Military Health System

One (1) alphanumeric character.

Code to indicate the type of record.

Institutional

Non-Institutional

N/A

Two (2) alphanumeric character.

Region Indicator is the region of the contractor responsible for the care provided.

Blank

North Contract

Overseas Contract

South Contract

West Contract

East Contract 2017

West Contract 2017

N/A

Four (4) alphanumeric characters.

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.

Use UB-04/UB-92 revenue codes (see Addendum H).

N/A

Seven (7) alphanumeric characters.

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.

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.

N/A

Eight (8) alphanumeric characters.

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.

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:

Not reported

Unreported/Not Used - Exempt from POA reporting

No - Not present at time of admission

Unknown - Documentation insufficient to determine if the condition was present at time of admission

Clinically Undetermined - The provider is unable to clinically determine if the condition was present at time of admission

Yes - Present at time of admission

N/A

Seven (7) alphanumeric characters.

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.

The sequential identifying number assigned by the contractor.

N/A

One (1) alphanumeric character.

The code that represents the branch classification of service with which the sponsor is affiliated. Download field from DEERS.

Foreign Army

Foreign Navy

Foreign Marine Corps

Foreign Air Force

Army

Coast Guard

Office of the Secretary of Defense

Air Force

Public Health Service

Marine Corps

Navy

NOAA

Space Force

Not applicable1

Not provided from DEERS

N/A

Nine (9) signed numeric digits including two (2) decimal places.

Amount the SCH would be allowed if reimbursed under DRG based payment system.

N/A

N/A

Three (3) alphanumeric characters.

Number identifying the DRG classification used to determine the SCH DRG CALCULATION.

N/A

N/A

Four occurrences of two (2) alphanumeric characters per occurrence/line item for non-institutional.

Code indicating care that requires special processing.

Hospice non-affiliated provider

Medicaid

Allogeneic bone marrow recipient (Wilford Hall referred only prior to 10/01/1997 and PCM/HCF referred after 12/31/2002)

Allogeneic bone marrow donor (Wilford Hall referred only prior to 10/01/1997 and PCM/HCF referred after 12/31/2002)

Liver transplant (Effective for care before 03/01/1997, or between 02/20/1998 and 08/31/1999 and after 05/31/2003)

HHC (non-institutional only)

Heart Transplant

Active duty cost-share ambulatory surgery taken from professional claim

Hospice

Capitated Arrangements

BMTs - DHA approved

Ambulatory Surgery Facility charge

VHA medical provider claim (care rendered by a VHA provider)

Hospital reimbursement reduced by manufacturer credit/replacement of device during warranty period

Hospital reimbursement reduced by manufacturer credit/recalled device

Partnership Program (internal providers with signed agreements)

HHC/CM Demonstration (After 03/15/1999, grandfathered into the Individual Case Management Program (ICMP))2

Active Duty Delayed Deductible

Medicare/TRICARE Dual Entitlement First Payer - Not a Medicare Benefit

Resource Sharing - External

Medicare/TRICARE Dual Entitlement (formally normal COB processing as Second Payer)

BRAC Medicare Pharmacy (Section 702) claim

Financially underwritten payment by contractor

Non-financially underwritten payment by financially underwritten contractor

Partial hospitalization - provider not contracted with or employed by the PHP billing for psychotherapy services in a PHP

Heart-lung transplant

Kidney transplant

Abused dependent of discharged or dismissed member

Access To Care (ATC) Demonstration (South Region only)

Active duty claims OCONUS

Abortion performed due to rape

Abortion performed due to incest

Abortion performed due to life endangering physical condition

SHCP - Non-MTF/eMSM-Referred Care

Applied Behavior Analysis (ABA) Pilot

SHCP - MTF/eMSM Referred Care

Comprehensive Autism Care Demonstration

Ablative Fractional Laser (AFL) treatments for symptomatic burns and scars

Autism Demonstration3

ACO Pilot for Part A services rendered by KP owned providers

ACO Pilot for Part A services rendered by KP contracted providers

ACO Pilot for Part A services rendered by non-KP providers (HGB Network and other providers)5

Applied Behavior Analysis (ABA) (Interim Benefit)

Bosnia Deductible

Breastfeeding Support Demonstration

IOP Behavioral Health Sequelae of Sexual Trauma Pilot

CMS Bundled Care Payment Initiative

ACO Pilot for Part B services rendered by KP owned providers

ACO Pilot for Part B services rendered by KP contracted providers

ACO Pilot for Part B services rendered by non-KP providers (HGB Network and other providers)5

Civil Action Payment

Childbirth Support Demonstration

Cost-Share, Co-Pay, Deductible Amount Reported-Waived6

SHCP - CCEP

Clinical Trials Demonstration

ICMP claims

NIAID COVID-19 Clinical Trials

Cancer Clinical Trials

CCTP

COVID-19 Services-Care for COVID-19 Patients

Digital Breast Tomosynthesis (DBT)

DCPE-DVA/VHA - C&P exams used to determine fit for duty

TDRL physical exams

ACO Pilot for Part D services rendered by KP Pharmacies

ACO Pilot for Part D services rendered by non-KP Pharmacies5

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)

Emergency services rendered by an unauthorized provider

TFL (First Payer - Not A Medicare Benefit)

TFL (First Payer - No TRICARE Provider Certification, i.e., Medicare benefits have been exhausted)

Buckley Prime Service Area Pilot

TFL (Second Payer)

TPR for eligible ADFM residing with a TPR Eligible Service Member

Service member enrolled in TPR

Good Faith Payment

Home Health Value-Based Purchasing (HHVBP) Demonstration

Allied Forces - Kosovo

Low Back Pain Demonstration

Laboratory Developed Tests (LDTs) Demonstration

Non-FDA Approved LDTs Demonstration

Platelet Rich Plasma Injections for the treatment of Musculoskeletal Conditions

Mental Health Active Duty Cost- Share

Maryland Multi-Payer Patient-Centered Medical Home Program (MMPCMHP)

TSP (Non-Network)

TSP (Network)

Operation Noble Eagle/Operation Enduring Freedom Demonstration (Reservists called to active duty under Executive Order 13223)

PI Temporarily Suspended Provider, Pharmacy, Entity, or Client Beneficiary Claim in ‘PROCESS STATUS’

Provisional Coverage for Emerging Services and Supplies

Pharmacy Redesign Pilot Program

ECHO (formerly PFPWD)

Philippines Demonstration Project

TRICARE Prime - Point of Service (POS)

Specialty Pharmacy Service (MOP Only)

Retail Network Pharmacy Services for DVA/VHA Beneficiaries (TPharm Retail Pharmacies Only)

Respite Benefit for Seriously Injured or Ill ADSMs4

Rare Diseases

Resource Sharing - Internal

Medicare/TRICARE Dual Entitlement (First Payer - No TRICARE Provider Certification, i.e., Medicare benefits have been exhausted)

SHCP Gamete Handling/Transportation

SHCP Portable CPAP Device

SHCP - Non-TRICARE Eligible

SHCP - TRICARE Eligible

SHCP - Emergency

TSS (Non-Network)

Special/Emergent Care

TSS (Network)

Specialized Treatment

New Technology Add-On Payments-DRG

Urgent Care Pilot

Mental Health Wraparound Demonstration

N/A