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TRICARE Systems Manual 7950.3-M, April 1, 2015
TRICARE Encounter Data (TED)
Chapter 2
Section 2.10
Data Requirements - Provider Record Data
Revision:  C-4, October 20, 2017
DATA ELEMENT DEFINITION
ELEMENT NAME:  AHA MULTI-HOSPITAL SYSTEM CODE
Notes And Special Instructions:
1  Not required if provider is not an institution or part of a multi-hospital system. Otherwise, required if available.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Provider
3-105
1
Yes1
Primary Picture (Format)
Four (4) alphanumeric characters.
Definition
Code assigned by the American Hospital Association (AHA) to identify multi-hospital systems.
Code/Value Specifications
Must be blank if provider is not an institution.
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
N/A
DATA ELEMENT DEFINITION
ELEMENT NAME:  AMERICAN HOSPITAL ASSOCIATION ID NUMBER
Notes And Special Instructions:
1  Required if available.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Provider
3-100
1
Yes1
Primary Picture (Format)
Nine (9) alphanumeric characters.
Definition
The identification number assigned to the institution by the American Hospital Association (AHA).
Code/Value Specifications
Must be blank if provider is not an institution.
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
N/A
DATA ELEMENT DEFINITION
ELEMENT NAME:  AREA WAGE INDEX
Notes And Special Instructions:
1  Zero fill for all non-institutional providers and all DRG-exempt institutional facilities not reimbursed using an area wage index.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Provider
3-140
1
Yes1
Primary Picture (Format)
Five (5) numeric digits, including four (4) decimal places.
Definition
Adjustment factored to the labor-related portion of the ASA to account for the differences in wages among geographic areas, based on the hospital’s physical address, not billing address.
Code/Value Specifications
N/A
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
N/A
DATA ELEMENT DEFINITION
ELEMENT NAME:  AREA WAGE INDEX EFFECTIVE DATE
Notes And Special Instructions:
1  Zero fill if not applicable.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Provider
3-145
1
Yes1
Primary Picture (Format)
Eight (8) alphanumeric characters, YYYYMMDD.
Definition
Date the Area Wage Index or a change to the index became effective.
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:  CONTRACTOR NUMBER
Notes And Special Instructions:
N/A
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Provider
3-020
1
Yes
Primary Picture (Format)
Two (2) alphanumeric characters.
Definition
Identification code for the contractor. Used to identify each contractor submitting Provider File Records.
Code/Value Specifications
DHA assigned contractor number.
04
North Region (Effective 04/01/2011)
05
South Region (Effective 04/01/2012)
08
West Region (Effective 04/01/2013)
10
Overseas (Effective 09/01/2016)
12
East Region 2017
13
West Region 2017
15
Overseas (Effective 09/01/2010)
70
TPharm (Retail Pharmacy, MOP)
71
TDEFIC (Effective for contract awarded 08/03/2007)
73
TPharm (Effective 05/01/2015)
74
TDEFIC (Effective 01/01/2015)
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
N/A
DATA ELEMENT DEFINITION
ELEMENT NAME:  EXEMPT/NON-EXEMPT INDICATOR
Notes And Special Instructions:
1  Report blank for all non-institutional providers.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Provider
3-150
1
Yes1
Primary Picture (Format)
One (1) alphanumeric character.
Definition
Indicates whether the institutional provider is exempted from the TRICARE DRG-based payment system.
Code/Value Specifications
b
Not applicable
C
DRG Non-exempt/Contracted Reimbursement Arrangement
E
DRG Exempt
N
DRG Non-exempt
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
N/A
DATA ELEMENT DEFINITION
ELEMENT NAME:  DRG EXEMPT/NON-EXEMPT INDICATOR EFFECTIVE DATE
Notes And Special Instructions:
1  Zero fill for all non-institutional providers.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Provider
3-155
1
Yes1
Primary Picture (Format)
Eight (8) alphanumeric characters, YYYYMMDD.
Definition
Date the exempt/non-exempt status of the institutional provider became effective or a status change became effective.
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:  IDME RATIO
Notes And Special Instructions:
1  Zero fill for all non-institutional providers and all DRG-exempt institutional facilities not reimbursed using an IDME Ratio.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Provider
3-130
1
Yes1
Primary Picture (Format)
Five (5) numeric digits, including four (4) decimal places.
Definition
The ratio used on a hospital-specific basis to standardize the charges for the cost effects of IDME factors for teaching hospitals.
Code/Value Specifications
N/A
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
N/A
DATA ELEMENT DEFINITION
ELEMENT NAME:  IDME RATIO EFFECTIVE DATE
Notes And Special Instructions:
1  Zero fill for all non-institutional providers and DRG-exempt institutional providers.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Provider
3-135
1
Yes1
Primary Picture (Format)
Eight (8) alphanumeric characters, YYYYMMDD.
Definition
Date the IDME ratio or a change to the IDME ratio became effective.
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:  INSTITUTIONAL OR NON-INSTITUTIONAL INDICATOR
Notes And Special Instructions:
1  An institution is any facility having the capability to retain a patient overnight, excluding freestanding Birthing Centers and freestanding ASCs. In addition, if the institution provides professional services related to DRG claims and/or has clinics affiliated with it (using the same TIN), it must be reported as a ‘non-Institutional’ provider, with indicator N. Refer to the instructions under PROVIDER SUB-IDENTIFIER for reporting.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Provider
3-030
1
Yes1
Primary Picture (Format)
One (1) alphanumeric character.
Definition
Code used to identify a provider as an institution or non-institution.
Code/Value Specifications
I
Institutional1
N
Non-Institutional
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
N/A
DATA ELEMENT DEFINITION
ELEMENT NAME:  MEDICARE NUMBER
Notes And Special Instructions:
1  Report blank for non-institutional and institutional providers not Medicare-approved or in a foreign country.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Provider
3-110
1
Yes1
Primary Picture (Format)
Eight (8) alphanumeric characters.
Definition
Number assigned to an institution by Medicare.
Code/Value Specifications
If Medicare Number is not blank, the first two characters must identify the Medicare State Code (two numeric digits) where the provider is located (refer to Addendum B, Figure 2.B-2) and characters three through six must identify the type of facility.
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
N/A
DATA ELEMENT DEFINITION
ELEMENT NAME:  PROVIDER ACCEPTANCE DATE
Notes And Special Instructions:
1  When submitting a provider record for a provider who has never met the criteria to provide services, the PROVIDER ACCEPTANCE and TERMINATION dates must be zero filled.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Provider
3-115
1
Yes1
Primary Picture (Format)
Eight (8) alphanumeric characters, YYYYMMDD.
Definition
Date a provider met criteria to provide services. If the provider was never qualified to provide services zero fill.
Code/Value Specifications
Must be valid date YYYYMMDD. Should be latest date of acceptance.
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:  PROVIDER ADDRESS
Notes And Special Instructions:
N/A
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Provider
3-040
1
Yes
Primary Picture (Format)
Group
Definition
Actual physical location of the provider’s place of business.
Code/Value Specifications
N/A
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
PROVIDER STREET ADDRESS
PROVIDER CITY
PROVIDER STATE OR COUNTRY CODE
PROVIDER ZIP CODE
N/A
DATA ELEMENT DEFINITION
ELEMENT NAME:  PROVIDER BILLING ADDRESS
Notes And Special Instructions:
1  If any PROVIDER BILLING ADDRESS element (3-070 through 3-085) is different than those of the PROVIDER ADDRESS, all billing address elements must be reported.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Provider
3-065
1
Yes1
Primary Picture (Format)
Group
Definition
Billing mailing address of the TRICARE Provider.
Code/Value Specifications
Left justify and blank fill. Blank fill if not required.1
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
PROVIDER BILLING STREET ADDRESS
PROVIDER BILLING CITY
PROVIDER BILLING STATE OR COUNTRY CODE
PROVIDER BILLING ZIP CODE
N/A
DATA ELEMENT DEFINITION
ELEMENT NAME:  PROVIDER BILLING CITY
Notes And Special Instructions:
1  If any PROVIDER BILLING ADDRESS element (3-070 through 3-085) is different than those of the PROVIDER ADDRESS, all billing address elements must be reported.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Provider
3-075
1
Yes1
Primary Picture (Format)
Eighteen (18) alphanumeric characters.
Definition
City name for mailing address of TRICARE provider.
Code/Value Specifications
Left justify and blank fill. Blank fill if not required.1
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
PROVIDER BILLING ADDRESS
DATA ELEMENT DEFINITION
ELEMENT NAME:  PROVIDER BILLING STATE OR COUNTRY CODE
Notes And Special Instructions:
1  If any PROVIDER BILLING ADDRESS element (3-070 through 3-085) is different than those of the PROVIDER ADDRESS, all billing address elements must be reported.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Provider
3-080
1
Yes1
Primary Picture (Format)
Three (3) alphanumeric characters.
Definition
State or country of provider’s mailing address. State Code must be left justified and blank fill to right.
Code/Value Specifications
Refer to Addendums A and B. Blank fill if not required.1
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
PROVIDER BILLING ADDRESS
DATA ELEMENT DEFINITION
ELEMENT NAME:  PROVIDER BILLING STREET ADDRESS
Notes And Special Instructions:
1  If any PROVIDER BILLING ADDRESS element (3-070 through 3-085) is different than those of the PROVIDER ADDRESS, all billing address elements must be reported.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Provider
3-070
1
Yes1
Primary Picture (Format)
Thirty (30) alphanumeric characters.
Definition
Billing mailing address of the provider. Can be street, P.O. Box or R. Route. Standard U.S. Postal Service (USPS) abbreviations must be used.
Code/Value Specifications
Left justify and blank fill. Blank fill if not required.1
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
PROVIDER BILLING ADDRESS
DATA ELEMENT DEFINITION
ELEMENT NAME:  PROVIDER BILLING ZIP CODE
Notes And Special Instructions:
1  If any PROVIDER BILLING ADDRESS element (3-070 through 3-085) is different than those of the PROVIDER ADDRESS, all billing address elements must be reported.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Provider
3-085
1
Yes1
Primary Picture (Format)
Nine (9) alphanumeric characters.
Definition
Zip code for provider mailing address.
Code/Value Specifications
Must be valid zip code or blank. Must be blank if not required.1
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
PROVIDER BILLING ADDRESS
DATA ELEMENT DEFINITION
ELEMENT NAME:  PROVIDER CITY
Notes And Special Instructions:
N/A
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Provider
3-050
1
Yes
Primary Picture (Format)
Eighteen (18) alphanumeric characters.
Definition
City in which the provider of medical care is located.
Code/Value Specifications
Must be left justified and blank filled.
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
PROVIDER ADDRESS
DATA ELEMENT DEFINITION
ELEMENT NAME:  PROVIDER CONTRACT AFFILIATION CODE
Notes And Special Instructions:
1  Codes 1, 2, and 3 apply only to financially underwritten contractors and subcontractors, and the TOP contract. Report 0 if not a financially underwritten contractor. All codes are irrespective of any Partnership agreements.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Provider
3-025
1
Yes
Primary Picture (Format)
One (1) alphanumeric character.
Definition
Code indicates whether the provider is under contract with the contractor.
Code/Value Specifications
0
Not applicable
1
Contracted1
2
Not Contracted1
3
Contracted/Not Contracted1
4
Active Duty - TPR
5
Non-Certified Providers (does not include sanction/suspended providers)
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
N/A
DATA ELEMENT DEFINITION
ELEMENT NAME:  PROVIDER MAJOR SPECIALTY/TYPE OF INSTITUTION
Notes And Special Instructions:
N/A
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Provider
3-090
1
Yes
Primary Picture (Format)
Ten (10) alphanumeric characters.
Definition
Code describing a provider’s major specialty for non-institutional TEDs or a code describing the type of institution for institutional TEDs. Type of Institution must be left justified and blank filled to the right.
Code/Value Specifications
Refer to http://www.wpc-edi.com/references/ for non-institutional provider specialty codes. Refer to Addendum D, Figure 2.D-1 for type of institution codes for Institutional TEDs. Refer to Addendum C, Figure 2.C-1 for assistance when assigning Provider Specialty Codes to Outpatient Hospital non-institutional provider records.
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
N/A
DATA ELEMENT DEFINITION
ELEMENT NAME:  PROVIDER NAME
Notes And Special Instructions:
N/A
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Provider
3-035
1
Yes
Primary Picture (Format)
Forty (40) alphanumeric characters.
Definition
Name of provider.
Code/Value Specifications
Must be left justified and blank filled. If this field is a person’s name, it should be in the form of last name, first name, middle initial (each name should be separated by a comma with no space between the name). Do not use articles such as the, A, An, etc. Use standard abbreviations such as St. for Saint, Comm for community, Hosp for hospital, etc.
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
N/A
DATA ELEMENT DEFINITION
ELEMENT NAME:  PROVIDER STATE OR COUNTRY CODE
Notes And Special Instructions:
For EMCs that are submitted with a Medicare UPIN with PIN or other alternative provider source identifier, the requirement to assign multiple provider sub-identifiers for providers with more than one location within the same TIN and zip code is not applicable. However, the requirement to identify the rendering provider by use of provider sub-identifier remains applicable. See the TRICARE Operations Manual (TOM), Chapter 8, Section 7.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Provider
3-055
1
Yes
Primary Picture (Format)
Three (3) alphanumeric characters.
Definition
Code assigned to identify the state or foreign country in which the provider is physically located. State codes will be left justified and blank filled to the right.
Code/Value Specifications
Reference Addendums A and B.
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
N/A
DATA ELEMENT DEFINITION
ELEMENT NAME:  PROVIDER STREET ADDRESS
Notes And Special Instructions:
N/A
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Provider
3-045
1
Yes
Primary Picture (Format)
Thirty (30) alphanumeric characters.
Definition
Street address of a DHA provider’s location. Standard U.S. Postal Service (USPS) abbreviations must be used. P. O. Box may be used only for providers with specialties of anesthesiology, radiology, or pathology.
Code/Value Specifications
Must be left justified and blank filled.
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
PROVIDER ADDRESS
DATA ELEMENT DEFINITION
ELEMENT NAME:  PROVIDER SUB-IDENTIFIER
Notes And Special Instructions:
N/A
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Provider
3-010
1
Yes
Primary Picture (Format)
Four (4) alphanumeric characters.
Definition
Identification number that uniquely identifies multiple providers using the same Taxpayer Identification Number (TIN).
Code/Value Specifications
Must be zero-filled if there are no multiple providers within the TIN and zip code.
For non-institutional providers, including institutions that render non-institutional care (e.g., outpatient), no two Provider Sub-Identifiers may be the same within a TIN and zip code.
For clinics, Provider Sub-Identifier is assigned with an alpha character in the first position or first two positions followed by two or three numeric digits, sequentially assigned with the clinic always assigned 01 or 001. Individual providers within the clinic would then begin with 02 or 002 having the same alpha character(s) in the first position as the clinic record.
For all other non-institutional providers, the Provider Sub-Identifier must be four numeric digits.
Institutional Provider Sub-Identifiers are to be numeric digits and sequentially assigned within the TIN. For requirements on reporting institutional providers as outpatient hospital non-institutional providers, see Provider Sub-Identifier Example 2.
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
N/A
provider sub-identifier example 1Example:  City Wide Clinic with a TIN of 123456789 has three locations in an area. They would be submitted to DHA in the following format:
tin
zip code
sub-id
name
spec
123456789
12345
A001
City Wide Clinic 1
193200000X
123456789
12345
A002
Doctor Jones
207KA0200X
123456789
12345
A003
Doctor Smith
208D00000X
123456789
12345
A004
Doctor Brown
207K00000X
123456789
12345
A005
Doctor Doe
207Q00000X
123456789
12345
B001
City Wide Clinic 2
193200000X
123456789
12345
B002
Doctor Watson
208D00000X
123456789
12345
B003
Doctor Allen
207RG0100X
123456789
54321
A00
City Wide Clinic 3
193200000X
123456789
54321
A002
Doctor Peterson
207QA0401X
123456789
54321
A003
Doctor Adams
2084P0802X
provider sub-identifier example 2Example:  Township Hospital with a TIN of 987654321 provides outpatient services (e.g., emergency room, etc.) and has two affiliated clinics in the area. These provider records should be reported to DHA in the following manner:
tin
zip code
i/n-i ind
sub-id
name
spec
987654321
67890
N
0000
Township Hospital
282N00000X
987654321
67890
N
A001
Township Ear Nose & Throat Clinic
193400000X
987654321
67890
N
A002
Dr. Jones
207YX0602X
987654321
67890
N
A003
Dr. Smith
207YP0228X
987654321
69116
N
A001
Township Surgeons Group
193400000X
987654321
69116
N
A002
Dr. Cutter
207XX0004X
987654321
69116
N
A003
Dr. Suture
207XX0005X
DATA ELEMENT DEFINITION
ELEMENT NAME:  PROVIDER TAXPAYER NUMBER
Notes And Special Instructions:
1  Claims for care rendered by an institutional provider located in the U.S. must be processed with a valid EIN. Contractor-assigned provider numbers will not be allowed.
For Retail Pharmacies the Provider Taxpayer Number may be either the IRS TIN assigned to the individual pharmacy supplying the care or the chain TIN of the pharmacy.
For Retain Pharmacies the Provider Acceptance Date may be either the date the pharmacy was eligible to provide services according to NCPDP or a date approved by DHA.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Provider
3-005
1
Yes
Primary Picture (Format)
Nine (9) alphanumeric characters.
Definition
The IRS TIN assigned to the provider supplying the care.
Code/Value Specifications
For institutions must be a nine digit EIN. For individual providers must be a nine digit TIN or SSN if TIN is not applicable. If not available, follow reporting requirements listed below.
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
N/A
provider taxpayer number reporting requirements
1.  The contractor responsible for certifying the provider shall assign an 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:
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.
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.
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.
2.  When neither the EIN nor the SSN is available for the provider and the provider is located in your contract area1.
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.
b.  If the provider is not an institutional provider and is located in the United States (U.S.), 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.
Example: The first provider from Maryland would be coded MD b 000001. Refer to instruction below, for exception.
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.
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.
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.
DATA ELEMENT DEFINITION
ELEMENT NAME:  PROVIDER TAXPAYER NUMBER IDENTIFIER
Notes And Special Instructions:
N/A
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Provider
3-015
1
Yes
Primary Picture (Format)
One (1) alphanumeric character.
Definition
Code to identify the Provider Taxpayer Identification Number as being an EIN or SSN or contractor assigned.
Code/Value Specifications
A
Assigned by contractor (valid only for non-institutional providers when no payment is made to the provider, and providers from foreign countries without a TIN.)
E
Indicates EIN
S
Indicates SSN (valid for non-institutional only)
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
N/A
DATA ELEMENT DEFINITION
ELEMENT NAME:  PROVIDER TERMINATION DATE
Notes And Special Instructions:
1  Required if update is to suspend or terminate a provider.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Provider
3-120
1
Yes1
Primary Picture (Format)
Eight (8) alphanumeric characters, YYYYMMDD.
Definition
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 fill.
Code/Value Specifications
Must be valid date, YYYYMMDD. Zero fill if not applicable, or if provider acceptance date is zero filled.
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:  PROVIDER ZIP CODE
Notes And Special Instructions:
1  First five digits are required.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Provider
3-060
1
Yes1
Primary Picture (Format)
Nine (9) alphanumeric characters.
Definition
Zip 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.
Code/Value Specifications
Must be valid five or nine digit zip code. If only five digits, left justify and blank fill. If a foreign country, must be three character foreign country code, left justify and blank fill, refer to Addendum A.
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
N/A
DATA ELEMENT DEFINITION
ELEMENT NAME:  RECORD EFFECTIVE DATE
Notes And Special Instructions:
N/A
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Provider
3-165
1
Yes
Primary Picture (Format)
Eight (8) alphanumeric characters, YYYYMMDD.
Definition
Date to indicate the effective date of the data on this record.
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:  RECORD TYPE INDICATOR
Notes And Special Instructions:
N/A
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Provider
3-001
1
Yes
Primary Picture (Format)
One (1) alphanumeric character.
Definition
Code to indicate the type of record.
Code/Value Specifications
3
Provider
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
N/A
DATA ELEMENT DEFINITION
ELEMENT NAME:  RURAL/URBAN INDICATOR
Notes And Special Instructions:
1  Report blank for all non-institutional providers and all DRG-exempt institutional facilities not reimbursed using a RURAL/URBAN INDICATOR.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Provider
3-125
1
Yes1
Primary Picture (Format)
One (1) alphanumeric character.
Definition
Indicates for DRG amount calculation whether the institution is located in a rural or urban area.
Code/Value Specifications
b
Not applicable
L
Large Urban
R
Rural
U
Urban
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
N/A
DATA ELEMENT DEFINITION
ELEMENT NAME:  TRANSACTION CODE
Notes And Special Instructions:
1  A record must be on file to Modify or Inactivate. A record cannot be on file if transaction is to add a new record.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Provider
3-160
1
Yes1
Primary Picture (Format)
One (1) alphanumeric character.
Definition
Code used to identify type of processing to be done on the record.
Code/Value Specifications
A
Add a record
I
Inactivate a record
M
Modify a record
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
N/A
DATA ELEMENT DEFINITION
ELEMENT NAME:  TYPE OF INSTITUTION TERM INDICATOR CODE
Notes And Special Instructions:
1  Blank fill if not applicable.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Provider
3-095
1
Yes1
Primary Picture (Format)
One (1) alphanumeric character.
Definition
Code used to identify type of institution as short or long term.
Code/Value Specifications
L
Long term (30 days or more)
S
Short term (less than 30 days)
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
N/A
- END -

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