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)
|
|
FI
|
Buckley Prime Service Area
Pilot (Effective 01/01/2021)
|
|
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
|