TRICARE Systems Manual 7950.3-M, April 1, 2015 TRICARE Duplicate Claims System (DCS) - TRICARE Encounter Data (TED) Version Chapter 4 Addendum B Report Descriptions And Examples Revision: C-14, May 30, 2018 Report Category: Set Report Report Menu Hierarchy And Format Name: REPORT => SET REPORTS => BASIC Printed Report Title: Duplicate Claim System Sets Grouped by Set Number Report Description: This report provides set-level information regarding all of the sets loaded in the Duplicate Claim System. The fields displayed on the report are: Institutional/Non-Institutional Indicator; Set Number; Status; Set Match Type; Multi-Contractor Set? (Y/N); Owner FI; Region; Initial Load Date; Current Load Date; Last Update Date; Adjustments? (Y/N); Total Amount Identified For Recoupment; Total Amount Actually Recouped; Total TED Adjustment Amount; and Set Level User Defined Code. Report Parameter Options: Users may customize the report by selecting: All “Standard” parameters (Claim Set Status, Adjustments, Set Owner Type, Claim Type, Match Type, Date Type, Set Range, FI, Region) plus Set Level User Defined Codes. Report Notes: The data used by this report format is set level data. Report Category: Set Report Report Menu Hierarchy And Format Name: REPORT => SET REPORTS => BASIC BY USER CODE Printed Report Title: Duplicate Claim System Sets Grouped by User Code Report Description: This report provides set-level information regarding all of the sets loaded in the Duplicate Claim System grouped by Set Level User Defined Codes. The fields displayed on the report are: Institutional/Non-Institutional Indicator; Set Number; Status; Set Match Type; Multi-Contractor Set? (Y/N); Owner FI; Region; Initial Load Date; Current Load Date; Last Update Date; Adjustments? (Y/N); Total Amount Identified For Recoupment; Total Amount Actually Recouped; Total TED Adjustment Amount; and Set Level User Defined Code. Report Parameter Options: Users may customize the report by selecting: All “Standard” parameters (Claim Set Status, Adjustments, Set Owner Type, Claim Type, Match Type, Date Type, Set Range, FI, Region) plus Set Level User Defined Codes. Report Notes: The data used by this report format is set level data. Report Category: Set Report Report Menu Hierarchy And Format Name: REPORT => SET REPORTS => USER LOG REPORT Printed Report Title: User Log Grouped By Set Number (Transaction History) Report Description: This report identifies the users who made changes to a set and the dates on which the changes occurred. The fields displayed on the report are: Set Number; Status; Owner FI; Region; Initial Load Date; Current Load Date; Transaction Date; User ID; Total Amount Identified For Recoupment; Total Amount Actually Recouped; and Total TED Adjustment Amount. The report will identify all of the sets meeting the criteria selected on the report parameter screen and list all of the changes made to those sets along with the associated User Ids. The system detects changes to: the status of a set; the Owner FI; the Region; and the three total dollar amount fields. Whenever a change to one or more of these fields occurs, a “log” record is created and will appear on this report along with the User ID associated with the change(s). The report will not show log entries generated as a result of: sets to which claims have been added during the monthly load process; or sets that have been archived out of the active database to history. Users may see entries with an “System” or “CLAIMADD” as the User ID. These two User IDs are used by the DCS for set management purposes. These User Ids may appear when the system makes a change to a set. The report groups the data by Set Number in ascending order. Report Parameter Options: Users may customize the report by selecting: All “Standard” parameters (Claim Set Status, Adjustments, Set Owner Type, Claim Type, Match Type, Date Type, Set Range, FI, Region) plus User IDs. Report Notes: The data used by this report format is set level data. 4 Report Category: Set Report Report Menu Hierarchy And Format Name: REPORT => SET REPORTS => EXPLANATION REPORT => NOTEPAD Printed Report Title: Explanations Notepad Report Description: This report provides a listing of the notepad entries made on selected sets. The fields displayed on this report are: Set Number; Status; Match Type; Owner FI; Region; Initial Load Date; Current Load Date; and Notepad Entries. Report Parameter Options: Users may customize the report by selecting: All “Standard” parameters (Claim Set Status, Adjustments, Set Owner Type, Claim Type, Match Type, Date Type, Set Range, FI, Region). Report Notes: The data used by this report format is set level data. Report Category: Set Report Report Menu Hierarchy And Format Name: REPORT => SET REPORTS => EXPLANATION REPORT => VALIDATE Printed Report Title: Validate Status Explanations Report Description: This report provides a listing of the explanations entered when sets are resolved to a Validate status. The Duplicate Claims System requires that an explanation be entered when a set is resolved to a Validate status. One of the required Validate explanations describes why the amount actually recouped and the paid amount of the TED adjustments submitted do not equal the amount identified for recoupment. The other required Validate explanation describes why all of the identified line-items of a non-institutional actual duplicate claim have not been adjusted. The fields displayed on this report are: Set Number; Status; Match Type; Owner FI; Region; Initial Load Date; Current Load Date; and Validate Explanations. Report Parameter Options: Users may customize the report by selecting: All “Standard” parameters minus Claim Set Status (Adjustments, Set Owner Type, Claim Type, Match Type, Date Type, Set Range, FI, Region). Report Notes: The data used by this report format is set level data. Report Category: Set Report Report Menu Hierarchy And Format Name: REPORT => SET REPORTS => EXPLANATION REPORT => MODIFY Printed Report Title: Modify FI Explanations Report Description: This report provides a listing of the explanations entered when the Owner FI is changed on multi-contractor sets. The Duplicate Claims System requires that an explanation be entered when ownership of a multi-contractor set is changed from one contractor to another. The explanation entered should indicate who changed set ownership, who the change was discussed with at the receiving contractor, the date the discussions and the change took place, and why ownership was changed. The fields displayed on the report are: Set Number; Status; Match Type; Owner FI; Region; Initial Load Date; Current Load Date; and the Modify FI Explanations. Report Parameter Options: Users may customize the report by selecting: All “Standard” parameters minus Owner Type (Claim Set Status; Adjustments, Claim Type, Match Type, Date Type, Set Range, FI, Region). Report Notes: The data used by this report format is set level data.