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TRICARE Systems Manual 7950.4-M, April 2021
TRICARE Encounter Data (TED)
Chapter 2
Section 8.1
Financial Edit Requirements
Revision:  
ELEMENT NAME:  SERVICE BRANCH CLASSIFICATION CODE (SPONSOR) (1-060)
VALIDITY EDITS
REFER TO Section 5.1.
Relational Edits
1-060-11F
•  TPR [SERVICE MEMBER]
IF HEADER TYPE INDICATOR =
5
VOUCHER HEADER NON-ADMIN CLAIM RATE-ELIGIBLE OR
6
VOUCHER HEADER ADMIN CLAIM RATE-ELIGIBLE
AND ENROLLMENT/HEALTH PLAN CODE =
W
TPR SERVICE MEMBER - USA OR
WA
TPR FOREIGN SERVICE MEMBER
OR ANY OCCURRENCE OF SPECIAL PROCESSING CODE =
GU
SERVICE MEMBER ENROLLED IN TPR
AND TYPE OF SUBMISSION ≠
B
ADJUSTMENT TO NON-TED RECORD (HCSR) DATA OR
E
COMPLETE CANCELLATION OF NON-TED RECORD (HCSR) DATA
AND AMOUNT PAID BY GOVERNMENT CONTRACTOR (TOTAL) ≠ ZERO
THEN SERVICE BRANCH CLASSIFICATION CODE (SPONSOR) MUST =
A
ARMY OR
C
COAST GUARD OR
F
AIR FORCE OR
H
PHS OR
M
MARINES OR
N
NAVY OR
O
NOAA OR
Z
NOT PROVIDED FROM DEERS
AND HCC MEMBER CATEGORY CODE MUST =
A
ACTIVE DUTY OR
G
NATIONAL GUARD MEMBER (MOBILIZED OR ON ACTIVE DUTY FOR 31 CALENDAR DAYS OR MORE) OR
J
ACADEMY STUDENT OR
N
NATIONAL GUARD MEMBER (NOT ON ACTIVE DUTY OR ON ACTIVE DUTY FOR 30 CALENDAR DAYS OR LESS) OR
S
RESERVE MEMBER (MOBILIZED OR ON ACTIVE DUTY FOR 31 CALENDAR DAYS OR MORE) OR
V
RESERVE MEMBER (NOT ON ACTIVE DUTY OR ON ACTIVE DUTY FOR 30 CALENDAR DAYS OR LESS) OR
Z
UNKNOWN
AND HCC MEMBER RELATIONSHIP CODE MUST =
A
SELF OR
Z
UNKNOWN
1-060-18F
•  SHCP VOUCHER (SERVICE MEMBER CLAIMS ONLY)
IF ENROLLMENT/HEALTH PLAN CODE =
SR
SHCP - MTF/MARKET REFERRED CARE (EFFECTIVE 10/01/1999)
OR ANY OCCURRENCE OF SPECIAL PROCESSING CODE =
AR
SHCP - MTF/MARKET REFERRED CARE
OR TYPE OF SUBMISSION =
B
ADJUSTMENT TO NON-TED RECORD (HCSR) DATA OR
E
COMPLETE CANCELLATION OF NON-TED RECORD (HCSR) DATA
OR AMOUNT PAID BY GOVERNMENT CONTRACTOR (TOTAL) = ZERO
THEN BYPASS THIS EDIT
ELSE IF HEADER TYPE INDICATOR =
5
VOUCHER HEADER NON-ADMIN CLAIM RATE-ELIGIBLE OR
6
VOUCHER HEADER ADMIN CLAIM RATE-ELIGIBLE
AND ENROLLMENT/HEALTH PLAN CODE =
X
FOREIGN SERVICE MEMBER OR
SO
SHCP - NON-TRICARE ELIGIBLE OR
ST
SHCP - TRICARE ELIGIBLE
OR ANY OCCURRENCE OF SPECIAL PROCESSING CODE =
AD
FOREIGN ACTIVE DUTY CLAIMS (EFFECTIVE 06/30/1996) OR
CE
SHCP - CCEP OR
SC
SHCP - NON-TRICARE ELIGIBLE OR
SE
SHCP - TRICARE ELIGIBLE OR
SM
SHCP - EMERGENCY
THEN SERVICE BRANCH CLASSIFICATION CODE (SPONSOR) MUST =
A
ARMY OR
C
COAST GUARD OR
F
AIR FORCE OR
H
PHS OR
M
MARINES OR
N
NAVY OR
O
NOAA OR
Z
NOT PROVIDED FROM DEERS OR
1
FOREIGN ARMY OR
2
FOREIGN NAVY OR
3
FOREIGN MARINE CORPS OR
4
FOREIGN AIR FORCE
AND HCC MEMBER CATEGORY CODE MUST =
A
ACTIVE DUTY OR
G
NATIONAL GUARD MEMBER (MOBILIZED OR ON ACTIVE DUTY FOR 31 CALENDAR DAYS OR MORE) OR
J
ACADEMY STUDENT OR
N
NATIONAL GUARD MEMBER (NOT ON ACTIVE DUTY OR ON ACTIVE DUTY FOR 30 CALENDAR DAYS OR LESS) OR
S
RESERVE MEMBER (MOBILIZED OR ON ACTIVE DUTY FOR 31 CALENDAR DAYS OR MORE) OR
T
FOREIGN MILITARY MEMBER OR
V
RESERVE MEMBER (NOT ON ACTIVE DUTY OR ON ACTIVE DUTY FOR 30 CALENDAR DAYS OR LESS) OR
Z
UNKNOWN
AND HCC MEMBER RELATIONSHIP CODE MUST =
A
SELF OR
Z
UNKNOWN
1-060-30F
•  SHCP - NON-MTF/MARKET REFERRED VOUCHER (SERVICE MEMBER CLAIMS ONLY)
IF TYPE OF SUBMISSION =
B
ADJUSTMENT TO NON-TED RECORD (HCSR) DATA OR
E
COMPLETE CANCELLATION OF NON-TED RECORD (HCSR) DATA
OR AMOUNT PAID BY GOVERNMENT CONTRACTOR (TOTAL) = ZERO
THEN BYPASS THIS EDIT
ELSE IF HEADER TYPE INDICATOR =
5
VOUCHER HEADER NON-ADMIN CLAIM RATE ELIGIBLE OR
6
VOUCHER HEADER ADMIN CLAIM RATE ELIGIBLE
AND ENROLLMENT/HEALTH PLAN CODE =
SN
SHCP - NON-MTF/MARKET REFERRED CARE
OR ANY OCCURRENCE OF SPECIAL PROCESSING CODE =
AN
SHCP - NON-MTF/MARKET REFERRED CARE
THEN SERVICE BRANCH CLASSIFICATION CODE (SPONSOR) MUST =
A
ARMY OR
C
COAST GUARD OR
F
AIR FORCE OR
H
PHS OR
M
MARINES OR
N
NAVY OR
O
NOAA OR
Z
NOT PROVIDED FROM DEERS OR
1
FOREIGN ARMY OR
2
FOREIGN NAVY OR
3
FOREIGN MARINE CORPS OR
4
FOREIGN AIR FORCE
AND HCC MEMBER RELATIONSHIP CODE MUST =
A
SELF OR
Z
UNKNOWN
ELEMENT NAME:  SERVICE BRANCH CLASSIFICATION CODE (SPONSOR) (2-055)
VALIDITY EDITS
REFER TO Section 6.1.
Relational Edits
2-055-11F
•  TPR [SERVICE MEMBER]
IF HEADER TYPE INDICATOR =
5
VOUCHER HEADER NON-ADMIN CLAIM RATE-ELIGIBLE OR
6
VOUCHER HEADER ADMIN CLAIM RATE-ELIGIBLE
AND ENROLLMENT/HEALTH PLAN CODE =
W
TPR SERVICE MEMBER - USA OR
WA
TPR FOREIGN SERVICE MEMBER
OR ANY OCCURRENCE OF SPECIAL PROCESSING CODE =
GU
SERVICE MEMBER ENROLLED IN TPR
AND TYPE OF SUBMISSION ≠
B
ADJUSTMENT TO NON-TED RECORD (HCSR) DATA OR
E
COMPLETE CANCELLATION OF NON-TED RECORD (HCSR) DATA
AND THE TOTAL OF ALL OCCURRENCES/LINE ITEMS OF AMOUNT PAID BY GOVERNMENT CONTRACTOR BY PROCEDURE CODE ≠ ZERO
THEN SERVICE BRANCH CLASSIFICATION CODE (SPONSOR) MUST =
A
ARMY OR
C
COAST GUARD OR
F
AIR FORCE OR
H
PHS OR
M
MARINES OR
N
NAVY OR
O
NOAA OR
Z
NOT PROVIDED FROM DEERS
AND HCC MEMBER CATEGORY CODE MUST =
A
ACTIVE DUTY OR
G
NATIONAL GUARD MEMBER (MOBILIZED OR ON ACTIVE DUTY FOR 31 CALENDAR DAYS OR MORE) OR
J
ACADEMY STUDENT OR
N
NATIONAL GUARD MEMBER (NOT ON ACTIVE DUTY OR ON ACTIVE DUTY FOR 30 CALENDAR DAYS OR LESS) OR
S
RESERVE MEMBER (MOBILIZED OR ON ACTIVE DUTY FOR 31 CALENDAR DAYS OR MORE) OR
V
RESERVE MEMBER (NOT ON ACTIVE DUTY OR ON ACTIVE DUTY FOR 30 CALENDAR DAYS OR LESS) OR
Z
UNKNOWN
AND HCC MEMBER RELATIONSHIP CODE MUST =
A
SELF OR
Z
UNKNOWN
2-055-20F
•  SHCP VOUCHERS (SERVICE MEMBER CLAIMS ONLY)
IF ENROLLMENT/HEALTH PLAN CODE =
SR
SHCP - MTF/MARKET REFERRED CARE (EFFECTIVE 10/01/1999)
OR ANY OCCURRENCE OF SPECIAL PROCESSING CODE =
AR
SHCP - MTF/MARKET REFERRED CARE
OR TYPE OF SUBMISSION =
B
ADJUSTMENT TO NON-TED RECORD (HCSR) DATA OR
E
COMPLETE CANCELLATION OF NON-TED RECORD (HCSR) DATA
OR AMOUNT PAID BY GOVERNMENT CONTRACTOR (TOTAL) = ZERO
THEN BYPASS THIS EDIT
ELSE IF HEADER TYPE INDICATOR =
5
VOUCHER HEADER NON-ADMIN CLAIM RATE-ELIGIBLE OR
6
VOUCHER HEADER ADMIN CLAIM RATE-ELIGIBLE
AND ENROLLMENT/HEALTH PLAN CODE =
X
FOREIGN SERVICE MEMBER OR
SO
SHCP - NON-TRICARE ELIGIBLE OR
ST
SHCP - TRICARE ELIGIBLE OR
SU
SHCP - REFERRAL DESIGNATION UNKNOWN
OR ANY OCCURRENCE OF SPECIAL PROCESSING CODE =
AD
FOREIGN ACTIVE DUTY CLAIMS (EFFECTIVE 06/30/1996) OR
CE
SHCP - CCEP OR
SC
SHCP - NON-TRICARE ELIGIBLE OR
SE
SHCP - TRICARE ELIGIBLE OR
SM
SHCP - EMERGENCY
THEN SERVICE BRANCH CLASSIFICATION CODE (SPONSOR) MUST =
A
ARMY OR
C
COAST GUARD OR
F
AIR FORCE OR
H
PHS OR
M
MARINES OR
N
NAVY OR
O
NOAA OR
Z
NOT PROVIDED FROM DEERS OR
1
FOREIGN ARMY OR
2
FOREIGN NAVY OR
3
FOREIGN MARINE CORPS OR
4
FOREIGN AIR FORCE
AND HCC MEMBER CATEGORY CODE MUST =
A
ACTIVE DUTY OR
G
NATIONAL GUARD MEMBER (MOBILIZED OR ON ACTIVE DUTY FOR 31 CALENDAR DAYS OR MORE) OR
J
ACADEMY STUDENT OR
N
NATIONAL GUARD MEMBER (NOT ON ACTIVE DUTY OR ON ACTIVE DUTY FOR 30 CALENDAR DAYS OR LESS) OR
S
RESERVE MEMBER (MOBILIZED OR ON ACTIVE DUTY FOR 31 CALENDAR DAYS OR MORE) OR
T
FOREIGN MILITARY MEMBER OR
V
RESERVE MEMBER (NOT ON ACTIVE DUTY OR ON ACTIVE DUTY FOR 30 CALENDAR DAYS OR LESS) OR
Z
UNKNOWN
AND HCC MEMBER RELATIONSHIP CODE MUST =
A
SELF OR
Z
UNKNOWN
2-055-32F
•  SHCP - NON-MTF/MARKET REFERRED VOUCHER (SERVICE MEMBER CLAIMS ONLY)
IF TYPE OF SUBMISSION =
B
ADJUSTMENT TO NON-TED RECORD (HCSR) DATA OR
E
COMPLETE CANCELLATION OF NON-TED RECORD (HCSR) DATA
OR AMOUNT PAID BY GOVERNMENT CONTRACTOR (TOTAL) = ZERO
THEN BYPASS THIS EDIT
ELSE IF HEADER TYPE INDICATOR =
5
VOUCHER HEADER NON-ADMIN CLAIM RATE-ELIGIBLE OR
6
VOUCHER HEADER ADMIN CLAIM RATE ELIGIBLE
AND ENROLLMENT/HEALTH PLAN CODE =
SN
SHCP - NON-MTF/MARKET REFERRED CARE
OR ANY OCCURRENCE OF SPECIAL PROCESING CODE =
AN
SHCP - NON-MTF/MARKET REFERRED CARE
THEN SERVICE BRANCH CLASSIFICATION CODE (SPONSOR) MUST =
A
ARMY OR
C
COAST GUARD OR
F
AIR FORCE OR
H
PHS OR
M
MARINES OR
N
NAVY OR
O
NOAA OR
Z
NOT PROVIDED FROM DEERS OR
1
FOREGIN ARMY OR
2
FOREIGN NAVY OR
3
FOREIGN MARINE CORPS OR
4
FOREIGN AIR FORCE
AND HCC MEMBER RELATIONSHIP CODE MUST =
A
SELF OR
Z
UNKNOWN
ELEMENT NAME:  AGR SERVICE LEGAL AUTHORITY CODE (2-056)
VALIDITY EDITS
REFER TO Section 6.1
Relational Edits
NONE
- END -
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