ALL NINES, OR ALL
BLANKS)
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Relational Edits
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NONE
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ELEMENT NAME: PERSON
IDENTIFIER TYPE CODE (SPONSOR) (2-051)
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VALIDITY EDITS
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2-051-01V
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MUST BE A VALID
VALUE (REFER TO Section 2.7). |
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Relational Edits
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NONE
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ELEMENT NAME: SERVICE
BRANCH CLASSIFICATION CODE (SPONSOR) (2-055)
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VALIDITY EDITS
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2-055-01V
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MUST BE A VALID
SERVICE BRANCH CLASSIFICATION CODE (SPONSOR) (REFER TO Section 2.8). |
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Relational Edits
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ELEMENT NAME: AGR
SERVICE LEGAL AUTHORITY CODE (2-056)
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VALIDITY EDITS
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2-056-01V
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MUST BE VALID
AGR SERVICE LEGAL AUTHORITY CODE (REFER TO Section 2.4). |
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Relational Edits
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ELEMENT NAME: PERSON
LAST NAME (PATIENT) (2-061)
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VALIDITY EDITS
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2-061-01V
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MUST BE AT LEAST
ONE CHARACTER (LEFT-JUSTIFIED).
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Relational Edits
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NONE
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ELEMENT NAME: PERSON
FIRST NAME (PATIENT) (2-062)
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VALIDITY EDITS
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NONE
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Relational Edits
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NONE
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ELEMENT NAME: PERSON
MIDDLE NAME (PATIENT) (2-063)
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VALIDITY EDITS
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NONE
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Relational Edits
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NONE
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ELEMENT NAME: PERSON
CADENCY NAME (PATIENT) (2-064)
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VALIDITY EDITS
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NONE
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Relational Edits
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NONE
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ELEMENT NAME: PERSON
IDENTIFIER (PATIENT) (2-065)
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VALIDITY EDITS
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2-065-01V
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MUST BE NINE
NUMERIC DIGITS AND CANNOT EQUAL ALL BLANKS.
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Relational Edits
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NONE
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ELEMENT NAME: PERSON
IDENTIFIER TYPE CODE (PATIENT) (2-066)
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VALIDITY EDITS
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2-066-01V
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MUST BE A VALID
VALUE (REFER TO Section 2.7). |
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Relational Edits
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NONE
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ELEMENT NAME: PERSON
BIRTH CALENDAR DATE (PATIENT) (2-070)
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VALIDITY EDITS
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2-070-01V
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MUST BE VALID
GREGORIAN DATE AND CANNOT BE > DHA CURRENT SYSTEM DATE.
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Relational Edits
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2-070-01R
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PATIENT AGE1 MUST
BE < 125 YEARS
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2-070-02R
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PERSON BIRTH
CALENDAR DATE (PATIENT) MUST BE ≤ BEGIN DATE OF CARE.
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ELEMENT NAME: DEERS
DEPENDENT SUFFIX (2-075)
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VALIDITY EDITS
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2-075-01V
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IF TYPE OF SERVICE
(SECOND POSITION) =
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M
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MOP DRUGS, SUPPLIES,
PRESCRIPTION AUTHORIZATIONS, AND REVIEWS
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OR TYPE
OF SUBMISSION =
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B
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ADJUSTMENT OF
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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THEN MUST
BE A VALID DEERS DEPENDENT SUFFIX OR BLANK (REFER TO Section 2.4) OTHERWISE MUST BE
BLANK
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Relational Edits
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NONE
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ELEMENT NAME: PATIENT
IDENTIFIER (DoD) (2-080)
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VALIDITY EDITS
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2-080-01V
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MUST NOT BE
BLANK FILLED
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2-080-02V
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MUST NOT EQUAL
ALL ZEROES
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UNLESS TYPE
OF SUBMISSION =
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D
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COMPLETE DENIAL
TED RECORD DATA
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OR ALL
OCCURRENCES/LINE ITEMS CONTAIN AN ADJUSTMENT/DENIAL REASON CODE
(REFER TO Addendum G, Figure 2.G-1 OR Figure 2.G-2).
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AND THE
TED RECORD CORRECTION INDICATOR =
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1
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ADJUSTMENT/CANCELLATION
(TYPE OF SUBMISSION A, B, C,
OR E) SOLELY TO CORRECT A PROVISIONALLY ACCEPTED TED
RECORD OR
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3
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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
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Relational Edits
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NONE
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ELEMENT NAME: DEERS
IDENTIFIER (PATIENT) (2-082)
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VALIDITY EDITS
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2-082-01V
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POSITIONS 10
AND 11 MUST BE NUMERIC
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Relational Edits
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NONE
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ELEMENT NAME: PERSON
SEX (PATIENT) (2-085)
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VALIDITY EDITS
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2-085-01V
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PERSON SEX (PATIENT)
MUST =
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F
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FEMALE OR
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M
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MALE OR
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Z
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UNKNOWN
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Relational Edits
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NONE
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ELEMENT NAME: PATIENT
ZIP CODE (2-090)
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VALIDITY EDITS
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2-090-01V
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MUST BE NINE
DIGITS OR FIVE DIGITS WITH FOUR BLANKS
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MUST BE A VALID
ZIP CODE (BASED ON BEGIN DATE OF CARE) IN THE GOVERNMENT PROVIDED
ELECTRONIC ZIP CODE FILE OR
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MUST BE A THREE
CHARACTER FOREIGN COUNTRY CODE (BASED ON THE COUNTRY CODES TABLE1) FOLLOWED
BY SIX BLANKS
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Relational Edits
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NONE
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ELEMENT NAME: OVERRIDE
CODE (2-095)
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VALIDITY EDITS
|
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2-095-01V
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OCCURRENCE NUMBER
1--MUST BE A VALID OVERRIDE CODE (REFER TO Section 2.6) |
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2-095-02V
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OCCURRENCE NUMBER
2--MUST BE A VALID OVERRIDE CODE (REFER TO Section 2.6) |
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2-095-03V
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OCCURRENCE NUMBER
3--MUST BE A VALID OVERRIDE CODE (REFER TO Section 2.6) |
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2-095-04V
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A VALUE CANNOT
BE CODED MORE THAN ONCE (EXCEPT BLANK).
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2-095-05V
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ALL OCCURRENCES
OF OVERRIDE CODE MUST BE BLANK FILLED FOLLOWING THE FIRST OCCURRENCE
OF A BLANK FILLED OVERRIDE CODE.
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Relational Edits
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2-095-11R
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IF ANY OCCURRENCE
OF OVERRIDE CODE =
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NC
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NON-CERTIFIED
PROVIDER (DOES NOT INCLUDE SANCTIONED/SUSPENDED PROVIDERS)
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THEN ONE
OCCURRENCE OF SPECIAL PROCESSING CODE MUST =
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AD
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FOREIGN ACTIVE
DUTY CLAIMS OR
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AN
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SHCP - NON-MTF/eMSM
REFERRED CARE OR
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AR
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SHCP - MTF/eMSM
REFERRED CARE OR
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CE
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SHCP - CCEP OR
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EU
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EMERGENCY SERVICES
RENDERED BY AN UNAUTHORIZED PROVIDER OR
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GU
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SERVICE MEMBER
ENROLLED IN TPR OR
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MN
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TSP - NETWORK OR
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MS
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TSP - NON-NETWORK 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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OR ENROLLMENT/HEALTH
PLAN CODE MUST =
|
SN
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SHCP - NON-MTF/eMSM-REFERRED
CARE OR
|
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SR
|
SHCP - MTF/eMSM
REFERRED CARE OR
|
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SU
|
SHCP - REFERRAL
DESIGNATION UNKNOWN
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- END -