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TRICARE Systems Manual 7950.3-M, April 1, 2015
TRICARE Encounter Data (TED)
Chapter 2
Section 2.2
Data Requirements - Data Element Layout
Revision:  C-21, January 31, 2019
1.0  Batch/Voucher Header Data Element
Position
ELN
Element Name
Format
From
Thru
0-001
HEADER TYPE INDICATOR
X
1
1
0-005
CONTRACT IDENTIFIER
2
34
0-010
CONTRACT NUMBER
X(13)
2
14
0-015
BATCH/VOUCHER IDENTIFIER
X
15
15
0-020
BATCH/VOUCHER NUMBER
16
34
0-025
BATCH/VOUCHER CLIN/ASAP ACCOUNT NUMBER
X(8)
16
23
0-030
BATCH/VOUCHER DATE
YYYYDDD
24
30
0-035
BATCH/VOUCHER SEQUENCE NUMBER
X(2)
31
32
0-040
BATCH/VOUCHER RESUBMISSION NUMBER
X(2)
33
34
0-045
TOTAL NUMBER OF RECORDS
9(7)
35
41
0-050
TOTAL AMOUNT PAID
S9(10)V99
42
53
0-055
INITIAL TRANSMISSION DATE (DHA DERIVED)
YYYYMMDD
54
61
0-060
DHA BATCH/VOUCHER PROCESSING DATE (DHA DERIVED)
YYYYMMDD
62
69
0-065
FUND ACCOUNTING
S9(8)V99
70
79
2.0  Institutional Data Element
Position
ELN
Element Name
Format
From
Thru
1-001
RECORD TYPE INDICATOR
X
1
1
1-005
TED RECORD INDICATOR
2
25
1-010
INTERNAL CONTROL NUMBER (ICN)
2
18
1-015
FILING DATE
YYYYDDD
2
8
1-020
FILING STATE/COUNTRY CODE
X(3)
9
11
1-025
SEQUENCE NUMBER
X(7)
12
18
1-030
TIME STAMP
X(6)
19
24
1-035
ADJUSTMENT KEY
X
25
25
1-040
DATE TED RECORD PROCESSED TO COMPLETION
YYYYMMDD
26
33
1-045
DATE ADJUSTMENT IDENTIFIED
YYYYMMDD
34
41
1-050
PERSON IDENTIFIER (SPONSOR)
X(9)
42
50
1-051
PERSON IDENTIFIER TYPE CODE (SPONSOR)
X
51
51
1-056
PAY GRADE CODE (SPONSOR)
X(2)
52
53
1-057
PAY PLAN CODE (SPONSOR)
X(5)
54
58
1-060
SERVICE BRANCH CLASSIFICATION CODE (SPONSOR)
X
59
59
1-065
AGR SERVICE LEGAL AUTHORITY CODE
X
60
60
1-066
HEALTH CARE COVERAGE MEMBER CATEGORY CODE
X
61
61
1-070
HEALTH CARE COVERAGE MEMBER RELATIONSHIP CODE
X
62
62
1-075
PERSON NAME (PATIENT)
63
157
1-076
PERSON LAST NAME (PATIENT)
X(35)
63
97
1-077
PERSON FIRST NAME (PATIENT)
X(25)
98
122
1-078
PERSON MIDDLE NAME (PATIENT)
X(25)
123
147
1-079
PERSON CADENCY NAME (PATIENT)
X(10)
148
157
1-080
PERSON IDENTIFIER (PATIENT)
X(9)
158
166
1-081
PERSON IDENTIFIER TYPE CODE (PATIENT)
X
167
167
1-085
PERSON BIRTH CALENDAR DATE (PATIENT)
YYYYMMDD
168
175
1-095
PATIENT IDENTIFIER (DOD)
X(10)
176
185
1-097
DEERS IDENTIFIER (PATIENT)
X(11)
186
196
1-100
PERSON SEX (PATIENT)
X
197
197
1-105
PATIENT ZIP CODE
X(9)
198
206
1-110
ENROLLMENT/HEALTH PLAN CODE
X(2)
207
208
1-111
HEALTH CARE DELIVERY PROGRAM PLAN COVERAGE CODE
X(3)
209
211
1-112
REGION INDICATOR
X(2)
212
213
1-115
PCM LOCATION DMIS-ID (ENROLLMENT) CODE
X(4)
214
217
1-120
AMOUNT BILLED (TOTAL)
S9(7)V99
218
226
1-125
AMOUNT ALLOWED (TOTAL)
S9(7)V99
227
235
1-130
AMOUNT PAID BY OTHER HEALTH INSURANCE
S9(7)V99
236
244
1-131
OTHER GOVERNMENT PROGRAM TYPE CODE
X
245
245
1-132
OTHER GOVERNMENT PROGRAM BEGIN REASON CODE
X
246
246
1-135
AMOUNT PATIENT COST-SHARE
S9(7)V99
247
255
1-136
HEALTH CARE COVERAGE COPAYMENT FACTOR CODE
X
256
256
1-140
AMOUNT PAID BY GOV’T CONTRACTOR (TOTAL)
S9(7)V99
257
265
1-145
AMOUNT INTEREST PAYMENT
S9(7)V99
266
274
1-150
REASON FOR INTEREST PAYMENT
X(2)
275
276
1-155
PROCESSING INFORMATION
277
313
1-160
OVERRIDE CODE
X(6)
277
282
1-165
TYPE OF SUBMISSION
X
283
283
1-170
CA/NAS NUMBER
X(15)
284
298
1-175
CA/NAS REASON FOR ISSUANCE
X
299
299
1-180
CA/NAS EXCEPTION REASON
X(2)
300
301
1-185
SPECIAL PROCESSING CODE
X(8)
302
309
1-186
HEALTH CARE DELIVERY PROGRAM SPECIAL ENTITLEMENT CODE
X(2)
310
311
1-190
PRICING RATE CODE
X(2)
312
313
1-195
PROVIDER STATE OR COUNTRY CODE
X(3)
314
316
1-200
PROVIDER TAXPAYER NUMBER
X(9)
317
325
1-205
PROVIDER SUB-IDENTIFIER
X(4)
326
329
1-208
SCH DRG CALCULATION
S9(7)V99
330
338
FILLER
X
339
339
1-215
PROVIDER ORGANIZATIONAL NPI NUMBER (TYPE 2)
X(10)
340
349
1-220
PROVIDER ZIP CODE
X(9)
350
358
1-225
PROVIDER PARTICIPATION INDICATOR
X
359
359
1-230
PROVIDER NETWORK STATUS INDICATOR
X
360
360
1-235
TYPE OF INSTITUTION
X(2)
361
362
1-240
CLAIM FORM TYPE/EMC INDICATOR
X
363
363
1-245
TYPE OF BILL
364
365
1-250
FREQUENCY CODE
X
364
364
1-255
TYPE OF ADMISSION
X
365
365
1-260
POINT OF ORIGIN
X
366
366
1-265
ADMISSION DATE
YYYYMMDD
367
374
1-270
PATIENT STATUS
X(2)
375
376
1-275
BEGIN DATE OF CARE
YYYYMMDD
377
384
1-280
END DATE OF CARE
YYYYMMDD
385
392
1-283
ADMINISTRATIVE CLIN
X(18)
393
410
1-285
COVERED DAYS
S9(3)
411
413
1-290
DRG NUMBER
X(3)
414
416
1-292
HIPPS CODE
X(5)
417
421
1-293
ICD VERSION
X
422
422
1-295
ADMISSION DIAGNOSIS
X(7)
423
429
1-300
PRINCIPAL TREATMENT DIAGNOSIS/PRESENT ON ADMISSION
X(8)
430
437
1-305
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-1
X(8)
438
445
1-306
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-2
X(8)
446
453
1-307
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-3
X(8)
454
461
1-308
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-4
X(8)
462
469
1-309
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-5
X(8)
470
477
1-310
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-6
X(8)
478
485
1-311
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-7
X(8)
486
493
1-312
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-8
X(8)
494
501
1-313
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-9
X(8)
502
509
1-314
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-10
X(8)
510
517
1-315
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-11
X(8)
518
525
1-316
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-12
X(8)
526
533
1-317
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-13
X(8)
534
541
1-318
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-14
X(8)
542
549
1-319
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-15
X(8)
550
557
1-320
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-16
X(8)
558
565
1-321
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-17
X(8)
566
573
1-322
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-18
X(8)
574
581
1-323
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-19
X(8)
582
589
1-324
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-20
X(8)
590
597
1-325
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-21
X(8)
598
605
1-326
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-22
X(8)
606
613
1-327
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-23
X(8)
614
621
1-328
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-24
X(8)
622
629
1-345
PRINCIPAL OPERATION/NON-SURGICAL PROCEDURE CODE
X(7)
630
636
1-350
SECONDARY OPERATION/NON-SURGICAL PROCEDURE CODE-1
X(7)
637
643
1-351
SECONDARY OPERATION/NON-SURGICAL PROCEDURE CODE-2
X(7)
644
650
1-352
SECONDARY OPERATION/NON-SURGICAL PROCEDURE CODE-3
X(7)
651
657
1-353
SECONDARY OPERATION/NON-SURGICAL PROCEDURE CODE-4
X(7)
658
664
1-354
SECONDARY OPERATION/NON-SURGICAL PROCEDURE CODE-5
X(7)
665
671
1-355
SECONDARY OPERATION/NON-SURGICAL PROCEDURE CODE-6
X(7)
672
678
1-356
SECONDARY OPERATION/NON-SURGICAL PROCEDURE CODE-7
X(7)
679
685
1-357
SECONDARY OPERATION/NON-SURGICAL PROCEDURE CODE-8
X(7)
686
692
1-358
SECONDARY OPERATION/NON-SURGICAL PROCEDURE CODE-9
X(7)
693
699
1-359
SECONDARY OPERATION/NON-SURGICAL PROCEDURE CODE-10
X(7)
700
706
1-360
SECONDARY OPERATION/NON-SURGICAL PROCEDURE CODE-11
X(7)
707
713
1-361
SECONDARY OPERATION/NON-SURGICAL PROCEDURE CODE-12
X(7)
714
720
1-362
SECONDARY OPERATION/NON-SURGICAL PROCEDURE CODE-13
X(7)
721
727
1-363
SECONDARY OPERATION/NON-SURGICAL PROCEDURE CODE-14
X(7)
728
734
1-364
SECONDARY OPERATION/NON-SURGICAL PROCEDURE CODE-15
X(7)
735
741
1-365
SECONDARY OPERATION/NON-SURGICAL PROCEDURE CODE-16
X(7)
742
748
1-366
SECONDARY OPERATION/NON-SURGICAL PROCEDURE CODE-17
X(7)
749
755
1-367
SECONDARY OPERATION/NON-SURGICAL PROCEDURE CODE-18
X(7)
756
762
1-368
SECONDARY OPERATION/NON-SURGICAL PROCEDURE CODE-19
X(7)
763
769
1-369
SECONDARY OPERATION/NON-SURGICAL PROCEDURE CODE-20
X(7)
770
776
1-370
SECONDARY OPERATION/NON-SURGICAL PROCEDURE CODE-21
X(7)
777
783
1-371
SECONDARY OPERATION/NON-SURGICAL PROCEDURE CODE-22
X(7)
784
790
1-372
SECONDARY OPERATION/NON-SURGICAL PROCEDURE CODE-23
X(7)
791
797
1-373
SECONDARY OPERATION/NON-SURGICAL PROCEDURE CODE-24
X(7)
798
804
1-374
TED RECORD CORRECTION INDICATOR
X
805
805
1-375
TOTAL OCCURRENCE/LINE ITEM COUNT
9(3)
806
808
1-377
AMOUNT NETWORK PROVIDER DISCOUNT
S9(7)V99
809
817
1-378
ADJUSTMENT SEQUENCE NUMBER
X(3)
818
820
1-379
SCH DRG NUMBER
X(3)
821
823
FILLER
X(17)
824
840
1-380
OCCURRENCE/LINE ITEM NUMBER (OCCURS 1 TO 450 TIMES)
9(3)
841
843
1-385
REVENUE CODE
X(4)
844
847
1-390
UNITS OF SERVICE BY REVENUE CODE
S9(10)
848
857
1-395
TOTAL CHARGE BY REVENUE CODE
S9(7)V99
858
866
1-400
ADJUSTMENT/DENIAL REASON CODE
X(5)
867
871
FILLER
X(30)
872
901
3.0  Non-Institutional Data Element
Position
ELN
Element Name
Format
From
Thru
2-001
RECORD TYPE INDICATOR
X
1
1
2-005
TED RECORD INDICATOR
2
25
2-010
INTERNAL CONTROL NUMBER (ICN)
2
18
2-015
FILING DATE
YYYYDDD
2
8
2-020
FILING STATE/COUNTRY CODE
X(3)
9
11
2-025
SEQUENCE NUMBER
X(7)
12
18
2-030
TIME STAMP
X(6)
19
24
2-035
ADJUSTMENT KEY
X
25
25
2-040
DATE TED RECORD PROCESSED TO COMPLETION
YYYYMMDD
26
33
2-045
DATE ADJUSTMENT IDENTIFIED
YYYYMMDD
34
41
2-050
PERSON IDENTIFIER (SPONSOR)
X(9)
42
50
2-051
PERSON IDENTIFIER TYPE CODE (SPONSOR)
X
51
51
2-055
SERVICE BRANCH CLASSIFICATION CODE (SPONSOR)
X
52
52
2-056
AGR SERVICE LEGAL AUTHORITY CODE
X
53
53
2-060
PERSON NAME (PATIENT)
54
148
2-061
PERSON LAST NAME (PATIENT)
X(35)
54
88
2-062
PERSON FIRST NAME (PATIENT)
X(25)
89
113
2-063
PERSON MIDDLE NAME (PATIENT)
X(25)
114
138
2-064
PERSON CADENCY NAME (PATIENT)
X(10)
139
148
2-065
PERSON IDENTIFIER (PATIENT)
X(9)
149
157
2-066
PERSON IDENTIFIER TYPE CODE (PATIENT)
X
158
158
2-070
PERSON BIRTH CALENDAR DATE (PATIENT)
YYYYMMDD
159
166
2-075
DEERS DEPENDENT SUFFIX
X(2)
167
168
2-080
PATIENT IDENTIFIER (DOD)
X(10)
169
178
2-082
DEERS IDENTIFIER (PATIENT)
X(11)
179
189
2-085
PERSON SEX (PATIENT)
X
190
190
2-090
PATIENT ZIP CODE
X(9)
191
199
2-095
OVERRIDE CODE
X(6)
200
205
2-100
TYPE OF SUBMISSION
X
206
206
2-105
CLAIM FORM TYPE/EMC INDICATOR
X
207
207
2-108
ADMINISTRATIVE CLIN
X(18)
208
225
2-110
PCM LOCATION DMIS-ID (ENROLLMENT) CODE
X(4)
226
229
2-112
AMOUNT INTEREST PAYMENT
S9(7)V99
230
238
2-113
REASON FOR INTEREST PAYMENT
X(2)
239
240
2-114
ICD VERSION
X
241
241
2-115
PRINCIPAL TREATMENT DIAGNOSIS/PRESENT ON ADMISSION
X(8)
242
249
2-116
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-1
X(8)
250
257
2-117
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-2
X(8)
258
265
2-118
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-3
X(8)
266
273
2-119
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-4
X(8)
274
281
2-120
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-5
X(8)
282
289
2-121
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-6
X(8)
290
297
2-122
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-7
X(8)
298
305
2-123
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-8
X(8)
306
313
2-124
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-9
X(8)
314
321
2-125
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-10
X(8)
322
329
2-126
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-11
X(8)
330
337
2-127
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-12
X(8)
338
345
2-128
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-13
X(8)
346
353
2-129
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-14
X(8)
354
361
2-130
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-15
X(8)
362
369
2-131
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-16
X(8)
370
377
2-132
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-17
X(8)
378
385
2-133
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-18
X(8)
386
393
2-134
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-19
X(8)
394
401
2-135
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-20
X(8)
402
409
2-136
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-21
X(8)
410
417
2-137
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-22
X(8)
418
425
2-138
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-23
X(8)
426
433
2-340
SECONDARY TREATMENT DIAGNOSIS/PRESENT ON ADMISSION-24
X(8)
434
441
2-139
TED RECORD CORRECTION INDICATOR
X
442
442
2-140
TOTAL OCCURRENCE/LINE ITEM COUNT
9(3)
443
445
2-141
ADJUSTMENT SEQUENCE NUMBER
X(3)
446
448
FILLER
X(20)
449
468
2-145
OCCURRENCE/LINE ITEM NUMBER (OCCURS 1 TO 99 TIMES)
9(3)
469
471
2-150
BEGIN DATE OF CARE
YYYYMMDD
472
479
2-155
END DATE OF CARE
YYYYMMDD
480
487
2-160
PROCEDURE CODE
X(5)
488
492
2-165
PROCEDURE CODE MODIFIER
X(8)
493
500
2-170
NATIONAL DRUG CODE
X(11)
501
511
2-175
NUMBER OF SERVICES
S9(3)
512
514
2-180
AMOUNT BILLED BY PROCEDURE CODE
S9(7)V99
515
523
2-185
AMOUNT ALLOWED BY PROCEDURE CODE
S9(7)V99
524
532
2-190
AMOUNT PAID BY OTHER HEALTH INSURANCE
S9(7)V99
533
541
2-191
OTHER GOVERNMENT PROGRAM TYPE CODE
X
542
542
2-192
OTHER GOVERNMENT PROGRAM BEGIN REASON CODE
X
543
543
2-195
AMOUNT APPLIED TOWARD DEDUCTIBLE
S9(3)V99
544
548
2-200
AMOUNT PATIENT COST-SHARE
S9(7)V99
549
557
2-201
HEALTH CARE COVERAGE COPAYMENT FACTOR CODE
X
558
558
2-205
AMOUNT PAID BY GOV’T CONTRACTOR BY PROCEDURE CODE
S9(7)V99
559
567
2-220
ADJUSTMENT/DENIAL REASON CODE
X(5)
568
572
2-225
PROVIDER INDIVIDUAL NPI NUMBER (TYPE 1)
X(10)
573
582
2-230
PROVIDER ORGANIZATIONAL NPI NUMBER (TYPE 2)
X(10)
583
592
2-235
PROVIDER STATE OR COUNTRY CODE
X(3)
593
595
2-240
PROVIDER TAXPAYER NUMBER
X(9)
596
604
2-245
PROVIDER SUB-IDENTIFIER
X(4)
605
608
2-250
PROVIDER ZIP CODE
X(9)
609
617
2-255
PROVIDER TAXONOMY SPECIALTY
X(10)
618
627
2-260
PROVIDER PARTICIPATION INDICATOR
X
628
628
2-265
PROVIDER NETWORK STATUS INDICATOR
X
629
629
2-270
PHYSICIAN REFERRAL NUMBER
X(13)
630
642
2-275
PLACE OF SERVICE
X(2)
643
644
2-280
TYPE OF SERVICE
X(2)
645
646
2-285
HEALTH CARE COVERAGE MEMBER CATEGORY CODE
X
647
647
2-291
PAY GRADE CODE (SPONSOR)
X(2)
648
649
2-292
PAY PLAN CODE (SPONSOR)
X(5)
650
654
2-295
HEALTH CARE COVERAGE MEMBER RELATIONSHIP CODE
X
655
655
2-300
ENROLLMENT/HEALTH PLAN CODE
X(2)
656
657
2-301
HEALTH CARE DELIVERY PROGRAM PLAN COVERAGE CODE
X(3)
658
660
2-303
REGION INDICATOR
X(2)
661
662
2-305
SPECIAL PROCESSING CODE
X(8)
663
670
2-306
HEALTH CARE DELIVERY PROGRAM SPECIAL ENTITLEMENT CODE
X(2)
671
672
2-310
CA/NAS NUMBER
X(15)
673
687
2-315
CA/NAS REASON FOR ISSUANCE
X
688
688
2-320
CA/NAS EXCEPTION REASON
X(2)
689
690
2-325
PRICING RATE CODE
X(2)
691
692
2-330
AMBULATORY PAYMENT CLASSIFICATION CODE
X(5)
693
697
2-331
OPPS PAYMENT STATUS INDICATOR CODE
X(2)
698
699
2-335
AMOUNT NETWORK PROVIDER DISCOUNT
S9(7)V99
700
708
FILLER
X(30)
709
738
4.0  Provider File Record
Position
ELN
Element Name
Format
From
Thru
3-001
RECORD TYPE INDICATOR
X
1
1
3-005
PROVIDER TAXPAYER NUMBER
X(9)
2
10
3-010
PROVIDER SUB-IDENTIFIER
X(4)
11
14
3-015
PROVIDER TAXPAYER NUMBER IDENTIFIER
X
15
15
3-020
CONTRACTOR NUMBER
X(2)
16
17
3-025
PROVIDER CONTRACT AFFILIATION CODE
X
18
18
3-030
INSTITUTIONAL/NON-INSTITUTIONAL INDICATOR
X
19
19
3-035
PROVIDER NAME
X(40)
20
59
3-040
PROVIDER ADDRESS
60
119
3-045
PROVIDER STREET ADDRESS
X(30)
60
89
3-050
PROVIDER CITY
X(18)
90
107
3-055
PROVIDER STATE OR COUNTRY CODE
X(3)
108
110
3-060
PROVIDER ZIP CODE
X(9)
111
119
3-065
PROVIDER BILLING ADDRESS
120
179
3-070
PROVIDER BILLING STREET ADDRESS
X(30)
120
149
3-075
PROVIDER BILLING CITY
X(18)
150
167
3-080
PROVIDER BILLING STATE OR COUNTRY CODE
X(3)
168
170
3-085
PROVIDER BILLING ZIP CODE
X(9)
171
179
3-090
PROVIDER MAJOR SPECIALTY/TYPE OF INSTITUTION
X(10)
180
189
3-095
TYPE OF INSTITUTION TERM INDICATOR CODE
X
190
190
3-100
AMERICAN HOSPITAL ASSOCIATION ID NUMBER
X(9)
191
199
3-105
AHA MULTI-HOSPITAL SYSTEM CODE
X(4)
200
203
3-110
MEDICARE NUMBER
X(8)
204
211
3-115
PROVIDER ACCEPTANCE DATE
YYYYMMDD
212
219
3-120
PROVIDER TERMINATION DATE
YYYYMMDD
220
227
3-125
RURAL/URBAN INDICATOR
X
228
228
3-130
IDME RATIO
9V9(4)
229
233
3-135
IDME RATIO EFFECTIVE DATE
YYYYMMDD
234
241
3-140
AREA WAGE INDEX
9V9(4)
242
246
3-145
AREA WAGE INDEX EFFECTIVE DATE
YYYYMMDD
247
254
3-150
DRG EXEMPT/NONEXEMPT INDICATOR
X
255
255
3-155
DRG EXEMPT/NONEXEMPT EFFECTIVE DATE
YYYYMMDD
256
263
3-160
TRANSACTION CODE
X
264
264
3-165
RECORD EFFECTIVE DATE
YYYYMMDD
265
272
FILLER
X(17)
273
289
5.0  Transmission Records
5.1  The requirement for all electronic transmissions will incorporate the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated standards wherever feasible.
5.2  The first record in each transmission to the Defense Health Agency (DHA), whether by teleprocessing or magnetic tape, will be a transmission header, using the following format. Where value is specified under comments, the value must be reported exactly as shown.
Transmission Header Record Format
pOSITION(S)
Description
Content
Comment
1-8
Alpha
Data Type
Must be “TED Data”.
9-10
**
Delimiter
Must be **.
11-22
Alphanumeric
File Name
Must be named in accordance with Chapter 1, Section 1.1, paragraph 7.7.3.1.5.
23-24
**
Delimiter
Must be **
25-29
Alpha
Must be “FSIZE”
30-Variable
Numeric
File Size
Includes the total number of batch/voucher header records, provider, pricing and TED records (variable length). Includes transmission header, excludes transmission trailer.
Variable (2 positions)
**
Delimitier
Must be **.
Variable (6 positions)
Alpha
Record Type
Must be “RTYPEV”.
Variable (2 positions)
**
Delimiter
Must be **.
Variable (7 positions)
Alpha
Must be “MAXRLEN”.
Variable
Numeric
Maximum Record Length
Length of the longest variable length record within the transmission. Must be > 0.
Variable (2 positions)
**
Delimiter
Must be **.
Variable - 80
Blank
Reserved
Must be HEX 40.
5.3  Appended to the end of each transmission to DHA, whether by teleprocessing or magnetic tape, will be a transmission trailer record. The format for the transmission trailer record follows:
Transmission Trailer Record Format
pOSITION(S)
Description
Content
Comment
1
Alpha
Record ID
Must be “@” sign.
2-3
Alphanumeric
Contractor Number
DHA-assigned Contractor number.
4-10
Alphanumeric
Transmission Date
Enter in YYYYDDD format.
11-14
Numeric
Batch Count
Number of batches and/or vouchers in the transmission.
15-20
Numeric
Record Count
Includes the total number of batch/voucher header records, provider, pricing and variable length TED records. Excludes transmission header and transmission trailer.
21-80
Blank
Reserved
Must be HEX 40.
5.4  Transmissions will be returned to the contractor, with appropriate error codes appended, if any of the following occur:
Error Code
Error Type
Validation Rule
1200
Transmission header record not found
First record of the file must be a Transmission Header (first position is T).
1201
No records found in Transmission file
Byte count of the file = 0.
1202
Data Type is incorrect
Data Type must be “TED Data” - upper/lower case as shown is required. Cannot be all lower or all upper case.
1203
Second transmission header found
Second Transmission Header (first position is ‘T’) must not be found.
1207
Value of MAXRLEN in transmission header is not possible
MAXRLEN must be a valid value based on the combinations of record lengths included. Compare against all possible record lengths for Header (1), Inst (450), Non-Inst (99), and Provider (1) records.
1210
Transmission trailer record not found
A record must be found with first position = ‘@’.
1220
Second record is not a batch or voucher header record
Second record of the transmission must be batch/voucher record (record type = 0 or 5).
1240
Header record error in FSIZE, Record Type, or MAXRLEN fields)
‘FISIZE’, ‘RTYPEV’ and ‘MAXRLEN’ literals must be found in Transmission Header record and value of MAXRLEN must be > 0 and < 25535.
1250
Record type other than 0, 1, 2, 3, 4, 5, T, or @ is invalid)
Record Type (first position of the record) must be 0, 1, 2, 3, 4, 5, 6, 9, T, or @.
1260
Extraneous data found after transmission trailer record
No record should be found after Trailer Record of the transmission file.
1290
Count of batch/voucher headers on trailer not equal headers read
Count of batch/voucher headers on trailer must match count of batch/vouchers.
1291
Batch/voucher Identifier code invalid
Batch/voucher identifier must be = 3, 4, or 5.
1295
Total record count on transmission trailer record not in balance.
Record count of transmission trailer must match total record count (except transmission header and trailer) of the file.
1296
Contractor number in trailer record does not match batch/voucher contract number
The contractor number (positions 2-3) in the transmission trailer record must correspond with the contractor number (ELN 0-010) in the batch/voucher header record(s) in the transmission file.
1299
Transmission header file-size not in possible in file
Transmission Header file size (FSIZE) must match total record count (except transmission header) of the file.
1998
Invalid non-printable character
Transmission file must not contain invalid non-printable characters (ASCII Values 0-9, 11-31, 127-255)
1999
Invalid printable character
Transmission file must not contain invalid printable characters (e.g., binary values, >, <, :, ;, \, “, |, etc.). The only acceptable characters are A-Z (uppercase only), 0-9, ‘, @, *, #, and blank.
6.0  Print/Report Transmissions
6.1  All errors in batch/voucher, TED, and TEPRV records detected by the DHA editing system will be reported to the contractor in 133-byte record print image format. Except for special situations, error files will be teleprocessed to the contractor the day of processing. The format of the error records returned to the contractor will be:
Errors Records Returned Format
Position
Description
From
Thru
Number of errors on this TED record
1
3
Batch/Voucher, TED, or TEPRV data as submitted
4
Variable
Error code number (occurs 1 to 500 times based on number of errors above)
Variable
Variable
6.2  The format of the error code number is 10 characters:
Error Code Format
Description
Position
ELN (Element Locator Number)
1 to 4
Edit error number within ELN
5 to 6
Validity/Relational/Financial edit indicator
7 to 7
Line item/occurrence number from TED record if applicable
8 to 10
6.3  The associated error reports will list each edit incurred on each batch/voucher, TED, or TEPRV record. A brief description of the edit condition is included. If the edit is a relational edit or financial edit, the ELNs and element names for the elements that are involved in the edit condition will be included, along with the values reported by the contractor for those elements.
- END -

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