Administration
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HPOB
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November 1, 2022
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Foreword
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Revision:
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The TRICARE Systems Manual
(TSM), 7950.4-M, defines the contractor’s responsibilities for automated processing
of health care information, reporting and transmission of relevant
data between the contractor and the Defense Health Agency (DHA).
The manual provides the requirements for the contractors to interface
with the Defense Enrollment Eligibility Reporting System (DEERS)
for obtaining beneficiary eligibility verifications from DEERS and
performing TRICARE Prime enrollments onto DEERS, as well as TRICARE
Encounter Data reporting requirements.
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The Department of Defense (DoD)
has a License Agreement with the American Medical Association (AMA) regarding
the use of the Physician’s Current Procedural Terminology (CPT),
a coding work of medical nomenclature developed by the AMA. In accordance
with the terms of that Agreement, the DoD has agreed to:
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1.
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Include a Copyright notice
in every section that references CPT codes;
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2.
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Specifically identify procedure
codes as CPT procedure codes;
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3.
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Use only short descriptions
with CPT codes and delete all long descriptions; and
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4.
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Italicize short descriptions
wherever they are used.
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The TRICARE Manuals provide
instructions, guidance and responsibilities in addition to the requirements
set forth in the incorporated federal statutes and the regulations
and may not be interpreted in contradiction thereto.
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Jose L. Lozoya, Acting
Chief
Health Plan Operations Support
Section (HPOSS)
Defense Health Agency (DHA)
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Note: Links from the documents contained
within this manual (and placed on the TRICARE Manuals web site)
may include links providing direct access to other Internet resources,
including web sites. Because of the dynamic nature of the Internet,
DHA cannot be responsible for the accuracy of or content of information
contained in the links to other web sites.
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