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TRICARE Systems Manual 7950.3-M, April 1, 2015
TRICARE Duplicate Claims System (DCS) - TRICARE Encounter Data (TED) Version
Chapter 4
Addendum A
Duplicate Claims System (DCS) Displayed Data Fields
Revision:  C-14, May 30, 2018
Figure 4.A-1  TRICARE Encounter Data (TED) Data Elements
Field Name
Description
Sponsor ID
Sponsor Social Security Number (SSN) or Other Sponsor Identifier
Sponsor ID Type Code
Sponsor ID Qualifier
DOB
Patient Date Of Birth
Patient ID
Patient Sponsor SSN or Other Patient Identifier
Provider Tax ID
Provider Taxpayer Number
Provider Sub ID
Multiple Provider ID
Proc Code/Proced Code
Procedure Code
Diagnosis
Principle Treatment Diagnosis Code
DRG
Diagnosis Related Group Number
Inst Admit Date
Admission Date
Inst Care Begin Date
Institutional Care Begin Date; Blank For Non-Institutional
Non-Inst Care Begin Date
Non-Institutional Care Begin Date
Inst Care End Date
Institutional Care End Date; Blank For Non-Institutional
Non-Inst Care End Date
Non-Institutional Care End Date
Billing Freq
Billing Frequency Code (1 = Complete, 2 = Initial, 3 = Interim, 4 = Final)
Billed Amount (Total)
Institutional Amount Billed Total
Billed Amount (Line)
Non-Institutional Line Item Amount Billed Total
Allowed Amount (Total)
Institutional Amount Allowed
Allowed Amount (Line)
Non-Institutional Line Item Amount Allowed
Place Serv
Place Of Service
Type Serv
Type Of Service
PTC Date
Processed To Completion Date
ICN
Internal Control Number
Prov Gp NPI
Provider Group National Provider Identifier
Time Stamp
System time assigned when issuing an initial HCSR
Proc FI
Health Care Service Record (HCSR) Fiscal Intermediary (FI) Contractor Number
Processing Contract
Contract Number
Batch Sequence #
Batch Sequence Number
Voucher Sequence #
Voucher Sequence Number
Cycle Number
Defense Health Agency (DHA) Processing Cycle (Year, Month, Cycle Number)
Name
Patient Name
Age
Patient Age
Enrolled
Enrollment Status
Patient Zip Code
Patient Zip Code
Provider Zip Code
Provider Zip Code
Provider Network Status Indicator
Provider Network or Non-Network Indicator
Provider Specialty
Provider Specialty Code
Type Institution
Type Of Institution Code
Disp
Discharge Disposition
Govt Pd Amount (Line)
Line Item Paid By Government Contractor
Govt Pd Amount (Total)
Amount Paid By Government Contractor
L
Claim Line Item Number
TED Line #
Non-Inst Adjustment Line Item Number; For Inst = 00
Adjust PTC Date
Adjustment Processed to Completion Date
Govt Pd Amount (Adjustment)
Claim Level Adjustment Paid Amount for Institutional Claim
Line Item Level Adjustment Paid Amount for Non-Institutional Claim
SPC 1
First Special Processing Code
SPC 2
Second Special Processing Code
SPC 3
Third Special Processing Code
SPC 4
Fourth Special Processing Code
SRC
Special Rate Code
PRC
Pricing Rate Code
NPI
National Provider ID
Claim Form Type
Primary Claim Form Submitted
Figure 4.A-2  Generated Data Elements
Field Name
Description
Set #
Extract claim set control number. A unique reference to tie together a set of potential duplicate claims.
Match Type
Claim set match criteria category: EXACT MATCH, NEAR MATCH, DATE OVERLAP, CPT-4, CODE, OTHER. Determined during the initial extract and set construction.
Claim Match
Claim match criteria category. Same as claim set categories.
M (match type code for line item)
Line item match criteria category. Same as claim set categories.
Risk
Financially underwritten, non-financially underwritten indicator for claim. Please note that for the purposes of this system:
Financially underwritten = Risk
Non-Financially underwritten = Not at-risk.
Mass Change Level
The latest MASS CHANGE cluster rule applied to the claim.
Patient Region
Patient health service region code.
Provider Region
Provider health service region code.
Owner FI
Owner FI represents, for the claim set, the contractor that has been assigned responsibility for resolving particular potential duplicate claim sets. Typically, all claims within a set will have the same responsible FI/contractor (Resp FI), in which case the Owner FI will be the same as the responsible FI/contractor. However, for “multi-contractor” claim sets where the responsible FI/contractors are not the same for all claims within the set, an Owner FI is originally assigned by the system to be the responsible FI/Contractor from the claim within the set having the latest PTC date.
Resp FI / Rsp FI
Resp FI or Rsp FI represents, for the claim, the contractor that is currently responsible for administering the claim. When the claim is initially extracted from TED, the Resp FI is identical to the Proc FI (Processing FI). However, contract awarding and transitions may require claim administration by a new contractor, in which case the system will assign a new Resp FI for the claim.
Owner Region
Owner Region is a narrative descriptor of the contract number and represents, for the claim set, the Owner FI/contractor region. Typically, all claims within a set will have the same Responsible Contract, in which case the Owner Region will be the same as the Responsible Contract. However, for multi-contractor claim sets where the contractors are not the same for all claims within the set, an Owner Region is assigned by the system to be the Responsible Contract from the claim within the set having the latest processed-to-completion date. The initial assignment is done in tandem with the assignment of Owner FI.
Responsible Contract
Responsible Contract represents, for the claim, the contract under which the claim is currently administered. When the claim is initially extracted from TED, the Responsible Contract is identical to the Processing Contract. However, contract awarding and transitions may require claim administration under a new contract, in which case the system will assign a new Responsible Contract for the claim.
Dupe?
Dupe? is an indicator to describe whether or not the claim or line item is a duplicate. During the extract processes Dupe? will be set to N (no) for the base claim within a set and will be set to blank for the remaining claims and line items.
Reason Code
Reason Code is a code used for each claim within a set to designate why the claim in the set is or is not a duplicate. During the initial loading of a set into the system, the base claim within a set will be assigned (in conjunction with Dupe? being set to N) a reason code of BASE representing initial submission. The system will provide an option list of valid codes intended to cover the majority of possible conditions and a code for an “other” option for the occasions when the condition cannot be classified. Some Reason Code selections will require an additional explanation field for further elaboration.
TED Adjust?
TED Adjust? is a flag for the user to designate which adjustment or cancellation corrects the duplicate condition. All adjustments and cancellations that apply are checked Y (yes), and those that do not apply can be left blank or checked N (no). The TED Adjustment field is the sum (for the claim) of paid dollar amounts for those that apply. Display screens enable TED Adjust? to be checked for any institutional claim and any non-institutional line item.
Status
Status indicates the claim set life cycle phase from initial system loading to final purging. Status is set by the system as a consequence of specific user actions or periodic system functions.
Identified Recoup
Identified Recoup is a dollar amount that is entered by the user or by the system upon initial determination that a claim or a line item is a duplicate. It represents the amount of overpayment for the claim or line item that has been identified for recoupment.
Actual Recoup
Actual Recoup is a dollar amount that is entered by the user upon completion of recoupment for a duplicate claim. It represents the amount of overpayment for the claim that has actually been recouped.
TED Adjustment
TED Adjustment is a dollar amount that is maintained by the system (not by the user) to accumulate TED adjustment or cancellations made during resolution of a duplicate claim. It is calculated as the sum of all adjustment and cancellation paid amounts that have been flagged by the user as being associated with correcting the duplicate. This is the sum of claim level paid amounts for institutional claims and line item paid amounts for non-institutional claims.
ID Recoup
ID Recoup is a dollar amount calculated by the system as the sum of Identified Recoup amounts for all claims within a set. It represents the total amount of overpayment for the claim set that has been identified for recoupment.
Actual Recoup
Actual Recoup is a dollar amount calculated by the system as the sum of claim level actual recoupment amounts for all claims within a set. It represents the total amount of overpayment for the set that has actually been recouped.
Adjust Amount
Adjustment Amount is a dollar amount calculated by the system as the sum of TED Adjustment amounts for all claims within a set. It represents the total amount of adjustments and cancellations that have been flagged by the user as being associated with correcting all duplicate claims within the set.
Initial Load Date
Initial Load Date represents the date the claim set was initially loaded into the system. The LASTDATE reflects the most recent claim set update date - for specific types of updates.
Current Load Date
Current Load Date represents the date the claim set was initially loaded into the system or the date set ownership changed, or the date a new claim was appended to the set, whichever is the latest date.
Last Update Date
Last Update Date represents the most recent date a claim set was updated. Changes to the following will change the Last Update Date: Status, Match Type, Multi-FI Indicator, Owner FI, Owner Region, ID Recoup, Actual Recoup, Set Adjustment Amount, and Adjust Indicator. The Last Update Date will not change solely due to a change to: User Defined Codes, Dupe? field, Solicited (S?) Indicator, TED Adjust?, Reason Code, Reason Code Explanation, or Notepad.
S?
S? is the Solicited Indicator.
Set User Def
- END -

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