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TRICARE Systems Manual 7950.3-M, April 1, 2015
TRICARE Encounter Data (TED)
Chapter 2
Section 2.8
Data Requirements - Institutional/Non-Institutional Record Data Elements (Q - S)
Revision:  C-60, March 29, 2022
DATA ELEMENT DEFINITION
ELEMENT NAME:  REASON FOR INTEREST PAYMENT
Notes And Special Instructions:
1  Left justify and blank fill, if not applicable.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Institutional
Non-Institutional
1-150
2-113
1
1
No
No
Primary Picture (Format)
Two (2) alphanumeric1 characters.
Definition
This field will be used to determine the fiscal responsibility for the interest payment based on the following hierarchy.
A
Claims pended at Government direction that the Government has specifically directed the contractor to hold for an extended period of time. These will primarily be claims pending a Program Integrity investigation (the Government is fiscally responsible for any interest). (Terminated 07/08/2019)
B
Claims requiring Government intervention (the Government is fiscally responsible for any interest). (Terminated 07/08/2019)
C
Claims requiring development for potential third-party liability (the Government is fiscally responsible for any interest). (Terminated 07/08/2019)
D
Claims requiring an action/interface with another prime contractor (the contractor is fiscally responsible for any interest). (Terminated 07/08/2019)
E
Claims retained by the contractor that do not fall into one of the above categories (the contractor is fiscally responsible for any interest). (Terminated 07/08/2019)
F
10 USC 1095c(a)(2) interest payment (the contractor is fiscally responsible for any interest). (Effective 07/09/2019).
G
10 USC 1095c(a)(2) interest payment (the Government is fiscally responsible for any interest). (Effective 07/09/2019).
Code/Value Specifications
N/A
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
N/A
DATA ELEMENT DEFINITION
ELEMENT NAME:  RECORD TYPE INDICATOR
Notes And Special Instructions:
1  Refer to the Section 1.1, paragraph 1.0 for further instructions.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Institutional
Non-Institutional
1-001
2-001
1
1
Yes1
Yes1
Primary Picture (Format)
One (1) alphanumeric character.
Definition
Code to indicate the type of record.
Code/Value Specifications
1
Institutional
2
Non-Institutional
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
N/A
DATA ELEMENT DEFINITION
ELEMENT NAME:  REGION INDICATOR
Notes And Special Instructions:
Report blanks for MOP, Retail Pharmacy, TDEFIC and adjustments to non-TED records.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Institutional
Non-Institutional
1-112
2-303
1
Up to 99
Yes
Yes
Primary Picture (Format)
Two (2) alphanumeric character.
Definition
Region Indicator is the region of the contractor responsible for the care provided.
Code/Value Specifications
b
Blank
NC
North Contract
OC
Overseas Contract
SC
South Contract
WC
West Contract
E7
East Contract 2017
W7
West Contract 2017
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
N/A
DATA ELEMENT DEFINITION
ELEMENT NAME:  REVENUE CODE
Notes And Special Instructions:
N/A
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Institutional
1-385
Up to 450
Yes
Primary Picture (Format)
Four (4) alphanumeric characters.
Definition
Code which identifies revenue categories associated with the type of service rendered. Like revenue codes must be combined to one occurrence for reporting on the TED record. Like denied revenue codes with the same Adjustment/Denial Reason Code must be combined to one occurrence for reporting on the TED record. Denied and non-denied revenue codes cannot be reported on the same occurrence. Room and board revenue codes must be combined if the code and rate are the same.
Code/Value Specifications
Use UB-04/UB-92 revenue codes (see Addendum H).
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
N/A
DATA ELEMENT DEFINITION
ELEMENT NAME:  SECONDARY OPERATION/NON-SURGICAL PROCEDURE (OP/NSP) CODES
Notes And Special Instructions:
1  Required if available.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Institutional
1-350 --1-373
24
Yes1
Primary Picture (Format)
Seven (7) alphanumeric characters.
Definition
Codes identifying the procedures, other than the principal procedure, performed during the period reported on the TED record. The secondary OP/NSP code(s) shall not duplicate the primary OP/NSP code. Do not duplicate secondary OP/NSP codes.
Code/Value Specifications
Use the most current procedure code edition (ICD-9-CM or ICD-10-PCS) as directed by DHA. Must code the most detailed procedure. Do not code the decimal point.
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
N/A
DATA ELEMENT DEFINITION
ELEMENT NAME:  SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION (POA) INDICATOR
Notes And Special Instructions:
1  Required if available.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Institutional
Non-Institutional
1-305 -- 1-328
2-116 -- 2-138, 2-340
24
24
Yes1
Yes1
Primary Picture (Format)
Eight (8) alphanumeric characters.
Definition
Secondary Treatment Diagnosis: Code corresponding to additional conditions that co-exist at the time of admission or during the treatment encounter. The secondary treatment diagnosis code(s) shall not duplicate the primary treatment diagnosis code. Do not duplicate secondary treatment diagnosis codes.
POA Indicator: Diagnosis present at the time the order for inpatient admission occurs.
Code/Value Specifications
Secondary Treatment Diagnosis (Positions 1 through 7): Use the most current diagnoses edition (ICD-9-CM or ICD-10-CM) as directed by DHA. Must code the most detailed procedure. Do not code decimal point.
POA Indicator (Position 8):
Valid POA values are:
b
Not reported
1
Unreported/Not Used - Exempt from POA reporting
N
No - Not present at time of admission
U
Unknown - Documentation insufficient to determine if the condition was present at time of admission
W
Clinically Undetermined - The provider is unable to clinically determine if the condition was present at time of admission
Y
Yes - Present at time of admission
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
N/A
DATA ELEMENT DEFINITION
ELEMENT NAME:  SEQUENCE NUMBER
Notes And Special Instructions:
N/A
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Institutional
Non-Institutional
1-025
2-025
1
1
Yes
Yes
Primary Picture (Format)
Seven (7) alphanumeric characters.
Definition
A sequential number assigned by the contractor to identify the individual claim. Once assigned, the sequence number cannot be re-used with the same Filing Date and Filing State/Country.
Code/Value Specifications
The sequential identifying number assigned by the contractor.
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
INTERNAL CONTROL NUMBER
DATA ELEMENT DEFINITION
ELEMENT NAME:  SERVICE BRANCH CLASSIFICATION CODE (SPONSOR)
Notes And Special Instructions:
1  Use X for CHAMPVA Claims.
2  Required if available on DEERS, if not available from DEERS report from the claim or report Z in this field.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Institutional
Non-Institutional
1-060
2-055
1
1
Yes2
Yes2
Primary Picture (Format)
One (1) alphanumeric character.
Definition
The code that represents the branch classification of service with which the sponsor is affiliated. Download field from DEERS.
Code/Value Specifications
1
Foreign Army
2
Foreign Navy
3
Foreign Marine Corps
4
Foreign Air Force
A
Army
C
Coast Guard
D
Office of the Secretary of Defense
F
Air Force
H
Public Health Service
M
Marine Corps
N
Navy
O
NOAA
S
Space Force
X
Not applicable1
Z
Not provided from DEERS
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
N/A
DATA ELEMENT DEFINITION
ELEMENT NAME:  SOLE COMMUNITY HOSPITAL (SCH) DRG CALCULATION
Notes And Special Instructions:
1  Required for SCH records with admission dates on or after January 1, 2014 and AMOUNT ALLOWED (TOTAL) greater than zero. All others must have a zero value.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Institutional
1-208
1
Yes1
Primary Picture (Format)
Nine (9) signed numeric digits including two (2) decimal places.
Definition
Amount the SCH would be allowed if reimbursed under DRG based payment system.
Code/Value Specifications
N/A
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
N/A
DATA ELEMENT DEFINITION
ELEMENT NAME:  SOLE COMMUNITY HOSPITAL (SCH) DRG NUMBER
Notes And Special Instructions:
1  Required if SCH DRG CALCULATION is greater than zero.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Institutional
1-379
1
Yes1
Primary Picture (Format)
Three (3) alphanumeric characters.
Definition
Number identifying the DRG classification used to determine the SCH DRG CALCULATION.
Code/Value Specifications
N/A
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
N/A
DATA ELEMENT DEFINITION
ELEMENT NAME:  SPECIAL PROCESSING CODE
Notes And Special Instructions:
1  Required if TED record processing is applicable to special processing conditions. Can report from 0 to 4 codes, left justify and blank fill. Do not duplicate. Each occurrence consists of two characters.
2  Whenever SPECIAL PROCESSING CODE = E (grandfathered HHC claims) is coded, SPECIAL PROCESSING CODE CM must be present.
3  Whenever SPECIAL PROCESSING CODE = AU (AUTISM DEMONSTRATION) is coded, SPECIAL PROCESSING CODE PF (ECHO) must be present.
4  Whenever SPECIAL PROCESSING CODE = RB (Respite Benefit for Seriously Injured or Ill Service Member) is coded, SPECIAL PROCESSING CODE SE (SHCP-TRICARE Eligible) must be present.
5  Required for all claims paid under the ACO demonstration, except claims for beneficiaries who are enrolled in the ACO demonstration but who receive care overseas. These claims will be processed by TOP.
6  The contractor shall populate the Cost-Share, Copay, Deductible field with the amount the beneficiary would have paid had no waiver been granted.
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
BEGIN DATE
END DATE
0
Hospice non-affiliated provider
19991001
99991231
1
Medicaid
19991001
99991231
3
Allogeneic bone marrow recipient (Wilford Hall referred only prior to 10/01/1997 and PCM/HCF referred after 12/31/2002)
20030101
99991231
4
Allogeneic bone marrow donor (Wilford Hall referred only prior to 10/01/1997 and PCM/HCF referred after 12/31/2002)
20030101
99991231
5
Liver transplant (Effective for care before 03/01/1997, or between 02/20/1998 and 08/31/1999 and after 05/31/2003)
20030601
99991231
6
HHC (non-institutional only)
19991001
99991231
7
Heart Transplant
19991001
99991231
10
Active duty cost-share ambulatory surgery taken from professional claim
20020801
99991231
11
Hospice
20020801
99991231
12
Capitated Arrangements
20020801
99991231
14
BMTs - DHA approved
20020801
99991231
16
Ambulatory Surgery Facility charge
20020801
99991231
17
VHA medical provider claim (care rendered by a VHA provider)
20020801
99991231
49
Hospital reimbursement reduced by manufacturer credit/replacement of device during warranty period
20090622
99991231
50
Hospital reimbursement reduced by manufacturer credit/recalled device
20090622
99991231
A
Partnership Program (internal providers with signed agreements)
19991001
99991231
E
HHC/CM Demonstration (After 03/15/1999, grandfathered into the Individual Case Management Program (ICMP))2
19990315
19991001
Q
Active Duty Delayed Deductible
19991001
99991231
R
Medicare/TRICARE Dual Entitlement First Payer - Not a Medicare Benefit
20011001
99991231
S
Resource Sharing - External
19991001
99991231
T
Medicare/TRICARE Dual Entitlement (formally normal COB processing as Second Payer)
20011001
99991231
U
BRAC Medicare Pharmacy (Section 702) claim
20000701
20010401
V
Financially underwritten payment by contractor
19991001
99991231
W
Non-financially underwritten payment by financially underwritten contractor
19991001
99991231
X
Partial hospitalization - provider not contracted with or employed by the PHP billing for psychotherapy services in a PHP
19991001
99991231
Y
Heart-lung transplant
19991001
99991231
Z
Kidney transplant
19991001
99991231
AB
Abused dependent of discharged or dismissed member
19990728
99991231
AC
Access To Care (ATC) Demonstration (South Region only)
20110914
20150504
AD
Active duty claims OCONUS
19960630
99991231
AE
Abortion performed due to rape
20130102
99991231
AF
Abortion performed due to incest
20130102
99991231
AG
Abortion performed due to life endangering physical condition
20130102
99991231
AN
SHCP - Non-MTF/eMSM-Referred Care
19991001
20040531
AP
Applied Behavior Analysis (ABA) Pilot
20130725
20141231
AR
SHCP - MTF/eMSM Referred Care
19991001
20040531
AS
Comprehensive Autism Care Demonstration
20140725
20231231
AT
Ablative Fractional Laser (AFL) treatments for symptomatic burns and scars
20210224
20260223
AU
Autism Demonstration3
20080315
20150314
A1
ACO Pilot for Part A services rendered by KP owned providers
20190101
20221231
A2
ACO Pilot for Part A services rendered by KP contracted providers
20190101
20221231
A3
ACO Pilot for Part A services rendered by non-KP providers (HGB Network and other providers)5
20190101
20221231
BA
Applied Behavior Analysis (ABA) (Interim Benefit)
20120913
99991231
BD
Bosnia Deductible
19951208
19961220
BF
Breastfeeding Support Demonstration
20220101
20261231
BH
IOP Behavioral Health Sequelae of Sexual Trauma Pilot
20200901
20210831
BP
CMS Bundled Care Payment Initiative
20130221
99991231
B1
ACO Pilot for Part B services rendered by KP owned providers
20190101
20221231
B2
ACO Pilot for Part B services rendered by KP contracted providers
20190101
20221231
B3
ACO Pilot for Part B services rendered by non-KP providers (HGB Network and other providers)5
20190101
20221231
CA
Civil Action Payment
19990701
99991231
CB
Childbirth Support Demonstration
20220101
20261231
CC
Cost-Share, Co-Pay, Deductible Amount Reported-Waived6
20191101
99991231
CE
SHCP - CCEP
19991001
99991231
CL
Clinical Trials Demonstration
20030317
20080331
CM
ICMP claims
19990315
99991231
CO
NIAID COVID-19 Clinical Trials
20201030
99991231
CP
Cancer Clinical Trials
20080401
99991231
CT
CCTP
20011228
99991231
CV
COVID-19 Services-Care for COVID-19 Patients
20191101
99991231
DB
Digital Breast Tomosynthesis (DBT)
20200101
20241231
DC
DCPE-DVA/VHA - C&P exams used to determine fit for duty
20100716
99991231
DE
TDRL physical exams
20090330
99991231
D1
ACO Pilot for Part D services rendered by KP Pharmacies
20190101
20221231
D2
ACO Pilot for Part D services rendered by non-KP Pharmacies5
20190101
20221231
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)
20091101
99991231
EU
Emergency services rendered by an unauthorized provider
19990601
99991231
FF
TFL (First Payer - Not A Medicare Benefit)
20011001
99991231
FG
TFL (First Payer - No TRICARE Provider Certification, i.e., Medicare benefits have been exhausted)
20011001
99991231
FI
Buckley Prime Service Area Pilot
20210101
99991231
FS
TFL (Second Payer)
20011001
99991231
GF
TPR for eligible ADFM residing with a TPR Eligible Service Member
20001030
20020831
GU
Service member enrolled in TPR
19991001
99991231
G1
Good-Faith Payment Debt Transfer5
19990101
99991231
G2
Good Faith Payment
20180101
99991231
HH
Home Health Value-Based Purchasing (HHVBP) Demonstration
20200101
99991231
KO
Allied Forces - Kosovo
19961220
19990601
LB
Low Back Pain Demonstration
20210101
20231231
LD
Laboratory Developed Tests (LDTs) Demonstration
20130101
99991231
L2
Non-FDA Approved LDTs Demonstration
20130101
99991231
MC
Platelet Rich Plasma Injections for the treatment of Musculoskeletal Conditions
20191001
20240930
MH
Mental Health Active Duty Cost- Share
19991001
99991231
MM
Maryland Multi-Payer Patient-Centered Medical Home Program (MMPCMHP)
20130503
20161229
MN
TSP (Non-Network)
19980101
20011231
MS
TSP (Network)
19980101
20011231
NE
Operation Noble Eagle/Operation Enduring Freedom Demonstration (Reservists called to active duty under Executive Order 13223)
20010914
20091031
NQ
PI Temporarily Suspended Provider, Pharmacy, Entity, or Client Beneficiary Claim in ‘PROCESS STATUS’
20200101
99991231
PC
Provisional Coverage for Emerging Services and Supplies
20150316
99991231
PD
Pharmacy Redesign Pilot Program
20000701
20010401
PF
ECHO (formerly PFPWD)
20020801
99991231
PH
Philippines Demonstration Project
20061001
20171231
PO
TRICARE Prime - Point of Service (POS)
19991001
99991231
PS
Specialty Pharmacy Service (MOP Only)
20150401
99991231
PV
Retail Network Pharmacy Services for DVA/VHA Beneficiaries (TPharm Retail Pharmacies Only)
20080918
99991231
RB
Respite Benefit for Seriously Injured or Ill ADSMs4
20080918
99991231
RD
Rare Diseases
20170310
99991231
RI
Resource Sharing - Internal
20020801
99991231
RS
Medicare/TRICARE Dual Entitlement (First Payer - No TRICARE Provider Certification, i.e., Medicare benefits have been exhausted)
20011001
99991231
SA
SHCP Gamete Handling/Transportation
20190801
99991231
SB
SHCP Portable CPAP Device
20190801
99991231
SC
SHCP - Non-TRICARE Eligible
19991001
99991231
SE
SHCP - TRICARE Eligible
19991001
99991231
SM
SHCP - Emergency
19991001
99991231
SN
TSS (Non-Network)
20000401
20021231
SP
Special/Emergent Care
19990601
99991231
SS
TSS (Network)
20000401
20021231
ST
Specialized Treatment
19970301
20030531
TA
New Technology Add-On Payments-DRG
20200101
99991231
UC
Urgent Care Pilot
20160523
20180101
WR
Mental Health Wraparound Demonstration
19980101
20010630
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
PROCESSING INFORMATION
- END -
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