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TRICARE Systems Manual 7950.3-M, April 1, 2015
TRICARE Encounter Data (TED)
Chapter 2
Section 2.5
Data Requirements - Institutional/Non-Institutional Record Data Elements (E - L)
Revision:  C-33, December 13, 2019
DATA ELEMENT DEFINITION
ELEMENT NAME:  END DATE OF CARE
Notes And Special Instructions:
N/A
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Institutional
Non-Institutional
1-280
2-155
1
Up to 99
Yes
Yes
Primary Picture (Format)
Eight (8) alphanumeric characters, YYYYMMDD.
Definition
Institutional: Latest date of care reported on this TED record.
Non-Institutional: The latest date of care for this procedure.
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:  ENROLLMENT/HEALTH PLAN CODE
Notes And Special Instructions:
Left justify and blank fill.
Enrollment/Health Plan Code U shall be used for CONUS and also for TRICARE Overseas Program (TOP) Prime enrollees.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Institutional
Non-Institutional
1-110
2-300
1
Up to 99
Yes
Yes
Primary Picture (Format)
Two (2) alphanumeric characters.
Definition
Code indicating whether the patient is enrolled with the contractor (Prime) or not (non-Prime) or a special care program.
Code/Value Specifications
T
TRICARE Standard Program (Terminated 12/31/2017)
U
TRICARE Prime, Civilian PCM
V
TRICARE Extra (Terminated 12/31/2017)
W
TPR Service Member - USA
X
Foreign Service Member
Y
CHCBP - Non-Network
Z
TRICARE Prime, MTF/eMSM/PCM
AA
CHCBP - Network
AS
TRICARE Select - Active Duty Survivors (Effective 01/01/2018)
AT
TRICARE Select - Active Duty Transitional Survivors (Effective 01/01/2018)
BB
TSP (Effective 10/01/1998 through 12/31/2001)
FE
TFL - Network (Effective 10/01/2001)
FS
TFL - Non-Network (Effective 10/01/2001)
GS
TRICARE Select - Guard/Reserve Survivors (Effective 01/01/2018)
GT
TRICARE Select - Guard/Reserve Transitional Survivors (Effective 01/01/2018)
ME
Medicare/TRICARE Dual Eligible Under 65/Network
MS
Medicare/TRICARE Dual Eligible Under 65/Non-Network
PS
TSRx (Effective 04/01/2001) - Non-Institutional Only
SN
SHCP - Non-MTF/eMSM-Referred Care (Effective 10/01/1999)
SO
SHCP - Non-TRICARE Eligible (Effective 10/01/1999 through 05/31/2004)
SR
SHCP - MTF/eMSM Referred Care (Effective 10/01/1999)
ST
SHCP - TRICARE Eligible (Effective 10/01/1999 through 05/31/2004)
SU
SHCP - Referral Designation Unknown (Effective 03/01/2002) - for Non-Institutional Pharmacy claims only
TS
TSS Demonstration Program (Effective 04/01/2000 through 12/31/2002)
TV
TRICARE Select (Effective 01/01/2018)
WA
TPR Foreign Service Member (Effective 09/01/2003)
WF
TPR for enrolled ADFM Residing with a TPR Eligible Service Member (Effective 09/01/2002)
WO
Includes Transitional Survivors Who Do Not Relocate TPR Foreign ADFM (Effective 09/01/2003)
XF
Foreign ADFM (Effective 09/01/2003)
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
N/A
DATA ELEMENT DEFINITION
ELEMENT NAME:  FILING DATE
Notes And Special Instructions:
N/A
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Institutional
Non-Institutional
1-015
2-015
1
1
Yes
Yes
Primary Picture (Format)
Seven (7) alphanumeric characters, YYYYDDD.
Definition
Date the request for payment of services rendered was received by the contractor for processing.
Code/Value Specifications
YYYY
4 digit calendar year of receipt
DDD
3 digit Julian date of receipt
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
INTERNAL CONTROL NUMBER
DATA ELEMENT DEFINITION
ELEMENT NAME:  FILING STATE/COUNTRY CODE
Notes And Special Instructions:
1  State code will consist of two alphanumeric characters, which is left justify and blank fill. The foreign countries will consist of three alphanumeric characters.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Institutional
Non-Institutional
1-020
2-020
1
1
Yes
Yes
Primary Picture (Format)
Three (3) alphanumeric characters.
Definition
Code that indicates the State or Country where the primary care was provided.
Code/Value Specifications
Refer to Addendums A1 and B1.
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
INTERNAL CONTROL NUMBER
DATA ELEMENT DEFINITION
ELEMENT NAME:  FREQUENCY CODE
Notes And Special Instructions:
1  The initial, interim, and final TED records must be submitted to DHA in correct sequence. If the person is transferred and the care is processed under DRG rules, then code 1 must be used; all other Transfers must use code 1 or 4 as appropriate.
Effective with filing dates on or after January 1, 2011, interim-interim and interim-final TED records (FREQUENCY CODES 3 and 4) must be submitted on batch/vouchers with HEADER TYPE INDICATOR 0 or 5. DRG and HHA interim billings are excluded from this requirement.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Institutional
1-250
1
Yes1
Primary Picture (Format)
One (1) alphanumeric character.
Definition
Code that describes the frequency of billing from the institution. For filing dates before January 1, 2011 all TED records for interim-interim and interim-final institutional bills must be submitted as an adjustment using the same TRI as the initial submission. Effective with filing dates on or after January 1, 2011 all TED records for interim-interim and interim-final institutional bills with the exception of interim billings reimbursed under the DRG or HHA payment methodology must be submitted as a unique TRI. See Section 1.1, paragraph 7.0.
Code/Value Specifications
0
Non-Payment/Zero Claim
1
Admit through Discharge TED record
2
Interim-Initial TED record
3
Interim-Interim TED record
4
Interim-Final TED record
7
Replacement of Prior Claim
8
Void/Cancel of Prior Claim
9
Final claim for HHA PPS Episode
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
TYPE OF BILL
DATA ELEMENT DEFINITION
ELEMENT NAME:  HEALTH CARE COVERAGE (HCC) COPAYMENT FACTOR CODE
Notes And Special Instructions:
If person not on DEERS but claim is payable (i.e., Government liability), report Z in this field.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Institutional
Non-Institutional
1-136
2-201
1
Up to 99
Yes
Yes
Primary Picture (Format)
One (1) alphanumeric character.
Definition
The code used to identify for each insured in managed care the category of copayment and deductible they must pay based on external forces for a particular health care coverage period. Actual rates depend on HCDP Plan Coverage Code. Download field from DEERS.
Code/Value Specifications
A
Active duty E-4 and below rate
B
Active duty E-5 and above rate
C
Retiree rate
W
Unknown copayment factor
Z
Not applicable
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
N/A
DATA ELEMENT DEFINITION
ELEMENT NAME:  HEALTH CARE COVERAGE (HCC) MEMBER CATEGORY CODE
Notes And Special Instructions:
If person not on DEERS but claim is payable (i.e., Government liability), report from the claim or report Z in this field.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Institutional
Non-Institutional
1-066
2-285
1
Up to 99
Yes
Yes
Primary Picture (Format)
One (1) alphanumeric character.
Definition
The member category code during the Health Care Coverage period. Download field from DEERS.
Code/Value Specifications
1
Transitional compensation not eligible for retirement
A
Active duty
B
Presidential Appointee
C
DoD civil service employee, except Presidential employee
D
Disabled American veteran
E
DoD contract employee
F
Former member (Reserve service, discharged from the Ready Reserve or Standby Reserve following notification of retirement eligibility)
G
National Guard member (mobilized or on active duty for 31 days or more) Early ID Alert status
H
Medal of Honor (MOH) recipient
I
Other Government Agency employee, except Presidential appointee
J
Academy student (does not include Officer Candidate School or Merchant Marine Academy)
K
Non-Appropriated Fund DoD employee
L
Lighthouse service
M
Non-Government Agency Personnel
N
National Guard member (not on active duty or on active duty for 30 days or less)
O
Other Government contract employee
P
TAMP member
Q
Reserve retiree not yet eligible for retired pay (“gray-area retiree”)
R
Retired military member eligible for retired pay
S
Reserve member (mobilized or on active duty for 31 days or more) Early ID Alert status
T
Foreign military member
U
DoD OCONUS hires
V
Reserve member (not on active duty or on active duty for 30 days or less)
W
DoD beneficiary, a person who receives benefits from the DoD based on prior association, condition or authorization, an example is a former spouse
Y
Service affiliates (including ROTC and Merchant Marines)
Z
Unknown
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
N/A
DATA ELEMENT DEFINITION
ELEMENT NAME:  HEALTH CARE COVERAGE (HCC) MEMBER RELATIONSHIP CODE
Notes And Special Instructions:
If person not on DEERS but claim is payable (i.e., Government liability), report from the claim or report Z in this field.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Institutional
Non-Institutional
1-070
2-295
1
Up to 99
Yes
Yes
Primary Picture (Format)
One (1) alphanumeric character.
Definition
The member relationship code for the HCC period. Download field from DEERS.
Code/Value Specifications
A
Self (i.e., the person and the other person are the same person)
B
Spouse
C
Child or stepchild
D
Pre-adoptive child
E
Ward (court ordered)
F
Dependent parent, dependent stepparent, dependent parent-in-law, or dependent stepparent-in-law
G
Surviving spouse
H
Former spouse (20/20/20)
I
Former spouse (20/20/15)
J
Former spouse (10/20/10)
K
Former spouse (transitional assistance (composite))
L
Foster child
Z
Unknown
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
N/A
DATA ELEMENT DEFINITION
ELEMENT NAME:  HEALTH CARE DELIVERY PROGRAM (HCDP) PLAN COVERAGE CODE
Notes And Special Instructions:
If person not on DEERS but claim is payable (i.e, Government liability), report 000 in this field.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Institutional
Non-Institutional
1-111
2-301
1
Up to 99
Yes
Yes
Primary Picture (Format)
Three (3) alphanumeric characters.
Definition
The code that represents the plan coverage a family member or sponsor has within a HCDP type. Download field from DEERS.
Code/Value Specifications
For valid values refer to Addendum L.
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
N/A
DATA ELEMENT DEFINITION
ELEMENT NAME:  HEALTH CARE DELIVERY PROGRAM (HCDP) SPECIAL ENTITLEMENT CODE
Notes And Special Instructions:
1  If the DEERS response does not return a HCDP SPECIAL ENTITLEMENT CODE, report 00 in this field.
2  Codes 04, 05, and 07 are no longer effective. Valid for adjustments or cancellations to previously submitted TED records with these values.
If person not on DEERS but claim is payable (i.e., Government liability), report 00 in this field.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Institutional
Non-Institutional
1-186
2-306
1
Up to 99
Yes1
Yes1
Primary Picture (Format)
Two (2) alphanumeric characters.
Definition
The code used to identify for each person insured in managed care any special category that they may have been given for copayment and deductible. Download field from DEERS.
Code/Value Specifications
00
Not applicable
01
Bosnia Participation Special Entitlement (Sponsor Only)
02
Noble Eagle Participation Special Entitlement (Sponsor Only)
03
Enduring Freedom Participation Special Entitlement
042
TA 60 Benefits Period After Special Operation
052
TA 120 Benefits Period After Special Operation
06
Kosovo Participation Special Entitlement (Sponsor Only)
072
Iraqi Freedom Participation Special Entitlement (Sponsor Only)
08
Special Entitlement for Guard/Reserve on Active Duty more than 30 days (excl. AGR)
30
TRICARE Senior Pharmacy Exception - Grandfathered Populations before 04/01/2001.
31
TRICARE Senior Pharmacy Exception - Direct Care (DC) over 65 members with Medicare A and B but no TFL.
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
N/A
DATA ELEMENT DEFINITION
ELEMENT NAME:  HIPPS CODE
Notes And Special Instructions:
1  Required if available. If not applicable blank fill.
If multiple HIPPS Codes are reported on a claim, the initial HIPPS code (i.e., the HIPPS code initiating the 60 day Episode of Care (EOC)) should be coded on the TED record.
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Institutional
1-292
1
Yes1
Primary Picture (Format)
Five (5) alphanumeric characters.
Definition
HIPPS rate codes identify specific patient characteristics (or case mix) on which TRICARE SNF and HHA payment determinations are made.
Code/Value Specifications
SNF HIPPS codes prior to October 1, 2019: Consists of a three character RUG code plus a two character modifier which is an assessment indicator.
SNF HIPPS codes on or after October 1, 2019: Consists of a four character PDPM code plus a one character modifier which is an assessment indicator.
HHA HIPPS codes prior to January 1, 2008: First character is always H for home health; the second, third, and fourth positions represent the care level of intensity; and the fifth character establishes the completeness of the OASIS data.
HHA HIPPS codes on or after January 1, 2008: The first position in the HIPPS code is a numeric value based on whether an episode is an early or later episode in a sequence of adjacent episodes; the second, third, and fourth positions of the code remain a one-to-one crosswalk to the three domains of the HHRG coding system; and the fifth position indicates a severity group for NRS.
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
N/A
DATA ELEMENT DEFINITION
ELEMENT NAME:  ICD VERSION
Notes And Special Instructions:
N/A
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Institutional
Non-Institutional
1-293
2-114
1
1
Yes
Yes
Primary Picture (Format)
One (1) alphanumeric character.
Definition
Code to indicate the International Classification of Diseases (ICD) version.
Code/Value Specifications
0
ICD-10
9
ICD-9
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
N/A
N/A
DATA ELEMENT DEFINITION
ELEMENT NAME:  INTERNAL CONTROL NUMBER (ICN)
Notes And Special Instructions:
N/A
Records/Locator Numbers
Record Name
Locator#
Occurrences
Required
Institutional
Non-Institutional
1-010
2-010
1
Up to 99
Yes
Yes
Primary Picture (Format)
Group
Definition
N/A
Code/Value Specifications
Refer to subordinate element definitions.
Algorithm
N/A
Subordinate And/Or Group Elements
Subordinate
Group
FILING DATE
FILING STATE/COUNTRY CODE
SEQUENCE NUMBER
TED RECORD INDICATOR
- END -

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