VALIDITY
EDITS
|
2-305-01V
|
OCCURRENCE NUMBER 1--MUST BE
A VALID SPECIAL PROCESSING CODE
|
|
AND BEGIN DATE
OF CARE MUST BE ON OR AFTER THE SPECIAL PROCESSING EFFECTIVE DATE
|
|
AND NO LATER THAN
THE SPECIAL PROCESSING TERMINATION DATE (REFER TO Section 2.8).
|
2-305-02V
|
OCCURRENCE NUMBER 2--MUST BE
A VALID SPECIAL PROCESSING CODE
|
|
AND BEGIN DATE
OF CARE MUST BE ON OR AFTER THE SPECIAL PROCESSING EFFECTIVE DATE
|
|
AND NO LATER THAN
THE SPECIAL PROCESSING TERMINATION DATE (REFER TO Section 2.8).
|
2-305-03V
|
OCCURRENCE NUMBER 3--MUST BE
A VALID SPECIAL PROCESSING CODE
|
|
AND BEGIN DATE
OF CARE MUST BE ON OR AFTER THE SPECIAL PROCESSING EFFECTIVE DATE
|
|
AND NO LATER THAN
THE SPECIAL PROCESSING TERMINATION DATE (REFER TO Section 2.8).
|
2-305-04V
|
OCCURRENCE NUMBER 4--MUST BE
A VALID SPECIAL PROCESSING CODE
|
|
AND BEGIN DATE
OF CARE MUST BE ON OR AFTER THE SPECIAL PROCESSING EFFECTIVE DATE
|
|
AND NO LATER THAN
THE SPECIAL PROCESSING TERMINATION DATE (REFER TO Section 2.8).
|
2-305-05V
|
A VALUE CANNOT BE CODED MORE
THAN ONCE (EXCEPT BLANK).
|
2-305-06V
|
ALL OCCURRENCES OF SPECIAL
PROCESSING CODE MUST BE BLANK FILLED FOLLOWING THE FIRST OCCURRENCE
OF A BLANK FILLED SPECIAL PROCESSING CODE.
|
Relational
Edits
|
2-305-02R
|
IF CA/NAS EXCEPTION REASON
=
|
6
|
RESOURCE SHARING
|
|
THEN AT LEAST
ONE SPECIAL PROCESSING CODE MUST =
|
S
|
RESOURCE SHARING - EXTERNAL
|
2-305-08R
|
IF ANY OCCURRENCE OF SPECIAL PROCESSING
CODE =
|
PF
|
ECHO
|
|
THEN NO OCCURRENCE
OF SPECIAL PROCESSING CODE =
|
6
|
HHC OR
|
|
|
A
|
PARTNERSHIP PROGRAM OR
|
|
|
E
|
HHC/CM DEMO (AFTER 03/15/1999,
GRANDFATHERED INTO THE ICMP) OR
|
|
|
S
|
RESOURCE SHARING - EXTERNAL OR
|
|
|
CM
|
ICMP OR
|
|
|
CT
|
CCTP OR
|
|
|
RI
|
RESOURCE SHARING - INTERNAL
|
2-305-12R
|
IF ANY OCCURRENCE OF SPECIAL PROCESSING
CODE =
|
U
|
BRAC MEDICARE PHARMACY
|
|
THEN TYPE OF SERVICE
(SECOND POSITION) MUST =
|
B
|
RETAIL DRUGS, SUPPLIES, PRESCRIPTION AUTHORIZATIONS,
AND REVIEWS
|
|
AND BEGIN DATE
OF CARE MUST BE < 04/01/2001
|
2-305-13R
|
IF ANY OCCURRENCE OF SPECIAL PROCESSING
CODE =
|
16
|
AMBULATORY SURGERY FACILITY
CHARGE
|
|
THEN PRICING RATE
CODE MUST =
|
0
|
PRICING NOT APPLICABLE (DENIED
SERVICE/SUPPLIES AND ALLOWED DRUGS) OR
|
|
|
1
|
PRICED MANUALLY OR
|
|
|
C
|
AMBULATORY SURGERY FACILITY
PAYMENT RATE OR
|
|
|
D
|
DISCOUNTED AMBULATORY SURGERY
- FACILITY PAYMENT RATE OR
|
|
|
E
|
AMBULATORY SURGERY-PAID AS
BILLED OR
|
|
|
P
|
CLAIM AUDITING SOFTWARE-ADDED
PROCEDURE, AMBULATORY SURGERY-FACILITY PAYMENT RATE OR
|
|
|
Q
|
CLAIM AUDITING SOFTWARE-ADDED
PROCEDURE, DISCOUNTED AMBULATORY SURGERY-FACILITY PAYMENT RATE OR
|
|
|
R
|
CLAIM AUDITING SOFTWARE-ADDED
PROCEDURE, AMBULATORY SURGERY-PAID AS BILLED OR
|
|
|
V
|
MEDICARE REIMBURSEMENT RATE OR
|
|
|
CA
|
CAH REIMBURSEMENT OR
|
|
|
P1
|
OPPS OR
|
|
|
P2
|
OPPS WITH COST OUTLIER OR
|
|
|
P3
|
OPPS WITH DISCOUNT
|
2-305-14R
|
IF ANY OCCURRENCE OF SPECIAL PROCESSING
CODE =
|
PO
|
TRICARE PRIME - POS
|
|
THEN ENROLLMENT/HEALTH
PLAN CODE MUST =
|
U
|
TRICARE PRIME, CIVILIAN PCM OR
|
|
|
Z
|
TRICARE PRIME, MTF/eMSM/PCM OR
|
|
|
WF
|
TPR FOR ENROLLED ADFM RESIDING
WITH A TPR ELIGIBLE SERVICE MEMBER OR
|
|
|
WO
|
INCLUDES TRANSITIONAL
SURVIVORS WHO DO NOT RELOCATE TPR FOREIGN ADFM OR
|
|
|
XF
|
FOREIGN ADFM
|
2-305-22R
|
IF ANY OCCURRENCE OF SPECIAL PROCESSING
CODE =
|
AN
|
SHCP - NON-MTF/eMSM-REFERRED
CARE OR
|
|
|
AR
|
SHCP - MTF/eMSM REFERRED CARE OR
|
|
|
CE
|
SHCP - CCEP OR
|
|
|
SC
|
SHCP - NON-TRICARE ELIGIBLE OR
|
|
|
SE
|
SHCP - TRICARE ELIGIBLE OR
|
|
|
SM
|
SHCP - EMERGENCY
|
|
THEN ENROLLMENT/HEALTH
PLAN CODE MUST =
|
SN
|
SHCP - NON-MTF/eMSM-REFERRED
CARE OR
|
|
|
SO
|
SHCP - NON-TRICARE ELIGIBLE OR
|
|
|
SR
|
SHCP - MTF/eMSM REFERRED CARE OR
|
|
|
ST
|
SHCP - TRICARE ELIGIBLE OR
|
|
|
SU
|
SHCP - REFERRAL DESIGNATION
UNKNOWN
|
2-305-24R
|
IF ANY OCCURRENCE OF SPECIAL PROCESSING
CODE =
|
E
|
HHC/CM DEMO (AFTER 03/15/1999,
GRANDFATHERED INTO THE ICMP)
|
|
THEN BEGIN DATE
OF CARE MUST BE ≥ 03/15/1999
|
|
AND AT LEAST ONE
OTHER OCCURRENCE OF SPECIAL PROCESSING CODE MUST =
|
CM
|
ICMP
|
2-305-26R
|
• TFL CLAIMS:
THE BEGIN DATE OF CARE MUST BE ≥ 10/01/2001.
|
|
IF AMOUNT ALLOWED BY PROCEDURE
CODE IS ≤ ZERO
|
|
THEN BYPASS THIS
EDIT
|
|
|
|
ELSE ANY OCCURRENCE
OF SPECIAL PROCESSING CODE =
|
FF
|
TFL (FIRST PAYOR-NOT A MEDICARE
BENEFIT) OR
|
|
|
FG
|
TFL (FIRST PAYOR-NO TRICARE
PROVIDER CERTIFICATION, i.e., MEDICAL BENEFITS HAVE BEEN EXHAUSTED) OR
|
|
|
FS
|
TFL (SECOND PAYOR)
|
|
THEN BEGIN DATE
OF CARE MUST BE ≥ 10/01/2001
|
|
AND ENROLLMENT/HEALTH
PLAN CODE MUST =
|
FE
|
TFL - NETWORK OR
|
|
|
FS
|
TFL - NON-NETWORK
|
2-305-30R
|
IF ANY OCCURRENCE OF SPECIAL PROCESSING
CODE =
|
PF
|
ECHO
|
|
THEN HCDP PLAN
COVERAGE CODE
MUST ≠
|
305
|
TRICARE SELECT - RETIRED SPONSORS
AND FAMILY MEMBERS OR
|
|
|
306
|
TRICARE SELECT - RESERVE SELECT
SPONSORS AND FAMILY MEMBERS OR
|
|
|
307
|
TRICARE SELECT - RETIRED RESERVE
SPONSORS AND FAMILY MEMBERS OR
|
|
|
401
|
TRS TIER 1 MEMBER-ONLY COVERAGE
(CONTINGENCY OPERATIONS) OR
|
|
|
402
|
TRS TIER 1 MEMBER AND FAMILY
COVERAGE (CONTINGENCY OPERATIONS) OR
|
|
|
405
|
TRS TIER 2 MEMBER-ONLY COVERAGE
(CERTIFIED QUALIFICATIONS) OR
|
|
|
406
|
TRS TIER 2 MEMBER AND FAMILY
COVERAGE (CERTIFIED QUALIFICATIONS) OR
|
|
|
407
|
TRS TIER 3 MEMBER-ONLY COVERAGE
(SERVICE AGREEMENT) OR
|
|
|
408
|
TRS TIER 3 MEMBER AND FAMILY
COVERAGE (SERVICE AGREEMENT) OR
|
|
|
409
|
TRS SURVIVOR CONTINUING WITH
INDIVIDUAL COVERAGE OR
|
|
|
410
|
TRS SURVIVOR CONTINUING WITH
FAMILY COVERAGE OR
|
|
|
411
|
TRS SURVIVOR NEW INDIVIDUAL
COVERAGE OR
|
|
|
412
|
TRS SURVIVOR NEW FAMILY COVERAGE OR
|
|
|
413
|
TRS MEMBER-ONLY COVERAGE OR
|
|
|
414
|
TRS MEMBER AND FAMILY COVERAGE OR
|
|
|
418
|
TRR MEMBER-ONLY COVERAGE OR
|
|
|
419
|
TRR MEMBER AND FAMILY COVERAGE OR
|
|
|
420
|
TRR SURVIVOR INDIVIDUAL COVERAGE OR
|
|
|
421
|
TRR SURVIVOR FAMILY COVERAGE
|
2-305-31R
|
IF ANY OCCURRENCE OF SPECIAL PROCESSING
CODE =
|
AU
|
AUTISM DEMONSTRATION
|
|
THEN BEGIN DATE
OF CARE MUST BE ≥ 03/15/2008
|
|
AND AT LEAST ONE
OTHER OCCURRENCE OF SPECIAL PROCESSING CODE MUST =
|
PF
|
ECHO
|
|
AND PATIENT AGE1 MUST
BE ≥ 18 MONTHS
|
2-305-32R
|
IF ANY OCCURRENCE OF SPECIAL PROCESSING
CODE =
|
RB
|
RESPITE BENEFIT FOR ADSMS
|
|
THEN BEGIN DATE
OF CARE MUST BE ≥ 01/01/2008
|
|
AND AT LEAST ONE
OTHER OCCURRENCE OF SPECIAL PROCESSING CODE MUST =
|
SE
|
SHCP - TRICARE ELIGIBLE
|
2-305-33R
|
IF ANY OCCURRENCE OF SPECIAL PROCESSING
CODE =
|
PS
|
SPECIALTY PHARMACY SERVICES
|
|
THEN TYPE OF SERVICE
(SECOND POSITION) MUST =
|
M
|
MOP DRUGS, SUPPLIES, PRESCRIPTION AUTHORIZATIONS,
AND REVIEWS
|
|
AND PROCEDURE
CODE MUST ≠
|
000MN
|
PRESCRIPTION MEDICAL NECESSITY
REVIEWS OR
|
|
|
000PA
|
PRESCRIPTION PRIOR AUTHORIZATIONS
|
2-305-34R
|
IF ANY OCCURRENCE OF SPECIAL PROCESSING
CODE =
|
PV
|
RETAIL PHARMACY FOR DVA/VHA
BENEFICIARIES
|
|
THEN TYPE OF SERVICE
(SECOND POSITION) MUST =
|
B
|
RETAIL DRUGS, SUPPLIES, PRESCRIPTION AUTHORIZATIONS,
AND REVIEWS
|
|
AND PROVIDER NETWORK
STATUS INDICATOR MUST =
|
1
|
NETWORK PROVIDER
|
|
AND PROCEDURE
CODE MUST ≠
|
000MN
|
PRESCRIPTION MEDICAL NECESSITY
REVIEWS OR
|
|
|
000PA
|
PRESCRIPTION PRIOR AUTHORIZATIONS
|
2-305-35R
|
IF ANY OCCURRENCE OF SPECIAL PROCESSING
CODE =
|
DE
|
TDRL PHYSICAL EXAMS
|
|
THEN BEGIN DATE
OF CARE MUST BE ≥ 03/30/2009
|
|
AND ENROLLMENT/HEALTH
PLAN CODE MUST =
|
SR
|
SHCP - MTF/eMSM REFERRED CARE
|
|
AND AT LEAST ONE
OTHER OCCURRENCE OF SPECIAL PROCESSING CODE MUST =
|
SE
|
SHCP - TRICARE ELIGIBLE
|
2-305-36R
|
IF ANY OCCURRENCE OF SPECIAL PROCESSING
CODE =
|
EF
|
TRICARE RESERVE AND NATIONAL
GUARD FAMILY MEMBER BENEFITS
|
|
THEN BEGIN DATE
OF CARE MUST BE ≥11/01/2009
|
|
AND ENROLLMENT/HEALTH
PLAN CODE MUST =
|
T
|
TRICARE STANDARD PROGRAM OR
|
|
|
V
|
TRICARE EXTRA OR
|
|
|
TV
|
TRICARE SELECT OR
|
|
|
ME
|
MEDICARE/TRICARE DUAL ELIGIBLE
UNDER 65/NETWORK OR
|
|
|
MS
|
MEDICARE/TRICARE DUAL ELIGIBILE
UNDER 65/NON-NETWORK
|
|
AND HCDP SPECIAL
ENTITLEMENT CODE MUST =
|
02
|
NOBLE EAGLE PARTICIPATION SPECIAL
ENTITLEMENT OR
|
|
|
03
|
ENDURING FREEDOM PARTICIPATION
SPECIAL ENTITLEMENT OR
|
|
|
08
|
SPECIAL ENTITLEMENT FOR GUARD/RESERVE
ON ACTIVE DUTY MORE THAN 30 DAYS (EXCL. AGR)
|
|
AND AMOUNT APPLIED
TOWARD DEDUCTIBLE MUST = ZERO
|
2-305-37R
|
IF ANY OCCURRENCE OF SPECIAL PROCESSING
CODE =
|
DC
|
DCPE-VHA
|
|
THEN BEGIN
DATE OF CARE MUST BE ≥ 10/01/2014
|
|
AND AT LEAST ONE
OTHER OCCURRENCE OF SPECIAL PROCESSING CODE MUST =
|
17
|
VHA MEDICAL PROVIDER CLAIM OR
|
|
|
AD
|
FOREIGN ACTIVE DUTY CLAIMS
|
|
AND ENROLLMENT/HEALTH
PLAN CODE MUST =
|
W
|
TPR SERVICE MEMBER - USA OR
|
|
|
X
|
FOREIGN SERVICE MEMBER OR
|
|
|
SR
|
SHCP - MTF/eMSM REFERRED CARE OR
|
|
|
WA
|
TPR FOREIGN SERVICE MEMBER
|
|
AND AT LEAST ONE
PROCEDURE CODE MUST = 99456
|
|
OR PRINCIPLE DIAGNOSIS
CODE MUST = V68.01 OR Z02.71
|
2-305-38R
|
IF ANY OCCURRENCE OF SPECIAL PROCESSING
CODE =
|
PH
|
PHILIPPINES DEMONSTRATION PROJECT
|
|
THEN BEGIN DATE
OF CARE MUST BE ≥ 01/01/2013
|
|
AND HCDP PLAN
COVERAGE CODE MUST =
|
003
|
TRICARE STANDARD FOR ADFMs OR
|
|
|
005
|
TRICARE STANDARD SURVIVORS
OF ACTIVE DUTY DECEASED SPONSORS OR
|
|
|
007
|
TRICARE STANDARD TRANSITIONAL
ASSISTANCE SPONSORS AND FAMILY MEMBERS OR
|
|
|
009
|
TRICARE STANDARD RETIRED AND
MOH SPONSORS AND FAMILY MEMBERS OR
|
|
|
010
|
TRICARE STANDARD TRANSITIONAL
SURVIVORS OF ACTIVE DUTY DECEASED SPONSORS OR
|
|
|
015
|
TRICARE STANDARD TRANSITIONAL
SURVIVORS OF NG/RESERVE DECEASED SPONSORS OR
|
|
|
017
|
TRICARE STANDARD SURVIVORS
OF NG/RESERVE DECEASED SPONSORS OR
|
|
|
018
|
TFL RETIRED SPONSORS AND FAMILY
MEMBERS AND MOH OR
|
|
|
020
|
TFL TRANSITIONAL SURVIVORS
OF ACTIVE DUTY DECEASED SPONSORS OR
|
|
|
021
|
TFL SURVIVORS OF ACTIVE DUTY
DECEASED SPONSORS OR
|
|
|
022
|
TFL TRANSITIONAL SURVIVORS
OF NG/RESERVE DECEASED SPONSORS OR
|
|
|
023
|
TFL SURVIVORS OF NG/RESERVE
DECEASED SPONSORS OR
|
|
|
028
|
TRICARE STANDARD FOR MEDICALLY
RETIRED SPONSORS AND FAMILY MEMBERS OR
|
|
|
029
|
TFL FOR MEDICALLY RETIRED SPONSORS
AND FAMILY MEMBERS OR
|
|
|
303
|
TRICARE SELECT - ADFMs OR
|
|
|
304
|
TRICARE SELECT - TAMP SPONSORS
AND FAMILY MEMBERS OR
|
|
|
305
|
TRICARE SELECT - RETIRED SPONSORS
AND FAMILY MEMBERS OR
|
|
|
306
|
TRICARE SELECT - RESERVE SELECT
SPONSORS AND FAMILY MEMBERS OR
|
|
|
307
|
TRICARE SELECT - RETIRED RESERVE
SPONSORS AND FAMILY MEMBERS OR
|
|
|
308
|
TRICARE SELECT - YOUNG ADULT OR
|
|
|
409
|
TRS SURVIVOR CONTINUING INDIVIDUAL
COVERAGE OR
|
|
|
410
|
TRS SURVIVOR CONTINUING FAMILY
COVERAGE OR
|
|
|
411
|
TRS SURVIVOR NEW INDIVIDUAL
COVERAGE OR
|
|
|
412
|
TRS SURVIVOR NEW FAMILY COVERAGE OR
|
|
|
413
|
TRS MEMBER-ONLY COVERAGE OR
|
|
|
414
|
TRS MEMBER AND FAMILY COVERAGE OR
|
|
|
418
|
TRR MEMBER-ONLY COVERAGE OR
|
|
|
419
|
TRR MEMBER AND FAMILY COVERAGE OR
|
|
|
420
|
TRR SURVIVOR INDIVIDUAL COVERAGE OR
|
|
|
421
|
TRR SURVIVOR FAMILY COVERAGE OR
|
|
|
422
|
TYA STANDARD FOR ADFMs OR
|
|
|
423
|
TYA STANDARD FOR RETIRED AND
MOH FAMILY MEMBERS OR
|
|
|
424
|
TYA RESERVE SELECT OR
|
|
|
425
|
TYA RETIRED RESERVE OR
|
|
|
999
|
UNVERIFIED NEWBORN
|
|
OR ENROLLMENT/HEALTH
PLAN
CODE =
|
AS
|
TRICARE SELECT - ACTIVE DUTY
SURVIVORS OR
|
|
|
AT
|
TRICARE SELECT - ACTIVE DUTY
TRANSITIONAL SURVIVORS OR
|
|
|
GS
|
TRICARE SELECT - GUARD/RESERVE
SURVIVORSOR
|
|
|
GT
|
TRICARE SELECT - GUARD/RESERVE
TRANSITIONAL SURVIVORS
|
|
AND PATIENT ZIP
CODE MUST =
|
PHL
|
PHILIPPINES
|
|
AND PROVIDER STATE
OR COUNTRY CODE MUST =
|
PHL
|
PHILIPPINES
|
2-305-39R
|
IF ANY OCCURRENCE OF SPECIAL PROCESSING
CODE =
|
AS
|
COMPREHENSIVE AUTISM CARE DEMONSTRATION
|
|
THEN PROCEDURE
CODE MUST BE 0359T, 0360T, 0361T, 0364T, 0365T, 0368T, 0369T, 0370T,
T1023, 97151, 97153, 97155, 97156, 97157, 97158, 99366, OR 99368
|
2-305-40R
|
IF BEGIN DATE OF CARE IS ≥
01/01/2018
|
|
AND ANY OCCURRENCE
OF SPECIAL PROCESSING CODE =
|
R
|
MEDICARE/TRICARE DUAL ENTITLEMENT
(FIRST PAYOR-NOT A MEDICARE BENEFIT) AND BEGIN DATE OF CARE ≥ 10/01/2001 OR
|
|
|
T
|
MEDICARE/TRICARE DUAL ENTITLEMENT
(SECOND PAYOR) AND BEGIN DATE OF CARE ≥ 10/01/2001 OR
|
|
|
RS
|
MEDICARE/TRICARE DUAL ENTITLEMENT
(FIRST PAYOR-NO TRICARE PROVIDER CERTIFICATION, i.e., MEDICARE BENEFITS
HAVE BEEN EXHAUSTED) AND BEGIN DATE OF CARE ≥ 10/01/2001
|
|
THEN ENROLLMENT/HEALTH
PLAN CODE MUST =
|
U
|
TRICARE PRIME, CIVILIAN CARE OR
|
|
|
Z
|
TRICARE PRIME, MTF/eMSM/PCM OR
|
|
|
ME
|
MEDICARE/TRICARE DUAL ELIGIBLE
UNDER 65/NETWORK OR
|
|
|
MS
|
MEDICARE/TRICARE DUAL ELIGIBLE
UNDER 65/NON-NETWORK OR
|
|
|
WF
|
TPR FOR ENROLLMENT ADFM RESIDING
WITH A TPR ELIGIBLE SERVICE MEMBER
|
2-305-41R
|
IF ANY OCCURRENCE OF SPECIAL PROCESSING
CODE =
|
LB
|
LOW BACK PAIN (LBP) DEMONSTRATION
|
|
THEN BEGIN DATE
OF CARE MUST BE > 01/01/2021 AND < 01/01/2024
|
|
AND AMOUNT OF
PATIENT COST SHARE MUST = ZERO
|
|
AND AMOUNT APPLIED
TO DEDUCTIBLE MUST = ZERO
|
|
AND PROVIDER STATE/COUNTRY
CODE MUST=
|
AZ
|
ARIZONA OR
|
|
|
CA
|
CALIFORNIA OR
|
|
|
CO
|
COLORADO OR
|
|
|
FL
|
FLORIDA OR
|
|
|
GA
|
GEORGIA OR
|
|
|
KY
|
KENTUCKY OR
|
|
|
NC
|
NORTH CAROLINA OR
|
|
|
OH
|
OHIO OR
|
|
|
TN
|
TENNESSEE OR
|
|
|
VA
|
VIRGINIA
|
|
AND PATIENT ZIP
CODE MUST BE A ZIP CODE IN THE FOLLOWING STATES: AZ, CA, CO, FL,
GA, KY, NC, OH, TN, OR VA
|
|
AND PROVIDER SPECIALTY
MUST NOT = 251E00000X - HOME HEALTH AGENCY
|
2-305-42R
|
IF CONTRACTOR NUMBER
=
|
HT9402-21-C-0007 TPHARM5
|
|
AND BATCH/VOUCHER
CLIN/ASAP ACCOUNT NUMBER ASAP DESCRIPTION FOUND IN DHA DATABASE
=
|
BA
|
BATCH
|
|
THEN BYPASS
THIS EDIT
|
|
|
|
ELSE IF
ANY OCCURRENCE OF SPECIAL PROCESSING CODE =
|
NQ
|
PI TEMPORARILY SUSPENDED PROVIDER,
PHARMACY, ENTITY, OR CLIENT BENEFICIARY CLAIM IN ‘PROCESS STATUS’
|
|
THEN BATCH/VOUCHER
CLIN/ASAP ACCOUNT NUMBER ASAP DESCRIPTION FOUND IN DHA DATABASE2 MUST
=
|
TD
|
TRICARE DOMESTIC OR
|
|
|
TF
|
TRICARE FOREIGN OR
|
|
|
TM
|
TRICARE MAIL ORDER PHARMACY OR
|
|
|
TR
|
TRICARE RETAIL PHARMACY
|
2-305-44R
|
IF ANY OCCURRENCE OF SPECIAL PROCESSING
CODE =
|
CB
|
CHILDBIRTH SUPPORT DEMONSTRATION
|
|
THEN PROCEDURE
CODE MUST BE 99509 OR 59899
|
|
AND BEGIN DATE
OF CARE MUST BE ≥ 01/01/2022 AND < 01/01/2027
|
|
UNLESS CONTRACT
NUMBER =
|
HT9402-20-D-0002 (TOP)
|
|
THEN BEGIN DATE
OF CARE MUST BE ≥ 01/01/2025 AND < 01/01/2027
|
2-305-45R
|
IF ANY OCCURRENCE OF SPECIAL PROCESSING
CODE =
|
BF
|
BREASTFEEDING SUPPORT DEMONSTRATION
|
|
THEN PROCEDURE
CODE MUST BE 99401, 99402, 99403, 99404, 99411, OR 99412
|
|
AND BEGIN DATE
OF CARE MUST BE ≥ 01/01/2022 AND < 01/01/2027
|
|
UNLESS CONTRACT
NUMBER =
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HT9402-20-D-0002 (TOP)
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THEN BEGIN DATE
OF CARE MUST BE ≥ 01/01/2025 AND < 01/01/2027
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