Military Health System

1.0  This chapter covers the Defense Health Agency (DHA) requirements for the presentation of data submitted by the contractor. It specifies the structure of files and records to be sent to DHA for editing and processing. It also gives a complete definition of each data element included in these records. The data element definitions are in alphabetical order by data element name. Data element definition forms, used for consistent presentation of each element, include element characteristics and parameters needed by the contractor for accurate submission of data required by DHA. Every data element is assigned an Element Locator Number (ELN) according to the following structure:

2.0  A Batch Header record is to be used as the first record in each batch/voucher of Institutional, Non-Institutional, and Provider records. Contractors use Batch Header records for Provider records and Batch/Voucher Header records for Institutional and Non-Institutional TRICARE Encounter Data (TED) records.

3.0  The Institutional record category is to be used primarily only when there is an inpatient admission to the institution. The Non-Institutional record category is to be used for submission of all other TED records, including outpatient maternity care rendered in an institution (cost-shared on an inpatient basis). The Provider record category is to be used to submit information for each provider who rendered care to TRICARE beneficiaries.

4.0  A data element “FILLER” has been included in all Record Layouts to provide for future expansion of data elements.

5.0  The following editing rules will apply to all data elements unless the Data Element Definition contains different instructions. Edits will be applied to all TED and Provider records.

6.0  All numeric fields (including monetary fields) must be right-justified and zero-filled. Non-numeric values are not permitted. All numeric fields which do not contain data must be completely zero-filled. Fields identified as signed numeric fields will be processed by DHA as positive values unless the low-order position of the field indicates it contains a negative value. All money fields are signed numeric containing dollars and cents without the decimal point.

7.0  All alphabetic fields must be left-justified and blank-filled. A HEX 40 must be used to represent a blank. All alphabetic fields which do not contain data must be completely blank-filled.

8.0  All alphanumeric fields must be left-justified and blank-filled. A HEX 40 must be used to represent a blank. All alphanumeric fields which do not contain data must be completely blank-filled.