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TRICARE Operations Manual 6010.59-M, April 1, 2015
Value-Based Programs (VBPs), Pilots, And Demonstrations
Chapter 29
Addendum A
Performance-Based Maternity Payments (P-BMP) Data Elements
Revision:  C-35, September 12, 2018
A.1
File Format
The contractor shall submit the first P-BMP report and subsequent annual P-BMP reports through Defense Health Agency (DHA) e-Commerce Extranet (per Chapter 14, Section 1).
A.2
Record Layout
Each record is terminated by a new-line character. All fields are variable length. Field lengths specified are the maximum field lengths. Numeric fields contain decimal points and leading negative signs where appropriate. Unless otherwise indicated, blank or missing values are indicated by consecutive delimiters.
The data shown in Figure 29.A-1 are examples of data values for many of the data elements. Since provider record content is modified periodically to add, delete, or change data values, users of this document should refer to the TRICARE Systems Manual (TSM), Chapter 2, Section 2.10, for the most current and definitive information about data values associated with each data element.
Figure 29.A-1  P-BMP Data Feed Record Data Elements
FIELD NUMBER
FIELD NAME (LOGICAL NAME)
FIELD LENGTH
DATA TYPE
VALUE RANGE
Description
2
Provider Sub Identifier
4
A-Numeric
None
Identification number that uniquely identifies multiple providers using the same TIN.
1
Provider Taxpayer Number (TIN)
9
A-Numeric
None
The IRS TIN assigned to the institution/provider supplying the care, e.g., 10130427, ZA000025. For institutions, it must be the Employer Identification Number (EIN). For individual providers it must be the EIN or Social Security Number (SSN), if available. If not available, the contractor shall report the contractor-assigned number.
3
Provider Taxpayer Number Identifier
1
A-Numeric
A, E, S
Code to identify the Provider TIN as being an EIN or SSN or contractor assigned:
A = Assigned by contractor
E = Tax Identification Number (EIN)
S = Social Security Number (SSN)
4
Contractor Number
2
A-Numeric
04, 05, 08, 10, 12, 13, 15, 71, 73, 74
Identification code for the contractor. Used to identify each contractor submitting Provider File Records. Code values are defined in the TSM, Chapter 2, Addendums A and B.
5
Provider Contract Affiliation Code
1
A-Numeric
0, 1, 2, 3, 4, 5
Code indicating whether the provider is under contract with the contractor. All codes are irrespective of any partnership agreements. For provider records:
0 = Not Applicable
1 = Contracted
2 = Not Contracted
3 = Contracted/Not Contracted
4 = Active Duty TPR
5 = Non-Certified Providers
6
Institutional/ Non-Institutional Indicator
1
A-Numeric
I, N
Code used to identify a provider as an institution or non-institution. Coded as follows:
I = Institution
N = Non-Institution
7
Provider or Hospital Name
40
A-Numeric
None
The name of the provider or Hospital.
8
Provider Street Address
30
A-Numeric
None
Street address of the provider’s location.
9
Provider City
18
A-Numeric
None
The city in which the provider of medical care is located.
10
Provider State or Country Code
3
A-Numeric
None
Code assigned to identify the state or foreign country in which the provider is physically located. Code values are defined in the TSM, Chapter 2, Addendums A and B.
11
Provider Zip Code
5
A-Numeric
None
The first five digits of the zip code or a three-character country code for provider’s health care business location where the care was provided. The first five digits are used along with other “key” elements to uniquely identify multiple providers using the same Provider Taxpayer Number.
12
Provider ZIP Code
4
A-Numeric
None
Digits 6 through 9 of the ZIP code of the location where the care was provided.
13
Provider Major Specialty/Type of Institution (HIPAA)
10
A-Numeric
Codes are located in the TSM for Institutional Codes, Chapter 2, Addendum D, Figure 2.D-1.
For non-institutional codes: http://www.wpc.edi.com/References/Code, describing a provider’s major specialty, e.g., Provider Taxonomy, for non-institutional TRICARE Encounter Data records (TEDs)/Health Care Service Records (HCSRs) or a code describing the Type of Institution for institutional TEDs/HCSRs.
14
Provider Acceptance Date
8
Numeric
None
Date a provider met criteria to provide services. If the provider was never qualified to provide services zero fill. Format YYYYMMDD.
15
Provider Termination Date
8
Numeric
None
Date a provider is either suspended or terminated as a valid TRICARE provider (not to be used as the date a change was made to the file). If the provider was never qualified to provide services, zero filled. Format YYYYMMDD.
16
Provider Individual
10
A-Numeric
None
The individual National Provider Identifier (NPI), e.g., 0123456789.
17
Provider Group NPI
10
A-Numeric
None
The group national provider Identifier, e.g., 0123456789.
18
Provider Network Status Indicator
1
A-Numeric
1, 2
Code assigned to identify whether or not the provider is a network or non-network provider (at the date of service). Coded as follows:
1 = Network provider
2 = Non-network provider
19
Maternity Care Value Indicator
8
Numeric
0, 1, 2
Code indicating the network hospital’s assigned maternity care performance ranking based on the number of core metrics that provider met as stated in Section 4, paragraph 4.2. Coded as follows:
0 = Below Value Tier (The network hospital met the target for two, one, or zero core metrics, or chose not to participate in the Leapfrog Hospital Survey, or who are rated “not applicable” by Leapfrog).
1 = Value Tier (The network hospital met the target for any three of the four core metrics.)
2 = High Value Tier (The network hospital met the target for all four core metrics.)
20
High-Risk Delivery Indicator
8
Numeric
0, 1
Code indicating the assigned High Value and Value tier network hospitals that also met the Leapfrog target for High-Risk Deliveries with at least 50 very-low birth weight babies per year. Coded as follows:
0 = Not High-Risk Delivery Tier (The network hospital with a Maternity Care Value Indicator of 1 (Value Tier) or 2 (High Value Tier) but did not meet a minimum threshold of very-low birth weight deliveries per year, or chose not to participate in the Leapfrog Hospital Survey , or who are rated “not applicable” by Leapfrog.)
1 = High-Risk Delivery Tier (The network hospital with a Maternity Care Value Indicator of 1 (Value Tier) or 2 (High Value Tier) who also met the Leapfrog target for High-Risk Deliveries with at least 50 very-low birth weight babies per year).
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