TRICARE Encounter Data (TED)
Chapter 2
Section 2.3
Data Requirements - Header
Record Data
Revision:
DATA ELEMENT DEFINITION
ELEMENT NAME: BATCH/VOUCHER CLIN/ASAP ACCOUNT NUMBER
|
Notes
And Special Instructions:
CLIN based CLIN/ASAP Account Numbers are
used for Invoicing (via the TED record) the Cost Reimbursement Benefit
CLINs (positions 1 through 6 of the CLIN/ASAP Account Number shall
equal the benefit contract CLIN or sub-CLIN you are invoicing),
ASAP based CLIN/ASAP Account Numbers are used for the reporting
of ‘pass-through’ costs.
|
Records/Locator Numbers
|
Record
Name
|
Locator#
|
Occurrences
|
Required
|
Header
|
0-025
|
1
|
Yes1
|
Primary
Picture (Format)
|
Eight
(8) alphanumeric characters.
|
Definition
|
This
field is used to identify the ASAP Account Number2 the
voucher will be drawn from. Each year when new non-financially underwritten
bank account(s) are setup by the contractor (per the financial provisions
of the contract), DHA will assign an eight digit CLIN/ASAP Account
Number to draw funds from as checks clear the non-financially underwritten
bank account(s).
|
Code/Value
Specifications
|
N/A
|
Algorithm
|
Section 1.1, paragraph 5.0 provides instructions
on how to assign TED records to the Accrual Fund.
|
Subordinate
And/Or Group Elements
|
Subordinate
|
Group
|
N/A
|
VOUCHER
NUMBER
|
DATA ELEMENT DEFINITION
ELEMENT NAME: BATCH/VOUCHER DATE
|
Notes
And Special Instructions:
N/A
|
Records/Locator Numbers
|
Record
Name
|
Locator#
|
Occurrences
|
Required
|
Header
|
0-030
|
1
|
Yes
|
Primary
Picture (Format)
|
Seven
(7) alphanumeric characters, YYYYDDD.
|
Definition
|
Date
the contractor first created the batch/voucher for transmission
to DHA. This date will not change through the resubmission process.
|
Code/Value
Specifications
|
YYYY
|
4
digit calendar year
|
|
DDD
|
3
digit Julian date
|
Algorithm
|
N/A
|
Subordinate
And/Or Group Elements
|
Subordinate
|
Group
|
N/A
|
BATCH/VOUCHER
NUMBER
|
DATA ELEMENT DEFINITION
ELEMENT NAME: BATCH/VOUCHER IDENTIFIER
|
Notes
And Special Instructions:
N/A
|
Records/Locator Numbers
|
Record
Name
|
Locator#
|
Occurrences
|
Required
|
Header
|
0-015
|
1
|
Yes
|
Primary
Picture (Format)
|
One
(1) alphanumeric character.
|
Definition
|
Identifies
the type of records submitted in the batch/voucher.
|
Code/Value
Specifications
|
3
|
Provider
(Batch Only)
|
|
5
|
Institutional/Non-Institutional
(Batch/Voucher)
|
Algorithm
|
N/A
|
Subordinate
And/Or Group Elements
|
Subordinate
|
Group
|
N/A
|
CONTRACT
IDENTIFIER
|
DATA ELEMENT DEFINITION
ELEMENT NAME: BATCH/VOUCHER NUMBER
|
Notes
And Special Instructions:
N/A
|
Records/Locator Numbers
|
Record
Name
|
Locator#
|
Occurrences
|
Required
|
Header
|
0-020
|
1
|
Yes
|
Primary
Picture (Format)
|
Group
|
Definition
|
Field
containing multiple elements that uniquely identify the batch/voucher.
|
Code/Value
Specifications
|
N/A
|
Algorithm
|
N/A
|
Subordinate
And/Or Group Elements
|
Subordinate
|
Group
|
BATCH/VOUCHER
ASAP ACCOUNT NUMBER
BATCH/VOUCHER
DATE
BATCH/VOUCHER
SEQUENCE NUMBER
BATCH/VOUCHER
RESUBMISSION NUMBER
|
CONTRACT
IDENTIFIER
|
DATA ELEMENT DEFINITION
ELEMENT NAME: BATCH/VOUCHER RESUBMISSION NUMBER
|
Notes
And Special Instructions:
N/A
|
Records/Locator Numbers
|
Record
Name
|
Locator#
|
Occurrences
|
Required
|
Header
|
0-040
|
1
|
Yes
|
Primary
Picture (Format)
|
Two
(2) alphanumeric characters.
|
Definition
|
Identifies
the number of submissions for the batch/voucher.
|
Code/Value
Specifications
|
N/A
|
Algorithm
|
Set
initial submission batch/voucher to 00 and increment by one (1)
with each resubmission of rejected TED records. Do not increment
if resubmitting a batch/voucher that failed batch/voucher header
edits.
|
Subordinate
And/Or Group Elements
|
Subordinate
|
Group
|
N/A
|
BATCH/VOUCHER
NUMBER
|
DATA ELEMENT DEFINITION
ELEMENT NAME: BATCH/VOUCHER SEQUENCE NUMBER
|
Notes
And Special Instructions:
Batch/Voucher
Sequence Number will not be duplicated for that date (i.e., once
sequence number 01 has been assigned to a batch or voucher it cannot
be assigned to any other batch or voucher for that day).
|
Records/Locator Numbers
|
Record
Name
|
Locator#
|
Occurrences
|
Required
|
Header
|
0-035
|
1
|
Yes
|
Primary
Picture (Format)
|
Two
(2) alphanumeric characters.
|
Definition
|
A
sequential number assigned by the contractor to uniquely identify
the batch/voucher. Once assigned, the number remains with the batch/voucher
throughout the resubmission process if applicable.
|
Code/Value
Specifications
|
N/A
|
Algorithm
|
Set
initial sequence number to 01 and increment by one (1) for each
subsequent batch/voucher for that date. Do not “reuse” sequence
number within Contract Identifier for that date.
|
Subordinate
And/Or Group Elements
|
Subordinate
|
Group
|
N/A
|
BATCH/VOUCHER
NUMBER
|
DATA ELEMENT DEFINITION
ELEMENT NAME: CONTRACT IDENTIFIER
|
Notes
And Special Instructions:
N/A
|
Records/Locator Numbers
|
Record
Name
|
Locator#
|
Occurrences
|
Required
|
Header
|
0-005
|
1
|
Yes
|
Primary
Picture (Format)
|
Group
|
Definition
|
Field
containing multiple elements that uniquely identify each batch/voucher
of records submitted by the contractor.
|
Code/Value
Specifications
|
N/A
|
Algorithm
|
N/A
|
Subordinate
And/Or Group Elements
|
Subordinate
|
Group
|
CONTRACT
NUMBER
BATCH/VOUCHER
IDENTIFIER
BATCH/VOUCHER
NUMBER
|
N/A
|
DATA ELEMENT DEFINITION
ELEMENT NAME: CONTRACT NUMBER
|
Notes
And Special Instructions:
N/A
|
Records/Locator Numbers
|
Record
Name
|
Locator#
|
Occurrences
|
Required
|
Header
|
0-010
|
1
|
Yes
|
Primary
Picture (Format)
|
Thirteen
(13) alphanumeric characters.
|
Definition
|
The
unique 13 digit contract number assigned to a contract.
|
Code/Value
Specifications
|
N/A
|
Algorithm
|
N/A
|
Subordinate
And/Or Group Elements
|
Subordinate
|
Group
|
N/A
|
CONTRACT
IDENTIFIER
|
DATA ELEMENT DEFINITION
ELEMENT NAME: FUND ACCOUNTING
|
Notes
And Special Instructions:
Note: For TMOP records, the FUND
ACCOUNTING must equal the sum of (AMOUNT ALLOWED BY PROCEDURE CODE
minus AMOUNT BILLED BY PROCEDURE CODE) for all included records.
For TPHARM MOP records, the FUND ACCOUNTING
must equal the sum of AMOUNT ALLOWED BY PROCEDURE CODE for all included
records for Batch/Voucher Dates on or after July 14, 2011. FUND
ACCOUNTING must be zero for Batch/Voucher Dates prior to July 14,
2011.
|
Records/Locator Numbers
|
Record
Name
|
Locator#
|
Occurrences
|
Required
|
Header
|
0-065
|
1
|
Yes1
|
Primary
Picture (Format)
|
Ten
(10) signed numeric digits including two (2) decimal places.
|
Definition
|
This
field contains the total Government drug cost dollars dispensed
by the contractor.
|
Code/Value
Specifications
|
N/A
|
Algorithm
|
N/A
|
Subordinate
And/Or Group Elements
|
Subordinate
|
Group
|
N/A
|
N/A
|
DATA ELEMENT DEFINITION
ELEMENT NAME: HEADER TYPE INDICATOR
|
Notes
And Special Instructions:
Contractors
are responsible for ensuring claims are submitted under the correct
Header Type Indicator when billing Administrative CLINs on a TED
record. TED records shall be submitted under the correct Header
Type Indicator in order to receive and retain Administrative CLIN
payment(s). Refer to Section G.II of the contract for guidance on
using this field to invoice Administrative CLINs.
|
Records/Locator Numbers
|
Record
Name
|
Locator#
|
Occurrences
|
Required
|
Header
|
0-001
|
1
|
Yes
|
Primary
Picture (Format)
|
One
(1) alphanumeric character.
|
Definition
|
Code
to indicate whether the record is a batch header or voucher header,
and whether a voucher contains admin rate eligible records.
|
Code/Value
Specifications
|
0
|
Batch
Header (used on all provider batches, and for institutional/non-institutional
non-admin claim rate TED records).
|
|
5
|
Voucher
Header (used only for institutional/non-institutional non-admin
claim rate eligible TED records).
|
|
6
|
Voucher
Header (used only for institutional/non-institutional admin claim
rate eligible TED records).
|
|
9
|
Batch
Header (institutional/non-institutional admin claim rate eligible
TED records).
|
Algorithm
|
N/A
|
Subordinate
And/Or Group Elements
|
Subordinate
|
Group
|
N/A
|
N/A
|
DATA ELEMENT DEFINITION
ELEMENT NAME: INITIAL TRANSMISSION DATE (DHA DERIVED)
|
Notes
And Special Instructions:
|
Records/Locator Numbers
|
Record
Name
|
Locator#
|
Occurrences
|
Required
|
Header
|
0-055
|
1
|
Yes1
|
Primary
Picture (Format)
|
Eight
(8) numeric digits, YYYYMMDD.
|
Definition
|
The
Initial Transmission Date is the date the contractor transmitted
the voucher to DHA.
1. Voucher:
Once submission 00 has cleared, the Initial Transmission Received
date cannot change, since this will be the date that
DHA obligates the non-financially underwritten money and the date
that will appear on the checks being issued to the providers/beneficiaries.
2. Batch:
This field will be zero filled.
|
Code/Value
Specifications
|
YYYY
|
4
digit calendar year
|
|
MM
|
2
digit calendar month
|
|
DD
|
2
digit calendar day
|
Algorithm
|
N/A
|
Subordinate
And/Or Group Elements
|
Subordinate
|
Group
|
N/A
|
N/A
|
DATA ELEMENT DEFINITION
ELEMENT NAME: DHA BATCH/VOUCHER PROCESSING DATE (DHA DERIVED)
|
Notes
And Special Instructions:
|
Records/Locator Numbers
|
Record
Name
|
Locator#
|
Occurrences
|
Required
|
Header
|
0-060
|
1
|
No1
|
Primary
Picture (Format)
|
Eight
(8) numeric digits, YYYYMMDD.
|
Definition
|
The
date the batch/voucher was processed by DHA.
|
Code/Value
Specifications
|
YYYY
|
4
digit calendar year
|
|
MM
|
2
digit calendar month
|
|
DD
|
2
digit calendar day
|
Algorithm
|
N/A
|
Subordinate
And/Or Group Elements
|
Subordinate
|
Group
|
N/A
|
N/A
|
DATA ELEMENT DEFINITION
ELEMENT NAME: TOTAL AMOUNT PAID
|
Notes
And Special Instructions:
Note: For MOP Contract MDA906-02-C-0013
records, the TOTAL AMOUNT PAID must equal AMOUNT PAID BY GOVERNMENT CONTRACTOR
BY PROCEDURE CODE for all included records.
|
Records/Locator Numbers
|
Record
Name
|
Locator#
|
Occurrences
|
Required
|
Header
|
0-050
|
1
|
Yes1
|
Primary
Picture (Format)
|
Twelve
(12) signed numeric digits including two (2) decimal places.
|
Definition
|
This
field contains the total benefit dollars paid by the contractor
and the interest paid for the TED records contained in either the
batch or voucher.
|
Code/Value
Specifications
|
N/A
|
Algorithm
|
N/A
|
Subordinate
And/Or Group Elements
|
Subordinate
|
Group
|
N/A
|
N/A
|
DATA ELEMENT DEFINITION
ELEMENT NAME: TOTAL NUMBER OF RECORDS
|
Notes
And Special Instructions:
N/A
|
Records/Locator Numbers
|
Record
Name
|
Locator#
|
Occurrences
|
Required
|
Header
|
0-045
|
1
|
Yes
|
Primary
Picture (Format)
|
Seven
(7) numeric digits.
|
Definition
|
Total
number of records submitted in the batch or voucher, exclusive of
the header and trailer records. (Refer to Section 2.2, paragraph 5.0.)
|
Code/Value
Specifications
|
N/A
|
Algorithm
|
N/A
|
Subordinate
And/Or Group Elements
|
Subordinate
|
Group
|
N/A
|
N/A
|
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