TRICARE Encounter Data (TED)
Chapter 2
Section 6.1
Non-Institutional
Edit Requirements (ELN 000 - 099)
Revision: C-54, September 16, 2021
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ELEMENT NAME: RECORD TYPE INDICATOR (2-001)
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VALIDITY
EDITS
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2-001-01V
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RECORD TYPE INDICATOR MUST
=
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2
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NON-INSTITUTIONAL
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Relational
Edits
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2-001-01R
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IF TYPE OF SUBMISSION =
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A
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ADJUSTMENT OR
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B
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ADJUSTMENT TO NON-TED RECORD
(HCSR) DATA OR
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C
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COMPLETE CANCELLATION OR
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E
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COMPLETE CANCELLATION OF NON-TED
RECORD (HCSR) DATA
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AND A MATCH IS
FOUND ON THE DHA DATABASE
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THEN THE RECORD
TYPE FOR THE TED ON THE DATABASE MUST = THE RECORD TYPE ON THE ADJUSTMENT/CANCELLATION
TED BEING SUBMITTED.
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ELEMENT NAME: FILING DATE (2-015)
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VALIDITY
EDITS
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2-015-01V
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MUST BE A VALID JULIAN DATE
AND CANNOT BE > DHA CURRENT SYSTEM DATE.
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Relational
Edits
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2-015-01R
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FILING DATE MUST BE ≤ DATE
TED RECORD PROCESSED TO COMPLETION (PTC)
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ELEMENT NAME: FILING STATE/COUNTRY CODE (2-020)
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VALIDITY
EDITS
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2-020-01V
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IF TYPE OF SUBMISSION =
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D
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COMPLETE DENIAL OR
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I
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INITIAL SUBMISSION OR
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O
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ZERO PAYMENT WITH 100% OHI/TPL OR
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R
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RESUBMISSION
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THEN MUST BE A
VALID STATE/COUNTRY CODE (REFER TO Addendums A AND B.)
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Relational
Edits
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NONE
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ELEMENT NAME: SEQUENCE NUMBER (2-025)
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VALIDITY
EDITS
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2-025-01V
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SEQUENCE NUMBER MUST BE A COMBINATION
OF ALPHABETIC OR NUMERIC CHARACTERS, LAST TWO CHARACTERS.
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Relational
Edits
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NONE
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ELEMENT NAME: TIME STAMP (2-030)
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VALIDITY
EDITS
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2-030-01V
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MUST BE NUMERIC.
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Relational
Edits
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2-030-01R
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IF FILING DATE IS ≥ 02/01/1995
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THEN TIME STAMP
MUST BE > ZERO
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ELEMENT NAME: ADJUSTMENT KEY (2-035)
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VALIDITY
EDITS
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2-035-01V
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MUST BE ALPHA, 0, OR 5.
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Relational
Edits
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NONE
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ELEMENT NAME: DATE TED RECORD PROCESSED TO
COMPLETION (2-040)
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VALIDITY
EDITS
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2-040-01V
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MUST BE A VALID GREGORIAN DATE
AND CANNOT BE > DHA CURRENT SYSTEM DATE.
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Relational
Edits
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2-040-01R
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DATE TED RECORD PROCESSED TO
COMPLETION (PTC) MUST BE ≤ BATCH/VOUCHER DATE
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ELEMENT NAME: DATE ADJUSTMENT IDENTIFIED
(2-045)
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VALIDITY
EDITS
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2-045-01V
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MUST BE A VALID GREGORIAN DATE OR ALL
ZEROES AND CANNOT BE > DHA CURRENT SYSTEM DATE.
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2-045-02V
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IF TYPE OF SUBMISSION =
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D
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DENIAL OR
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I
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INITIAL SUBMISSION OR
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O
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ZERO PAYMENT WITH 100% OHI/TPL OR
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R
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RESUBMISSION
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THEN DATE ADJUSTMENT
IDENTIFIED MUST BE ALL ZEROES.
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2-045-04V
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IF TYPE OF SUBMISSION =
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A
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ADJUSTMENT OR
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B
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ADJUSTMENT TO NON-TED RECORD
(HCSR) DATA OR
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C
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COMPLETE CANCELLATION OR
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E
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COMPLETE CANCELLATION OF NON-TED
RECORD (HCSR) DATA
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THEN DATE OF ADJUSTMENT
IDENTIFIED MUST BE A VALID GREGORIAN DATE
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Relational
Edits
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2-045-03R
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IF TYPE OF SUBMISSION =
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A
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ADJUSTMENT OR
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B
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ADJUSTMENT TO NON-TED RECORD
(HCSR) DATA OR
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C
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COMPLETE CANCELLATION OR
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E
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COMPLETE CANCELLATION OF NON-TED
RECORD (HCSR) DATA
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THEN DATE ADJUSTMENT
IDENTIFIED MUST BE ≤ DATE TED RECORD PROCESSED TO COMPLETION AND ≥ FILING
DATE
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ELEMENT NAME: PERSON IDENTIFIER (SPONSOR)
(2-050)
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VALIDITY
EDITS
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2-050-01V
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MUST BE NINE NUMERIC DIGITS
(CANNOT BE ALL ZEROES, ALL NINES, OR ALL
BLANKS)
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Relational
Edits
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NONE
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ELEMENT NAME: PERSON IDENTIFIER TYPE CODE
(SPONSOR) (2-051)
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VALIDITY
EDITS
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2-051-01V
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MUST BE A VALID VALUE (REFER
TO Section 2.7). |
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Relational
Edits
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NONE
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ELEMENT NAME: SERVICE BRANCH CLASSIFICATION
CODE (SPONSOR) (2-055)
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VALIDITY
EDITS
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2-055-01V
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MUST BE A VALID SERVICE BRANCH
CLASSIFICATION CODE (SPONSOR) (REFER TO Section 2.8). |
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Relational
Edits
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ELEMENT NAME: AGR SERVICE LEGAL AUTHORITY
CODE (2-056)
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VALIDITY
EDITS
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2-056-01V
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MUST BE VALID AGR SERVICE LEGAL
AUTHORITY CODE (REFER TO Section 2.4). |
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Relational
Edits
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ELEMENT NAME: PERSON LAST NAME (PATIENT)
(2-061)
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VALIDITY
EDITS
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2-061-01V
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MUST BE AT LEAST ONE CHARACTER
(LEFT-JUSTIFIED).
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Relational
Edits
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NONE
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ELEMENT NAME: PERSON FIRST NAME (PATIENT)
(2-062)
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VALIDITY
EDITS
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NONE
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Relational
Edits
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NONE
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ELEMENT NAME: PERSON MIDDLE NAME (PATIENT)
(2-063)
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VALIDITY
EDITS
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NONE
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Relational
Edits
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NONE
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ELEMENT NAME: PERSON CADENCY NAME (PATIENT)
(2-064)
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VALIDITY
EDITS
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NONE
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Relational
Edits
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NONE
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ELEMENT NAME: PERSON IDENTIFIER (PATIENT)
(2-065)
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VALIDITY
EDITS
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2-065-01V
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MUST BE NINE NUMERIC DIGITS AND
CANNOT EQUAL ALL BLANKS.
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Relational
Edits
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NONE
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ELEMENT NAME: PERSON IDENTIFIER TYPE CODE
(PATIENT) (2-066)
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VALIDITY
EDITS
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2-066-01V
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MUST BE A VALID VALUE (REFER
TO Section 2.7). |
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Relational
Edits
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NONE
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ELEMENT NAME: PERSON BIRTH CALENDAR DATE
(PATIENT) (2-070)
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VALIDITY
EDITS
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2-070-01V
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MUST BE VALID GREGORIAN DATE
AND CANNOT BE > DHA CURRENT SYSTEM DATE.
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Relational
Edits
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2-070-01R
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PATIENT AGE1 MUST
BE < 125 YEARS
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2-070-02R
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PERSON BIRTH CALENDAR DATE
(PATIENT) MUST BE ≤ BEGIN DATE OF CARE.
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ELEMENT NAME: DEERS DEPENDENT SUFFIX (2-075)
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VALIDITY
EDITS
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2-075-01V
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IF TYPE OF SERVICE (SECOND
POSITION) =
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M
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MOP DRUGS, SUPPLIES, PRESCRIPTION AUTHORIZATIONS,
AND REVIEWS
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OR TYPE OF SUBMISSION
=
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B
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ADJUSTMENT OF NON-TED RECORD
(HCSR) DATA OR
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E
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COMPLETE CANCELLATION OF NON-TED
RECORD (HCSR) DATA
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THEN MUST BE A
VALID DEERS DEPENDENT SUFFIX OR BLANK (REFER TO Section 2.4) OTHERWISE MUST BE
BLANK
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Relational
Edits
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NONE
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ELEMENT NAME: PATIENT IDENTIFIER (DoD) (2-080)
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VALIDITY
EDITS
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2-080-01V
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MUST NOT BE BLANK FILLED
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2-080-02V
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MUST NOT EQUAL ALL ZEROES
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UNLESS TYPE OF
SUBMISSION =
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D
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COMPLETE DENIAL TED RECORD
DATA
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OR ALL OCCURRENCES/LINE
ITEMS CONTAIN AN ADJUSTMENT/DENIAL REASON CODE (REFER TO Addendum G, Figure 2.G-1 OR Figure 2.G-2).
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AND THE TED RECORD
CORRECTION INDICATOR =
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1
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ADJUSTMENT/CANCELLATION (TYPE
OF SUBMISSION A, B, C, OR E)
SOLELY TO CORRECT A PROVISIONALLY ACCEPTED TED RECORD OR
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3
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ADJUSTMENT/CANCELLATION (TYPE
OF SUBMISSION A, B, C, OR E)
TO CORRECT BOTH EDIT ERRORS ON A PROVISIONALLY ACCEPTED TED RECORD
AND TO CORRECT CLAIM PROCESSING ERRORS OR UPDATE PRIOR DATA WITH
MORE CURRENT/ACCURATE INFORMATION
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Relational
Edits
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NONE
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ELEMENT NAME: DEERS IDENTIFIER (PATIENT)
(2-082)
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VALIDITY
EDITS
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2-082-01V
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POSITIONS 10 AND 11 MUST BE
NUMERIC
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Relational
Edits
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NONE
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ELEMENT NAME: PERSON SEX (PATIENT) (2-085)
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VALIDITY
EDITS
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2-085-01V
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PERSON SEX (PATIENT) MUST =
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F
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FEMALE OR
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M
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MALE OR
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Z
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UNKNOWN
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Relational
Edits
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NONE
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ELEMENT NAME: PATIENT ZIP CODE (2-090)
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VALIDITY
EDITS
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2-090-01V
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MUST BE NINE DIGITS OR FIVE
DIGITS WITH FOUR BLANKS
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MUST BE A VALID ZIP CODE (BASED
ON BEGIN DATE OF CARE) IN THE GOVERNMENT PROVIDED ELECTRONIC ZIP
CODE FILE OR
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MUST BE A THREE CHARACTER FOREIGN
COUNTRY CODE (BASED ON THE COUNTRY CODES TABLE1) FOLLOWED
BY SIX BLANKS
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Relational
Edits
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NONE
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ELEMENT NAME: OVERRIDE CODE (2-095)
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VALIDITY
EDITS
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2-095-01V
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OCCURRENCE NUMBER 1--MUST BE
A VALID OVERRIDE CODE (REFER TO Section 2.6) |
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2-095-02V
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OCCURRENCE NUMBER 2--MUST BE
A VALID OVERRIDE CODE (REFER TO Section 2.6) |
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2-095-03V
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OCCURRENCE NUMBER 3--MUST BE
A VALID OVERRIDE CODE (REFER TO Section 2.6) |
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2-095-04V
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A VALUE CANNOT BE CODED MORE
THAN ONCE (EXCEPT BLANK).
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2-095-05V
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ALL OCCURRENCES OF OVERRIDE
CODE MUST BE BLANK FILLED FOLLOWING THE FIRST OCCURRENCE OF A BLANK
FILLED OVERRIDE CODE.
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Relational
Edits
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2-095-11R
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IF ANY OCCURRENCE OF OVERRIDE
CODE =
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NC
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NON-CERTIFIED PROVIDER (DOES
NOT INCLUDE SANCTIONED/SUSPENDED PROVIDERS)
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THEN ONE OCCURRENCE
OF SPECIAL PROCESSING CODE MUST =
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AD
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FOREIGN ACTIVE DUTY CLAIMS OR
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AN
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SHCP - NON-MTF/eMSM REFERRED
CARE OR
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AR
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SHCP - MTF/eMSM REFERRED CARE OR
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CE
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SHCP - CCEP OR
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EU
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EMERGENCY SERVICES RENDERED
BY AN UNAUTHORIZED PROVIDER OR
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GU
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SERVICE MEMBER ENROLLED IN
TPR OR
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MN
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TSP - NETWORK OR
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MS
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TSP - NON-NETWORK OR
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SC
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SHCP - NON-TRICARE ELIGIBLE OR
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SE
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SHCP - TRICARE ELIGIBLE OR
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SM
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SHCP - EMERGENCY
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OR ENROLLMENT/HEALTH
PLAN CODE MUST =
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SN
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SHCP - NON-MTF/eMSM-REFERRED
CARE OR
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SR
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SHCP - MTF/eMSM REFERRED CARE OR
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SU
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SHCP - REFERRAL DESIGNATION
UNKNOWN
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2-095-12R
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IF ANY OCCURRENCE
OF OVERRIDE CODE =
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NP
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PAYMENT TO PROVIDER,
PHARMACY, ENTITY, OR CLIENT BENEFICIARY TEMPORARILY SUSPENDED AT DIRECTION
OF DHA, PI
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THEN BATCH/VOUCHER
CLIN/ASAP ACCOUNT NUMBER ASAP DESCRIPTION FOUND IN DHA DATABASE1 MUST
=
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BA
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BATCH
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- END -