Records/Locator
Numbers
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Record Name
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Locator#
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Occurrences
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Required
|
Provider
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3-005
|
1
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Yes
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Primary Picture (Format)
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Nine (9) alphanumeric characters.
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Definition
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The Internal Revenue Service
(IRS) TIN assigned to the provider supplying the care.
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Code/Value Specifications
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For institutions must be a
nine digit Employer Identification Number (EIN). For individual
providers must be a nine digit TIN or Social Security Number (SSN)
if TIN is not applicable. If not available, follow reporting requirements
listed below.
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Algorithm
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N/A
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Subordinate And/Or Group Elements
|
Subordinate
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Group
|
N/A
|
N/A
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provider taxpayer number reporting
requirements
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1. The contractor responsible
for certifying the provider shall assign an Assigned Provider Number
(APN) as outlined below when the actual TIN of a provider is not
available. The use of a contractor-assigned APN is restricted to
the following situations:
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a. The provider is located in
a foreign country and does not have a TIN. If a foreign provider
has a TIN, it is to be used. Otherwise, an APN is used regardless
of whether the claim is to be paid or denied.
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b. The provider does not meet
TRICARE certification requirements or the contractor does not have
substantial evidence that the provider meets the TRICARE certification
requirements.
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c. The contractor has substantial
evidence that the provider meets the TRICARE certification requirements.
In this case, the payment must be made to the beneficiary.
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2. When neither the EIN nor the
SSN is available for the provider and the provider is located in
your contract area1.
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a. If the provider is located
in a foreign country, the field is coded in the following manner.
|
Position 1 though 3 -
The three character alpha abbreviation of the country in which the
provider or institution is located ( Addendum A).
|
Position 4 through 9 -
A six digit sequential contractor assigned number. These numbers
are to be permanently assigned to the provider.
|
Example: The first
provider from Mexico will be coded MEX000001.
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b. If the provider is not an institutional
provider and is located in the United States (US), the field is
coded in the following manner.
|
Position 1 through 3 -
The two character abbreviation of the state (left justify and blank
fill) in which the provider or facility is located ( Addendum B).
|
Position 4 through 9 -
A six digit sequential contractor assigned number.
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Example: The first
provider from Maryland would be coded MD b 000001.
Refer to instruction below, for exception.
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c. For ECHO, if the TED record
is for transportation via a POV, assign a TIN of all nines and do
not submit a provider record.
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3. If it is necessary to assign
a number for a provider that is outside of your contract area, the
number is assigned following all the above rules except the fourth
high order digit must be an A.
|
Example: If a
beneficiary, whose care when traveling outside of your area is your
responsibility, received care in Mexico, it will be coded MEXA00001.
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Note: These
numbers, once assigned, will not be reassigned to another provider.
Upon receipt of a valid EIN or SSN, inactivate the APN provider
record and submit an ADD transaction for the actual
TIN. After the TIN record is added, subsequent adjustments to the
TED records previously reported using an APN shall be reported with
the current TIN and provider information.
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