TRICARE Systems Manual 7950.4-M, April 2021 TRICARE Encounter Data (TED) Chapter 2 Section 2.3 Data Requirements - Header Record Data Revision: DATA ELEMENT DEFINITION ELEMENT NAME: BATCH/VOUCHER CLIN/ASAP ACCOUNT NUMBER Notes And Special Instructions: 1 For Header Type Indicator 0 or 9, Batch/Voucher CLIN/ASAP Account Number can only be zero filled. 2 For Header Type Indicator 5 or 6, contractor must have “opened” CLIN/ASAP Accounts with DHA, Contract Resource Management (CRM) per Section G.II of the contract. CLIN based CLIN/ASAP Account Numbers are used for Invoicing (via the TED record) the Cost Reimbursement Benefit CLINs (positions 1 through 6 of the CLIN/ASAP Account Number shall equal the benefit contract CLIN or sub-CLIN you are invoicing), ASAP based CLIN/ASAP Account Numbers are used for the reporting of ‘pass-through’ costs. Records/Locator Numbers Record Name Locator# Occurrences Required Header 0-025 1 Yes1 Primary Picture (Format) Eight (8) alphanumeric characters. Definition This field is used to identify the Automated Standard Application for Payment (ASAP) Account Number2 the voucher will be drawn from. Each year when new non-financially underwritten bank account(s) are setup by the contractor (per the financial provisions of the contract), Defense Health Agency (DHA) will assign an eight digit Contract Line Item Number (CLIN)/ASAP Account Number to draw funds from as checks clear the non-financially underwritten bank account(s). Code/Value Specifications N/A Algorithm Section 1.1, paragraph 5.0 provides instructions on how to assign TED records to the Accrual Fund. Subordinate And/Or Group Elements Subordinate Group N/A VOUCHER NUMBER DATA ELEMENT DEFINITION ELEMENT NAME: BATCH/VOUCHER DATE Notes And Special Instructions: N/A Records/Locator Numbers Record Name Locator# Occurrences Required Header 0-030 1 Yes Primary Picture (Format) Seven (7) alphanumeric characters, YYYYDDD. Definition Date the contractor first created the batch/voucher for transmission to DHA. This date will not change through the resubmission process. Code/Value Specifications YYYY 4 digit calendar year DDD 3 digit Julian date Algorithm N/A Subordinate And/Or Group Elements Subordinate Group N/A BATCH/VOUCHER NUMBER DATA ELEMENT DEFINITION ELEMENT NAME: BATCH/VOUCHER IDENTIFIER Notes And Special Instructions: N/A Records/Locator Numbers Record Name Locator# Occurrences Required Header 0-015 1 Yes Primary Picture (Format) One (1) alphanumeric character. Definition Identifies the type of records submitted in the batch/voucher. Code/Value Specifications 3 Provider (Batch Only) 5 Institutional/Non-Institutional (Batch/Voucher) Algorithm N/A Subordinate And/Or Group Elements Subordinate Group N/A CONTRACT IDENTIFIER DATA ELEMENT DEFINITION ELEMENT NAME: BATCH/VOUCHER NUMBER Notes And Special Instructions: N/A Records/Locator Numbers Record Name Locator# Occurrences Required Header 0-020 1 Yes Primary Picture (Format) Group Definition Field containing multiple elements that uniquely identify the batch/voucher. Code/Value Specifications N/A Algorithm N/A Subordinate And/Or Group Elements Subordinate Group BATCH/VOUCHER ASAP ACCOUNT NUMBER BATCH/VOUCHER DATE BATCH/VOUCHER SEQUENCE NUMBER BATCH/VOUCHER RESUBMISSION NUMBER CONTRACT IDENTIFIER DATA ELEMENT DEFINITION ELEMENT NAME: BATCH/VOUCHER RESUBMISSION NUMBER Notes And Special Instructions: N/A Records/Locator Numbers Record Name Locator# Occurrences Required Header 0-040 1 Yes Primary Picture (Format) Two (2) alphanumeric characters. Definition Identifies the number of submissions for the batch/voucher. Code/Value Specifications N/A Algorithm Set initial submission batch/voucher to 00 and increment by one (1) with each resubmission of rejected TED records. Do not increment if resubmitting a batch/voucher that failed batch/voucher header edits. Subordinate And/Or Group Elements Subordinate Group N/A BATCH/VOUCHER NUMBER DATA ELEMENT DEFINITION ELEMENT NAME: BATCH/VOUCHER SEQUENCE NUMBER Notes And Special Instructions: Batch/Voucher Sequence Number will not be duplicated for that date (i.e., once sequence number 01 has been assigned to a batch or voucher it cannot be assigned to any other batch or voucher for that day). Records/Locator Numbers Record Name Locator# Occurrences Required Header 0-035 1 Yes Primary Picture (Format) Two (2) alphanumeric characters. Definition A sequential number assigned by the contractor to uniquely identify the batch/voucher. Once assigned, the number remains with the batch/voucher throughout the resubmission process if applicable. Code/Value Specifications N/A Algorithm Set initial sequence number to 01 and increment by one (1) for each subsequent batch/voucher for that date. Do not “reuse” sequence number within Contract Identifier for that date. Subordinate And/Or Group Elements Subordinate Group N/A BATCH/VOUCHER NUMBER DATA ELEMENT DEFINITION ELEMENT NAME: CONTRACT IDENTIFIER Notes And Special Instructions: N/A Records/Locator Numbers Record Name Locator# Occurrences Required Header 0-005 1 Yes Primary Picture (Format) Group Definition Field containing multiple elements that uniquely identify each batch/voucher of records submitted by the contractor. Code/Value Specifications N/A Algorithm N/A Subordinate And/Or Group Elements Subordinate Group CONTRACT NUMBER BATCH/VOUCHER IDENTIFIER BATCH/VOUCHER NUMBER N/A DATA ELEMENT DEFINITION ELEMENT NAME: CONTRACT NUMBER Notes And Special Instructions: N/A Records/Locator Numbers Record Name Locator# Occurrences Required Header 0-010 1 Yes Primary Picture (Format) Thirteen (13) alphanumeric characters. Definition The unique 13 digit contract number assigned to a contract. Code/Value Specifications N/A Algorithm N/A Subordinate And/Or Group Elements Subordinate Group N/A CONTRACT IDENTIFIER DATA ELEMENT DEFINITION ELEMENT NAME: FUND ACCOUNTING Notes And Special Instructions: 1 Required for TRICARE Mail Order Pharmacy (TMOP) and TRICARE Pharmacy (TPharm) MOP records only, must be zero filled for all others. Note: For TMOP records, the FUND ACCOUNTING must equal the sum of (AMOUNT ALLOWED BY PROCEDURE CODE minus AMOUNT BILLED BY PROCEDURE CODE) for all included records. For TPharm MOP records, the FUND ACCOUNTING must equal the sum of AMOUNT ALLOWED BY PROCEDURE CODE for all included records for Batch/Voucher Dates on or after July 14, 2011. FUND ACCOUNTING must be zero for Batch/Voucher Dates prior to July 14, 2011. Records/Locator Numbers Record Name Locator# Occurrences Required Header 0-065 1 Yes1 Primary Picture (Format) Ten (10) signed numeric digits including two (2) decimal places. Definition This field contains the total Government drug cost dollars dispensed by the contractor. Code/Value Specifications N/A Algorithm N/A Subordinate And/Or Group Elements Subordinate Group N/A N/A DATA ELEMENT DEFINITION ELEMENT NAME: HEADER TYPE INDICATOR Notes And Special Instructions: Contractors are responsible for ensuring claims are submitted under the correct Header Type Indicator when billing Administrative CLINs on a TED record. TED records shall be submitted under the correct Header Type Indicator in order to receive and retain Administrative CLIN payment(s). Refer to Section G.II of the contract for guidance on using this field to invoice Administrative CLINs. Records/Locator Numbers Record Name Locator# Occurrences Required Header 0-001 1 Yes Primary Picture (Format) One (1) alphanumeric character. Definition Code to indicate whether the record is a batch header or voucher header, and whether a voucher contains admin rate eligible records. Code/Value Specifications 0 Batch Header (used on all provider batches, and for institutional/non-institutional non-admin claim rate TED records). 5 Voucher Header (used only for institutional/non-institutional non-admin claim rate eligible TED records). 6 Voucher Header (used only for institutional/non-institutional admin claim rate eligible TED records). 9 Batch Header (institutional/non-institutional admin claim rate eligible TED records). Algorithm N/A Subordinate And/Or Group Elements Subordinate Group N/A N/A DATA ELEMENT DEFINITION ELEMENT NAME: INITIAL TRANSMISSION DATE (DHA DERIVED) Notes And Special Instructions: 1 Contractor shall leave this field blank. Data will be populated and maintained by DHA. Records/Locator Numbers Record Name Locator# Occurrences Required Header 0-055 1 Yes1 Primary Picture (Format) Eight (8) numeric digits, YYYYMMDD. Definition The Initial Transmission Date is the date the contractor transmitted the voucher to DHA. 1. Voucher: Once submission 00 has cleared, the Initial Transmission Received date cannot change, since this will be the date that DHA obligates the non-financially underwritten money and the date that will appear on the checks being issued to the providers/beneficiaries. 2. Batch: This field will be zero filled. Code/Value Specifications YYYY 4 digit calendar year MM 2 digit calendar month DD 2 digit calendar day Algorithm N/A Subordinate And/Or Group Elements Subordinate Group N/A N/A DATA ELEMENT DEFINITION ELEMENT NAME: DHA BATCH/VOUCHER PROCESSING DATE (DHA DERIVED) Notes And Special Instructions: 1 Contractor shall leave this field blank. Data will be populated by DHA. Records/Locator Numbers Record Name Locator# Occurrences Required Header 0-060 1 No1 Primary Picture (Format) Eight (8) numeric digits, YYYYMMDD. Definition The date the batch/voucher was processed by DHA. Code/Value Specifications YYYY 4 digit calendar year MM 2 digit calendar month DD 2 digit calendar day Algorithm N/A Subordinate And/Or Group Elements Subordinate Group N/A N/A DATA ELEMENT DEFINITION ELEMENT NAME: TOTAL AMOUNT PAID Notes And Special Instructions: 1 Must be zero filled for Provider file batch header records. Note: For MOP Contract MDA906-02-C-0013 records, the TOTAL AMOUNT PAID must equal AMOUNT PAID BY GOVERNMENT CONTRACTOR BY PROCEDURE CODE for all included records. Records/Locator Numbers Record Name Locator# Occurrences Required Header 0-050 1 Yes1 Primary Picture (Format) Twelve (12) signed numeric digits including two (2) decimal places. Definition This field contains the total benefit dollars paid by the contractor and the interest paid for the TED records contained in either the batch or voucher. Code/Value Specifications N/A Algorithm N/A Subordinate And/Or Group Elements Subordinate Group N/A N/A DATA ELEMENT DEFINITION ELEMENT NAME: TOTAL NUMBER OF RECORDS Notes And Special Instructions: N/A Records/Locator Numbers Record Name Locator# Occurrences Required Header 0-045 1 Yes Primary Picture (Format) Seven (7) numeric digits. Definition Total number of records submitted in the batch or voucher, exclusive of the header and trailer records. (Refer to Section 2.2, paragraph 5.0.) Code/Value Specifications N/A Algorithm N/A Subordinate And/Or Group Elements Subordinate Group N/A N/A - END -