Records/Locator
Numbers
|
Record Name
|
Locator#
|
Occurrences
|
|
Required
|
Institutional
Non-Institutional
|
1-185
2-305
|
4
4/Up to 99
|
|
Yes1
Yes1
|
Primary Picture (Format)
|
Four occurrences of two (2)
alphanumeric characters per occurrence/line item for non-institutional.
|
Definition
|
Code indicating care that requires
special processing.
|
Code/Value Specifications
|
|
BEGIN DATE
|
END DATE
|
|
0
|
Hospice non-affiliated provider
|
19991001
|
99991231
|
|
1
|
Medicaid
|
19991001
|
99991231
|
|
3
|
Allogeneic bone marrow recipient
(Wilford Hall referred only prior to 10/01/1997 and PCM/HCF referred
after 12/31/2002)
|
20030101
|
99991231
|
|
4
|
Allogeneic bone marrow donor
(Wilford Hall referred only prior to 10/01/1997 and PCM/HCF referred
after 12/31/2002)
|
20030101
|
99991231
|
|
5
|
Liver transplant (Effective
for care before
03/01/1997, or between 02/20/1998 and
08/31/1999 and after 05/31/2003)
|
20030601
|
99991231
|
|
6
|
HHC (non-institutional only)
|
19991001
|
99991231
|
|
7
|
Heart Transplant
|
19991001
|
99991231
|
|
10
|
Active duty cost-share ambulatory
surgery taken from professional claim
|
20020801
|
99991231
|
|
11
|
Hospice
|
20020801
|
99991231
|
|
12
|
Capitated Arrangements
|
20020801
|
99991231
|
|
14
|
BMTs - DHA approved
|
20020801
|
99991231
|
|
16
|
Ambulatory Surgery Facility
charge
|
20020801
|
99991231
|
|
17
|
VHA medical provider claim
(care rendered by a VHA provider)
|
20020801
|
99991231
|
|
49
|
Hospital reimbursement reduced
by manufacturer credit/replacement of device during warranty period
|
20090622
|
99991231
|
|
50
|
Hospital reimbursement reduced
by manufacturer credit/recalled device
|
20090622
|
99991231
|
|
A
|
Partnership Program (internal
providers with signed agreements)
|
19991001
|
99991231
|
|
E
|
HHC/CM Demonstration (After
03/15/1999, grandfathered into the Individual Case Management Program
(ICMP))2
|
19990315
|
19991001
|
|
Q
|
Active Duty Delayed Deductible
|
19991001
|
99991231
|
|
R
|
Medicare/TRICARE Dual Entitlement
First Payer - Not a Medicare Benefit
|
20011001
|
99991231
|
|
S
|
Resource Sharing - External
|
19991001
|
99991231
|
|
T
|
Medicare/TRICARE Dual Entitlement
(formally normal COB processing as Second Payer)
|
20011001
|
99991231
|
|
U
|
BRAC Medicare Pharmacy (Section
702) claim
|
20000701
|
20010401
|
|
V
|
Financially underwritten payment
by contractor
|
19991001
|
99991231
|
|
W
|
Non-financially underwritten
payment by financially underwritten contractor
|
19991001
|
99991231
|
|
X
|
Partial hospitalization - provider
not contracted with or employed by the PHP billing for psychotherapy
services in a PHP
|
19991001
|
99991231
|
|
Y
|
Heart-lung transplant
|
19991001
|
99991231
|
|
Z
|
Kidney transplant
|
19991001
|
99991231
|
|
AB
|
Abused dependent of discharged
or dismissed member
|
19990728
|
99991231
|
|
AC
|
Access To Care (ATC) Demonstration
(South Region only)
|
20110914
|
20150504
|
|
AD
|
Active duty claims OCONUS
|
19960630
|
99991231
|
|
AE
|
Abortion performed due to rape
|
20130102
|
99991231
|
|
AF
|
Abortion performed due to incest
|
20130102
|
99991231
|
|
AG
|
Abortion performed due to life
endangering physical condition
|
20130102
|
99991231
|
|
AN
|
SHCP - Non-MTF/eMSM-Referred
Care
|
19991001
|
20040531
|
|
AP
|
Applied Behavior Analysis (ABA)
Pilot
|
20130725
|
20141231
|
|
AR
|
SHCP - MTF/eMSM Referred Care
|
19991001
|
20040531
|
|
AS
|
Comprehensive Autism Care Demonstration
|
20140725
|
20281231
|
|
AT
|
Ablative Fractional Laser (AFL)
treatments for symptomatic burns and scars
|
20210224
|
20260223
|
|
AU
|
Autism Demonstration3
|
20080315
|
20150314
|
|
A1
|
ACO Pilot for Part A services
rendered by KP owned providers
|
20190101
|
20221231
|
|
A2
|
ACO Pilot for Part A services
rendered by KP contracted providers
|
20190101
|
20221231
|
|
A3
|
ACO Pilot for Part A services
rendered by non-KP providers (HGB Network and other providers)5
|
20190101
|
20221231
|
|
BA
|
Applied Behavior Analysis (ABA)
(Interim Benefit)
|
20120913
|
99991231
|
|
BD
|
Bosnia Deductible
|
19951208
|
19961220
|
|
BF
|
Breastfeeding Support Demonstration
|
20220101
|
20261231
|
|
BH
|
IOP Behavioral Health Sequelae
of Sexual Trauma Pilot
|
20200901
|
20210831
|
|
BP
|
CMS Bundled Care Payment Initiative
|
20130221
|
99991231
|
|
B1
|
ACO Pilot for Part B services
rendered by KP owned providers
|
20190101
|
20221231
|
|
B2
|
ACO Pilot for Part B services
rendered by KP contracted providers
|
20190101
|
20221231
|
|
B3
|
ACO Pilot for Part B services
rendered by non-KP providers (HGB Network and other providers)5
|
20190101
|
20221231
|
|
CA
|
Civil Action Payment
|
19990701
|
99991231
|
|
CB
|
Childbirth Support Demonstration
|
20220101
|
20261231
|
|
CC
|
Cost-Share, Co-Pay, Deductible
Amount Reported-Waived6
|
20191101
|
99991231
|
|
CE
|
SHCP - CCEP
|
19991001
|
99991231
|
|
CH
|
Children’s Hospital
|
20230701
|
99991231
|
|
CL
|
Clinical Trials Demonstration
|
20030317
|
20080331
|
|
CM
|
ICMP claims
|
19990315
|
99991231
|
|
CN
|
Cancer Hospital
|
20230701
|
99991231
|
|
CO
|
NIAID COVID-19 Clinical Trials
|
20201030
|
99991231
|
|
CP
|
Cancer Clinical Trials
|
20080401
|
99991231
|
|
CT
|
CCTP
|
20011228
|
99991231
|
|
CV
|
COVID-19 Services-Care for
COVID-19 Patients
|
20191101
|
99991231
|
|
DB
|
Digital Breast Tomosynthesis
(DBT)
|
20200101
|
20241231
|
|
DC
|
DCPE-DVA/VHA - C&P exams
used to determine fit for duty
|
20100716
|
99991231
|
|
DE
|
TDRL physical exams
|
20090330
|
99991231
|
|
D1
|
ACO Pilot for Part D services
rendered by KP Pharmacies
|
20190101
|
20221231
|
|
D2
|
ACO Pilot for Part D services
rendered by non-KP Pharmacies5
|
20190101
|
20221231
|
|
EF
|
TRICARE Reserve and National
Guard Family Member Benefits (Reservists and National Guard members
called to active duty for more than 30 days in support of a contingency operation)
|
20091101
|
99991231
|
|
EU
|
Emergency services rendered
by an unauthorized provider
|
19990601
|
99991231
|
|
FF
|
TFL (First Payer - Not A Medicare
Benefit)
|
20011001
|
99991231
|
|
FG
|
TFL (First Payer - No TRICARE
Provider Certification, i.e., Medicare benefits have been exhausted)
|
20011001
|
99991231
|
|
FI
|
Buckley Prime Service Area
Pilot
|
20210101
|
20221231
|
|
FS
|
TFL (Second Payer)
|
20011001
|
99991231
|
|
GF
|
TPR for eligible ADFM residing
with a TPR Eligible Service Member
|
20001030
|
20020831
|
|
GU
|
Service member enrolled in
TPR
|
19991001
|
99991231
|
|
G1
|
Good-Faith Payment Debt Transfer
|
19990101
|
20210630
|
|
G2
|
Good Faith Payment
|
20180101
|
99991231
|
|
HH
|
Home Health Value-Based Purchasing
(HHVBP) Demonstration
|
20200101
|
99991231
|
|
KO
|
Allied Forces - Kosovo
|
19961220
|
19990601
|
|
LB
|
Low Back Pain Demonstration
|
20210101
|
20231231
|
|
LD
|
Laboratory Developed Tests
(LDTs) Demonstration
|
20130101
|
99991231
|
|
L2
|
Non-FDA Approved LDTs Demonstration
|
20130101
|
99991231
|
|
MC
|
Platelet Rich Plasma Injections
for the treatment of Musculoskeletal Conditions
|
20191001
|
20240930
|
|
MH
|
Mental Health Active Duty Cost-
Share
|
19991001
|
99991231
|
|
MM
|
Maryland Multi-Payer Patient-Centered Medical
Home Program (MMPCMHP)
|
20130503
|
20161229
|
|
MN
|
TSP (Non-Network)
|
19980101
|
20011231
|
|
MS
|
TSP (Network)
|
19980101
|
20011231
|
|
NE
|
Operation Noble Eagle/Operation
Enduring Freedom Demonstration (Reservists called to active duty
under Executive Order 13223)
|
20010914
|
20091031
|
|
NQ
|
PI Temporarily Suspended Provider,
Pharmacy, Entity, or Client Beneficiary Claim in ‘PROCESS STATUS’
|
20200101
|
99991231
|
|
PC
|
Provisional Coverage for Emerging
Services and Supplies
|
20150316
|
99991231
|
|
PD
|
Pharmacy Redesign Pilot Program
|
20000701
|
20010401
|
|
PF
|
ECHO (formerly PFPWD)
|
20020801
|
99991231
|
|
PH
|
Philippines Demonstration Project
|
20061001
|
20171231
|
|
PO
|
TRICARE Prime - Point of Service
(POS)
|
19991001
|
99991231
|
|
PS
|
Specialty Pharmacy Service
(MOP Only)
|
20150401
|
99991231
|
|
PV
|
Retail Network Pharmacy Services
for DVA/VHA Beneficiaries (TPharm Retail Pharmacies Only)
|
20080918
|
99991231
|
|
RB
|
Respite Benefit for Seriously
Injured or Ill ADSMs4
|
20080918
|
99991231
|
|
RD
|
Rare Diseases
|
20170310
|
99991231
|
|
RI
|
Resource Sharing - Internal
|
20020801
|
20221231
|
|
RS
|
Medicare/TRICARE Dual Entitlement
(First Payer - No TRICARE Provider Certification, i.e., Medicare
benefits have been exhausted)
|
20011001
|
99991231
|
|
SA
|
SHCP Gamete Handling/Transportation
|
20190801
|
99991231
|
|
SB
|
SHCP Portable CPAP Device
|
20190801
|
99991231
|
|
SC
|
SHCP - Non-TRICARE Eligible
|
19991001
|
99991231
|
|
SE
|
SHCP - TRICARE Eligible
|
19991001
|
99991231
|
|
SM
|
SHCP - Emergency
|
19991001
|
99991231
|
|
SN
|
TSS (Non-Network)
|
20000401
|
20021231
|
|
SP
|
Special/Emergent Care
|
19990601
|
99991231
|
|
SS
|
TSS (Network)
|
20000401
|
20021231
|
|
ST
|
Specialized Treatment
|
19970301
|
20030531
|
|
TA
|
New Technology Add-On Payments-DRG
|
20200101
|
99991231
|
|
TC
|
New COVID-19 Treatments Add-On
Payment (NCTAP)
|
20230112
|
20230930
|
|
UC
|
Urgent Care Pilot
|
20160523
|
20180101
|
|
WR
|
Mental Health Wraparound Demonstration
|
19980101
|
20010630
|
Algorithm
|
N/A
|
Subordinate And/Or Group Elements
|
Subordinate
|
Group
|
N/A
|
PROCESSING INFORMATION
|