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TRICARE Systems Manual 7950.3-M, April 1, 2015
TRICARE Encounter Data (TED)
Chapter 2
Section 5.1
Institutional Edit Requirements (ELN 000 - 099)
Revision:  C-16, June 22, 2018
ELEMENT NAME:  RECORD TYPE INDICATOR (1-001)
VALIDITY EDITS
1-001-01V
RECORD TYPE INDICATOR MUST =
1
INSTITUTIONAL
Relational Edits
1-001-01R
IF TYPE OF SUBMISSION =
A
ADJUSTMENT OR
B
ADJUSTMENT TO NON-TED RECORD (HCSR) DATA OR
C
COMPLETE CANCELLATION OR
D
COMPLETE CANCELLATION OF NON-TED RECORD (HCSR) DATA
AND MATCH IS FOUND ON THE DHA DATABASE
THEN THE RECORD TYPE FOR THE TED ON THE DATABASE MUST EQUAL THE RECORD TYPE ON THE ADJUSTMENT/CANCELLATION TED BEING SUBMITTED.
ELEMENT NAME:  FILING DATE (1-015)
VALIDITY EDITS
1-015-01V
MUST BE A VALID JULIAN DATE AND CANNOT BE > DHA CURRENT SYSTEM DATE.
Relational Edits
1-015-01R
FILING DATE MUST BE ≤ DATE TED RECORD PROCESSED TO COMPLETION (PTC)
ELEMENT NAME:  FILING STATE/COUNTRY CODE (1-020)
VALIDITY EDITS
1-020-01V
IF TYPE OF SUBMISSION =
D
COMPLETE DENIAL OR
I
INITIAL SUBMISSION OR
O
ZERO PAYMENT WITH 100% OHI/TPL OR
R
RESUBMISSION
THEN MUST BE A VALID STATE/COUNTRY CODE (REFER TO Addendums A AND B).
Relational Edits
1-020-01R
IF PRICING RATE CODE =
H
TRICARE DRG REIMBURSEMENT WITH SHORT STAY OUTLIER OR
I
TRICARE DRG REIMBURSEMENT WITH COST OUTLIER OR
J
TRICARE DRG REIMBURSEMENT WITH NO OUTLIER OR
CI
CAH INPATIENT REHABILITATION FACILITY (IRF) REIMBURSEMENT OR
CP
CAH PSYCHIATRIC HOSPITAL PER DIEM RATE OR
DD
DISCOUNTED DRG OR
LT
STANDARD LTCH REIMBURSEMENT OR
RF
TRICARE IRF REIMBURSEMENT OR
SN
SITE-NEUTRAL LTCH REIMBURSEMENT
THEN FILING STATE/COUNTRY CODE MUST NOT BE A FOREIGN COUNTRY EXCEPT FOR PUERTO RICO (PRI).
ELEMENT NAME:  SEQUENCE NUMBER (1-025)
VALIDITY EDITS
1-025-01V
SEQUENCE NUMBER MUST BE A COMBINATION OF ALPHABETIC OR NUMERIC CHARACTERS
Relational Edits
NONE
ELEMENT NAME:  TIME STAMP (1-030)
VALIDITY EDITS
1-030-01V
MUST BE NUMERIC
Relational Edits
1-030-01R
IF FILING DATE IS ≥ 02/01/1995
THEN TIME STAMP MUST BE > ZERO
ELEMENT NAME:  ADJUSTMENT KEY (1-035)
VALIDITY EDITS
1-035-01V
MUST BE ALPHA, 0, OR 5.
Relational Edits
NONE
ELEMENT NAME:  DATE TED RECORD PROCESSED TO COMPLETION (1-040)
VALIDITY EDITS
1-040-01V
MUST BE VALID GREGORIAN DATE AND CANNOT BE > CURRENT SYSTEM DATE.
Relational Edits
1-040-01R
DATE TED RECORD PROCESSED TO COMPLETION MUST BE ≤ BATCH/VOUCHER DATE.
ELEMENT NAME:  DATE ADJUSTMENT IDENTIFIED (1-045)
VALIDITY EDITS
1-045-01V
MUST BE VALID GREGORIAN DATE OR ALL ZEROES AND CANNOT BE > DHA CURRENT SYSTEM DATE.
1-045-02V
IF TYPE OF SUBMISSION =
D
CONTRACTOR DENIAL OR
I
INITIAL SUBMISSION OR
O
ZERO PAYMENT WITH 100% OHI/TPL OR
R
RESUBMISSION
THEN DATE ADJUSTMENT IDENTIFIED MUST BE ALL ZEROES.
1-045-04V
IF TYPE OF SUBMISSION =
A
ADJUSTMENT OR
B
ADJUSTMENT TO NON-TED RECORD (HCSR) DATA OR
C
COMPLETE CANCELLATION OR
E
COMPLETE CANCELLATION OF NON-TED RECORD (HCSR) DATA
THEN DATE ADJUSTMENT IDENTIFIED MUST BE A VALID GREGORIAN DATE
Relational Edits
1-045-03R
IF TYPE OF SUBMISSION =
A
ADJUSTMENT OR
B
ADJUSTMENT TO NON-TED RECORD (HCSR) DATA OR
C
COMPLETE CANCELLATION OR
E
COMPLETE CANCELLATION OF NON-TED RECORD (HCSR) DATA
THEN DATE ADJUSTMENT IDENTIFIED MUST BE ≤ DATE TED RECORD PROCESSED TO COMPLETION (PTC) AND ≥ FILING DATE
ELEMENT NAME:  PERSON IDENTIFIER (SPONSOR) (1-050)
VALIDITY EDITS
1-050-01V
MUST BE NINE NUMERIC DIGITS (CANNOT BE ALL ZEROES, ALL NINES, OR ALL BLANKS).
Relational Edits
NONE
ELEMENT NAME:  PERSON IDENTIFIER TYPE CODE (SPONSOR) (1-051)
VALIDITY EDITS
1-051-01V
MUST BE A VALID VALUE LOCATED IN Section 2.7.
Relational Edits
NONE
ELEMENT NAME:  PAY GRADE CODE (SPONSOR) (1-056)
VALIDITY EDITS
1-056-01V
MUST BE A VALID PAY GRADE CODE (SPONSOR) (REFER TO Section 2.7)
Relational Edits
NONE
ELEMENT NAME:  PAY PLAN CODE (SPONSOR) (1-057)
VALIDITY EDITS
1-057-01V
MUST BE A VALID PAY PLAN CODE (SPONSOR) (REFER TO Addendum K)
Relational Edits
NONE
ELEMENT NAME:  SERVICE BRANCH CLASSIFICATION CODE (SPONSOR) (1-060)
VALIDITY EDITS
1-060-01V
MUST BE A VALID SERVICE BRANCH CLASSIFICATION CODE (SPONSOR) (REFER TO Section 2.8)
Relational Edits
REFER TO Section 8.1.
ELEMENT NAME:  AGR SERVICE LEGAL AUTHORITY CODE (1-065)
VALIDITY EDITS
1-065-01V
MUST BE A VALID AGR SERVICE LEGAL AUTHORITY CODE (REFER TO Section 2.4)
Relational Edits
REFER TO Section 8.1.
ELEMENT NAME:  HEALTH CARE COVERAGE (HCC) MEMBER CATEGORY CODE (1-066)
VALIDITY EDITS
1-066-01V
MUST BE A VALID HCC MEMBER CATEGORY CODE (REFER TO Section 2.5)
Relational Edits
1-066-01R
IF HCC MEMBER RELATIONSHIP CODE =
A
SELF
THEN HCC MEMBER CATEGORY CODE MUST ≠
A
ACTIVE DUTY OR
G
NATIONAL GUARD MEMBER (MOBILIZED OR ON ACTIVE DUTY FOR 31 DAYS OR MORE) OR
J
ACADEMY STUDENT OR
N
NATIONAL GUARD (NOT ON ACTIVE DUTY OR ON ACTIVE DUTY FOR 30 DAYS OR LESS) OR
S
RESERVE MEMBER (MOBILIZED OR ON ACTIVE DUTY FOR 31 DAYS OR MORE) OR
T
FOREIGN MILITARY MEMBER OR
V
RESERVE MEMBER (NOT ON ACTIVE DUTY OR ON ACTIVE DUTY FOR 30 DAYS OR LESS)
UNLESS ENROLLMENT/HEALTH PLAN CODE =
W
TPR SERVICE MEMBER - USA OR
X
FOREIGN SERVICE MEMBER OR
Y
CHCBP - NON-NETWORK OR
AA
CHCBP - NETWORK OR
SN
SHCP - NON-MTF/eMSM-REFERRED CARE OR
SO
SHCP - NON-TRICARE ELIGIBLE OR
SR
SHCP - MTF/eMSM REFERRED CARE OR
ST
SHCP - TRICARE ELIGIBLE OR
WA
TPR FOREIGN SERVICE MEMBER OR
WO
TPR FOREIGN ADFM
OR ANY OCCURRENCE OF SPECIAL PROCESSING CODE =
SC
SHCP - NON-TRICARE ELIGIBLE OR
SE
SHCP - TRICARE ELIGIBLE OR
SM
SHCP - EMERGENCY
OR HCDP PLAN COVERAGE CODE =
306
TRICARE SELECT - RESERVE SELECT SPONSORS AND FAMILY MEMBERS OR
307
TRICARE SELECT - RETIRED RESERVE SPONSORS AND FAMILY MEMBERS OR
401
TRS TIER 1 MEMBER-ONLY COVERAGE (CONTINGENCY OPERATIONS) OR
402
TRS TIER 1 MEMBER AND FAMILY COVERAGE (CONTINGENCY OPERATIONS) OR
405
TRS TIER 2 MEMBER-ONLY COVERAGE (CERTIFIED QUALIFICATIONS) OR
406
TRS TIER 2 MEMBER AND FAMILY COVERAGE (CERTIFIED QUALIFICATIONS) OR
407
TRS TIER 3 MEMBER-ONLY COVERAGE (SERVICE AGREEMENT) OR
408
TRS TIER 3 MEMBER AND FAMILY COVERAGE (SERVICE AGREEMENT) OR
409
TRS SURVIVOR CONTINUING WITH INDIVIDUAL COVERAGE OR
410
TRS SURVIVOR CONTINUING WITH FAMILY COVERAGE OR
411
TRS SURVIVOR NEW INDIVIDUAL COVERAGE OR
412
TRS SURVIVOR NEW FAMILY COVERAGE OR
413
TRS MEMBER-ONLY COVERAGE OR
414
TRS MEMBER AND FAMILY COVERAGE OR
418
TRR MEMBER-ONLY COVERAGE OR
419
TRR MEMBER AND FAMILY COVERAGE OR
420
TRR SURVIVOR INDIVIDUAL COVERAGE OR
421
TRR SURVIVOR FAMILY COVERAGE
1-066-02R
IF ANY OCCURRENCE OF SPECIAL PROCESSING CODE =
PF
ECHO
THEN HCC MEMBER CATEGORY CODE MUST =
A
ACTIVE DUTY OR
G
NATIONAL GUARD MEMBER (MOBILIZED OR ON ACTIVE DUTY FOR 31 DAYS OR MORE) OR
J
ACADEMY STUDENT OR
P
TAMP MEMBER OR
S
RESERVE MEMBER (MOBILIZED OR ON ACTIVE DUTY FOR 31 DAYS OR MORE)
1-066-03R
IF HCC MEMBER CATEGORY CODE =
T
FOREIGN MILITARY MEMBER
THEN ONE OCCURRENCE OF OVERRIDE CODE =
M
NATO
ELEMENT NAME:  HEALTH CARE COVERAGE (HCC) MEMBER RELATIONSHIP CODE (1-070)
1  PATIENT AGE IS CALCULATED BASED ON PERSON BIRTH CALENDAR DATE (PATIENT) AND BEGIN DATE OF CARE.
VALIDITY EDITS
1-070-01V
MUST BE A VALID HCC MEMBER RELATIONSHIP CODE (REFER TO Section 2.5).
Relational Edits
1-070-06R
IF ANY OCCURRENCE OF SPECIAL PROCESSING CODE =
PF
ECHO
THEN HCC MEMBER RELATIONSHIP CODE MUST =
A
SELF OR
B
SPOUSE OR
C
CHILD OR STEPCHILD OR
D
PRE-ADOPTIVE CHILD OR
E
WARD (COURT ORDERED) OR
G
SURVIVING SPOUSE
1-070-08R
IF HCC MEMBER CATEGORY CODE =
T
FOREIGN MILITARY MEMBER
AND HCC MEMBER RELATIONSHIP CODE =
A
SELF
THEN ANY OCCURRENCE OF SPECIAL PROCESSING CODE MUST =
AN
SHCP - NON-REFERRED CARE OR
AR
SHCP - REFERRED OR
SC
SHCP - NON-TRICARE ELIGIBLE OR
SM
SHCP - EMERGENCY
OR ENROLLMENT/HEALTH PLAN CODE MUST =
SN
SHCP - NON-MTF/eMSM REFERRED OR
SO
SHCP - NON-TRICARE ELIGIBLE OR
SR
SHCP - REFERRED
UNLESS TYPE OF SUBMISSION =
D
COMPLETE DENIAL OF INITIAL TED
THEN BYPASS THIS EDIT
ELEMENT NAME:  PERSON LAST NAME (PATIENT) (1-076)
VALIDITY EDITS
1-076-01V
MUST BE AT LEAST ONE CHARACTER (LEFT-JUSTIFIED).
Relational Edits
NONE
ELEMENT NAME:  PERSON FIRST NAME (PATIENT) (1-077)
VALIDITY EDITS
NONE
Relational Edits
NONE
ELEMENT NAME:  PERSON MIDDLE NAME (PATIENT) (1-078)
VALIDITY EDITS
NONE
Relational Edits
NONE
ELEMENT NAME:  PERSON CADENCY NAME (PATIENT) (1-079)
VALIDITY EDITS
NONE
Relational Edits
NONE
ELEMENT NAME:  PERSON IDENTIFIER (PATIENT) (1-080)
VALIDITY EDITS
1-080-01V
MUST BE NINE NUMERIC DIGITS AND CANNOT EQUAL ALL BLANKS.
Relational Edits
NONE
ELEMENT NAME:  PERSON IDENTIFIER TYPE CODE (PATIENT) (1-081)
VALIDITY EDITS
1-081-01V
MUST HAVE A VALID VALUE LISTED IN Section 2.7.
Relational Edits
NONE
ELEMENT NAME:  PERSON BIRTH CALENDAR DATE (PATIENT) (1-085)
1  PATIENT AGE IS CALCULATED BASED ON PERSON BIRTH CALENDAR DATE (PATIENT) AND BEGIN DATE OF CARE.
VALIDITY EDITS
1-085-01V
MUST BE A VALID GREGORIAN DATE AND CANNOT BE > DHA CURRENT SYSTEM DATE.
Relational Edits
1-085-01R
PATIENT AGE1 MUST BE < 125 YEARS
1-085-02R
PERSON BIRTH CALENDAR DATE (PATIENT) ≤ BEGIN DATE OF CARE
1-085-03R
PERSON BIRTH CALENDAR DATE (PATIENT) ≤ ADMISSION DATE
ELEMENT NAME:  PATIENT IDENTIFIER (DoD) (1-095)
VALIDITY EDITS
1-095-01V
MUST NOT BE BLANK FILLED.
1-095-02V
MUST NOT EQUAL ALL ZEROS.
UNLESS TYPE OF SUBMISSION =
D
COMPLETE DENIAL INITIAL TED RECORD DATA
OR ALL OCCURRENCES/LINE ITEMS (EXCLUDING REVENUE CODE 0001) CONTAIN AN ADJUSTMENT/DENIAL REASON CODE LISTED IN Addendum G, Figure 2.G-1 OR Figure 2.G-2.
Relational Edits
NONE
ELEMENT NAME:  DEERS IDENTIFIER (PATIENT) (1-097)
VALIDITY EDITS
1-097-01V
POSITIONS 10 AND 11 MUST BE NUMERIC.
Relational Edits
NONE
- END -

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