Back to Top Skip to main content the official website of the Military Health System (MHS) and the Defense Health Agency (DHA)

Utility Navigation Links

TRICARE Systems Manual 7950.4-M, April 2021
Defense Enrollment Eligibility Reporting System (DEERS)
Chapter 3
Section 5.1
Defense Enrollment Eligibility Reporting System (DEERS) Functions In Support Of The TRICARE Dental Program (TDP)
1.0  Introduction
This section provides TDP-specific/unique guidance that was not discussed or described elsewhere in the TRICARE Systems Manual (TSM).
2.0  Guidance
2.1  Claims Processing
2.1.1  The DEERS Claims Service (DCS) is used to determine benefit coverage for a given period.
2.1.2  The contractor shall use the DCS for all claims processing.
2.2  DCS Inquiry for Claims
2.2.1  The contractor shall install a prepayment eligibility verification system into its TRICARE operation that results in a query against DEERS for TRICARE claims and adjustments.
2.2.2  The contractor’s query should be conducted early in the claims processing cycle to assure extensive development/claims review is not done on claims for ineligible beneficiaries. The DCS Inquiry for Claims supports business events associated with DCS data for processing dental claims. This inquiry may also be used for general customer service requests, beneficiary self-service purposes or for predeterminations as long as there is prior coordination with the Defense Health Agency (DHA) and DMDC.
2.3  Copayment Factor for Coverage Inquiries (Does not apply to TRDP)
2.3.1  The Copayment Factor Code for a beneficiary is determined by DEERS and is returned on a DCS claims inquiry, but may be influenced by treatment information from a claim.  The contractor shall use this factor code to determine the actual copayment for the claim.  The different factors are determined by legislation, which considers factors such as pay grade. Although the rates are based on the population to which they pertain, these rates also apply to a sponsor’s family members. Examples of cost-share factors are:
•  Pay Grade E-1 to E-4.
•  Pay Grade E-5 and above.
•  Command Sponsored.  The contractor’s system shall be flexible enough to permit additional rate codes to be added, as required by the Department of Defense (DoD).
2.4  Special Entitlements
Congressional legislation may affect rates. The Special Entitlement Code and dates if applicable provide information to support this legislation. Effective dates will also be included in the response from DEERS. Note that a person may have multiple special entitlements. An example of a Special Entitlement plan is the Survivor Benefit Plan.
2.5  Key Support POCs
2.5.1  A list of key DMDC Support Office (DSO) personnel and the Joint Uniformed Services Personnel Advisory Committee (JUSPAC) and the Joint Uniformed Services Medical Advisory Committee (JUSMAC) Members is provided by the DHA. These individuals are designated by the DHA to assist DoD beneficiaries on issues regarding claims payments.
2.5.2  In extreme cases, the DSO may direct the claims processor to override the DEERS information; however, in most cases the DSO is able to correct the database to allow the claim to be reprocessed appropriately.
2.5.3  The contractor shall request data corrections using procedures in Section 4.3.
2.6  Other Health Insurance (OHI) Program
2.7  Standard Insurance Table (SIT) Program
- END -

Utility Navigation Links

DoD Seal is the official website of the Defense Health Agency (DHA) a component of the Military Health System

TRICARE is a registered trademark of the Department of Defense (DoD), DHA. All rights reserved.

CPT only © 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved.

If you have a question regarding TRICARE benefits, please go to the TRICARE Contact Us page page.
If you need help with technical/operational issues, please go to the TRICARE Manuals Online Help page.

The appearance of hyperlinks to external websites does not constitute endorsement by the DHA of these websites or the information, products or services contained therein. For other than authorized government activities, the DHA does not exercise any editorial control over the information you may find at other locations. Such links are provided consistent with the stated purpose of this DoD website.


DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.