MDR Data Dictionary by xiaohuicaicai

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									     MDR
Data Dictionary

    October 2011

Defense Health Cost Assessment and Program Evaluation
                                                    Table of Contents

The MDR Data Dictionary is organized using tabs that generally correspond to the data elements as named in the MDR.
The tabs are arranged in the order their data is presented on the MDR, with an informational tab following those that pertain
to a specific data type. Appendices' information is presented last, with the tabs in alphabetical order. To move to a specific
tab, click on the tab name. Names in blue are for organizational purposes only and are not tabs.




                   Detail Files                                          Reference Tables / Appendices
                   ADDP Claims                                           ACV Codes
                   ADDP Provider                                         AD Strength Accounting Codes
                   Ancillary - Lab Rad                                   AGR Code
                   Appointment-Master                                    AHFS Therapeutic Class Codes
                   Appointment-Weekly                                    APC Grouper Codes
                   CAPER (Basic & Enhanced)                              APG Grouper Codes
                   Case Management                                       APPT Request Status Codes
                   Casualty Death                                        CAPER Change Codes
                   Casualty Death (Restricted)                           County Codes
                   Completion Factors - SADR                             Country Codes
                   Completion Factors - SIDR                             CPT Codes Designated Facility
                   CPT Table                                             CPT Modifiers
                   Customer Satisfaction Survey                          Death Rank Codes
                   Designated Provider (Clinical)                        DEERS Contractor Codes
                   Designated Provider (Pharmacy)                        DEERS Country Codes
                   Designated Provider (Provider)                        DEERS HCDP Codes
                   DMIS ID Index Table                                   DEERS Origination/ Verification Codes
                   DMIS ID - Normative Data                              DEERS Regions
                                                                         Dental Insured Enrollment Management Contractor
                   Encounter Death
                                                                         Enrollment End Reason Code
                   TRICARE Enrollment                                    Dental Insurance HCDP Plan Coverage Code
                   TRICARE Enrollment - Normative Data                   Designated Provider Codes
                   Health Care Provider Record                           Diagnosis Related Group Codes
                   HCSR Institutional                                    Medicare Severity DRGs (MS-DRGs)
                   HCSR Non-Institutional FY00+                          Disposition Status
                   HCSR Non-Institutional pre FY00                       DMIS ID Information
                   ICD9 Diagnosis Codes                                  DoD Extenders
                   ICD9 Procedure Codes                                  Enrollment Status Codes
                   Longitudinal Eligibility                              Entitlement (Personnel) Condition Type Codes
                   Longitudinal Enrollment                               Filing State Country Codes
                   Longitudinal VM4 (LVM4)                               HCDP Codes
                   Master Death                                          HIPPS Codes
                   MCFAS                                                 Hospital Department Number
                   MEPRS                                                 Injury Codes
                   MEPRS-Expense Detail                                  Institution Type
                   MEPRS-Workload Detail                                 LVM4 Values
                   MEPRS - Ancillary                                     LVM6 Values
                   MEPRS - Normative Data                                Major Diagnostic Category Codes
                   MEPRS-MEPRS4 Descriptions                             Member Category Codes
                   MEPRS-Occ Codes                                       MCFAS Pay Grades
                                                                         Derived Medical Insured Enrollment Mgmt
                   MEPRS-Personnel
                                                                         Contractor Enrollment End Reason Code
                   MEPRS-Skill Type                                      MEPRS Codes 2
                   MEPRS-Duty Indicator                                  MEPRS Codes 3



   September 2011 Version                           Table of Contents                                   Page 2 of 1408
                                        Table of Contents
            MEPRS-Personnel Category                        MEPRS Definitions
            MEPRS-MEPRS3 Codes                              MEPRS DoD Occupation Codes
            MMSO Dental Care Claims                         Military Occupation Codes
            MMSO Dental Providers                           Metropolitan Statistical Area (MSA) Codes
            MPI (Master Person Index)                       MTF Location Codes
            Omni CAD                                        NAS Exception Codes
            PITE Aggregate                                  OPPS Payment Status Indicator
            PITE Beneficiary Level                          Override Codes (TED/HCSR)




September 2011 Version                  Table of Contents                                Page 3 of 1408
                                                     Summary of Changes

                        Tab                                                   Additions/Modifications
All Tabs                      Links and formats adjustments
DMIS ID Information           Monthly update
                              Added Direct Care Benefit Type Code E=Early Alert for Guard/Reserve Service Members
                              Added Medical Privilege Code 9 = Presumed Not Eligible
                              Added Data Elements:
                                             Walkback Mailing Address Change Flag;
                                             Walkback Mailing Address Source Extract;
VM6BEN                                       Walkback Unit Location Change Flag;
                                             Walkback Unit Location Source Extract;
                                             Walkback Dental Insured HCDP Change Flag;
                                             Walkback Dental Insured HCDP Source Extract;
                                             MHS Derived Country Code;
                                             TRICARE Young Adult Flag.




 October 2011 Version                               Summary of Changes                                              Page 4 of 1408
                       Summary of Changes




                              Return to the
                                Table of
                                Contents




October 2011 Version   Summary of Changes     Page 5 of 1408
                                                                                    ADDP Claims

                                                                 Active Duty Dental Plan (ADDP) DENTAL CARE CLAIMS
Common File Name: fy**.sas7bdat
Dataset Location: /mdr/pub/dental/addp/claims/fy**
Update Frequency: Updated monthly                                                                                   Source System: ADDP contractor

Description: Active duty dental claims
                                                                                 Position or SAS
  Data Element                            Definition                    Format                         Values                                            Notes
                                                                                    Variable
                                                                                                                    A=Active Duty Prime
                                                                                                                    B=TRICARE Global Remote Overseas Prime Active Duty
                                                                                                                    D=TRICARE Senior Prime
                                                                                                                    E=Non-Active Duty Prime
                                                                                                                    F=TRICARE Global Remote Overseas Prime Active Duty Family Member
                                                                                                                    G=TRICARE Plus (CHAMPUS/TFL Eligible)
                                                                                                    A, B, D, E, F, H=TRICARE Overseas Prime Active Duty
DEERS Alternative Indicates patients medical enrollment status on the
                                                                          $1          acv          G, H, J, L, M, J=TRICARE Overseas Prime Active Duty Family Member
Care Value        date of service.
                                                                                                   Q, R, U, V, Null L=TRICARE Plus (not CHAMPUS/TFL Eligible)
                                                                                                                    M=AD not reported enrolled (added FY05)
                                                                                                                    Q=AD enrolled to Op Forces
                                                                                                                    R=TRS
                                                                                                                    U=USTF/USFHP
                                                                                                                    V=TRICARE Retired Reserve
                                                                                                                    Null = Not Enrolled
                                                                                                                     A = Additional payment
                                                                                                                     B = History change
                                                                                                                     C = Refund reprocess
                                                                                                                     D = Cancel refund
                                                                                                    A, B, C, D, E, E = Transfer funds
                     Indicates the adjustment made to claim. Only
Adjustment Code                                                           $1         adjcode       F, G, H, I, J, or F = Utilization transfer/original (intraplan)
                     populated on claims that have been adjusted.
                                                                                                         Null        G = Utilization transfer/secondary (intraplan)
                                                                                                                     H = Administration
                                                                                                                     I = Refund
                                                                                                                     J = Product line transfer (interface claim)
                                                                                                                     Null = Not adjusted
                     Code identifying the reason for non-payment of
Adjustment Reason                                                         $2         adjkey
                     services or adjustment of the detail line item.
                                                                                                                  A = 0-4
                                                                                                                  B = 5-14
                                                                                                                  C = 15-17
                                                                                                                  D = 18-24
                                                                                                   A, B, C, D, E,
Age Group            The patient's age group.                             $1         agegrp                       E = 25-34
                                                                                                    F, G, H or X
                                                                                                                  F = 35-44
                                                                                                                  G = 45-64
                                                                                                                  H = 65+
                                                                                                                  X = All others
                     The amount allowed under the plan for the
Allowed Amount                                                            9.2         allow
                     specified services.
Anterior/Posterior                                                                                                  A = Anterior
                     Indicates anterior/posterior location.               $1          ap_id            A or P
Flag                                                                                                                P = Posterior



   October 2011 Version                                                             ADDP Claims                                                                       Page 6 of 1408
                                                                                     ADDP Claims

                                                                                  Position or SAS
  Data Element                         Definition                       Format                         Values                                           Notes
                                                                                     Variable
                   The approved amount that the plan would pay
Amount Paid                                                               9.2        approved
                   towards the dental services.
Authorization
                   Number of authorization for services.                 $16         authnum
Number
                   The date that dental services were first provided
Date of Service                                                        YYYYMMDD      begdate
                   for this claim.
                                                                                                                ACT = Active Duty
                                                                                                                DA = Dependent of Active Duty
                                                                                                                DCO = Direct Care Only
                                                                                                                DR = Dependent of Retired
                   Beneficiary Category on date of service, from                                                DS = Dependent of Survivor
DEERS Beneficiary match to DEERS data. Records with an "UNK"                                        ACT, GRD or GRD = Guard/Reserve
                                                                          $3          bencat
Category          value were generally not found in DEERS on the                                       IGR      IDG = Dependent of Inactive Guard
                  date of service.                                                                              IGR = Inactive Guard/Reserve
                                                                                                                NAT = NATO
                                                                                                                OTH = Other
                                                                                                                RET = Retired
                                                                                                                Z = Unknown

Billed Charge      The amount charged by the provider for services.       9.2           bill
Buccal Surface                                                                                                        N = No
                  Indicates buccal surface.                              $1           buc_ind           N or Y
Indicator                                                                                                             Y = Yes
Residence         Patient's catchment area ID. Indicates which
                                                                         $4            catch                          See DMIS Information for list of DMIS ID.
Catchment Area Id inpatient MTF the patient lives near, if any.
                  Current Dental Terminology (CDT) procedure code
CDT Code                                                                 $5             cdt
                  for the service.
                  The CDT version that was used to determine the
CDT Version #                                                            $2           cdtvers
                  procedure code.
                  Set to the most recent date that any data element
Change Date       on the MDR record was changed. For records that
                                                                     yyyymmdd        chgdate
(MDR)             never change, this will be equal to the initial
                  processing date.
Claim Number      The unique number for the claim.                      $13           claimid
Claim Finalized   The date that the claim was adjudicated and
                                                                    YYYYMMDD          clmfindt
Date              payment decisions made.
Claim Paid Date    The date that the claim was paid.                   YYYYMMDD      clmpddt

Claim Receipt Date The date that the claim was received for payment. YYYYMMDD        clmrecdt


                                                                                                    01, 02, 03, 04,
                                                                                                    05, 06, 07, 08,
CM                 Calendar month of service date                         $2            cm
                                                                                                     09, 10, 11 or
                                                                                                          12




   October 2011 Version                                                              ADDP Claims                                                                  Page 7 of 1408
                                                                                           ADDP Claims

                                                                                        Position or SAS
  Data Element                             Definition                          Format                     Values                                        Notes
                                                                                           Variable
                                                                                                                      1 = Dependent of Active Duty/Guard/Reserve
                                                                                                                      2 = Retired
                     Common Beneficary Category on date of service.
Ben Cat Common                                                                   $1        comben           1-4       3 = Dependent of Retired/Survivor, Other, Unknown, Inactive Guard/Reseve
                     Based on beneficiary category.
                                                                                                                          Dependent, Inactive Guard/Reserve
                                                                                                                      4 = Active Duty and Guard
CY                    Calendar year of service date                              $4           cy          ex: 2009
                     Derived field based on the dental treatment facility
Derived DTF          code that is found on the claim. If coded then the                                               N = No
                                                                                 $1         d_dtfref       N or Y
Referral Indicator   DTF Referral Indicator is defined as "Y", if not                                                 Y = Yes (DTF Referral)
                     coded the indicator is defined as "N".
                     Patient's zip code on date of service, from match
DEERS Zip Code                                                                   $5        deerszip
                     to DEERS data.
DEERS Enrollment DMIS id of the facility where the patient is enrolled
                                                                                 $4        denrsite                   See DMIS Information for list of DMIS ID.
DMIS Id          to on date of service, from match to DEERS data.
                                                                                                                      1 = No dental treatment needed
Dental Readiness     Code indicating the provider's assessment of the
                                                                                 $1       dentalclass     1, 2 or 3   2 = Minor dental treatment needed
Classification       member's dental readiness.
                                                                                                                      3 = Urgent or emergent dental care required
                     IF the HCDP code is coded as dental, the patient                                                 Y = eligible
Dental HCDP Flag                                                                 $1        dhcdp_fl        Y or N
                     is eligible (Y) if not the patient is not eligible (N).                                          N = not eligible
Distal Surface                                                                                                        N = No
                     Indicates distal surface.                                   $1         dis_ind        N or Y
Indicator                                                                                                             Y = Yes
Dental Treatment     A code representing the referring Dental
                                                                                 $4       dtf_dmisid                  See DMIS Information for list of DMIS ID.
Facility Code        Treatment Facility
DEERS Sponsor        Patient's sponsor service on date of service, from
                                                                                 $1        dsponsvc
Service              match to DEERS data.
DEERS Sponsor        Patient's sponsor service aggregate on date of
                                                                                 $1        dsvcagg
Service Aggregate    service, from match to DEERS data.
                  Code found on the claim indicating whether the
                                                                                                                      D = DTF area
DTF Area          care was provided in a DTF Service Area or if the     $1                 dtf_area       D or R
                                                                                                                      R = Remote
                  claim is considered remote.
                  Unique person identifier. This data element is a
DEERS Person ID -
                  vast improvement over the raw DEERS Person ID,       $10                   edipn
Derived
                  which is frequently blank.
                  The last date that dental services were provided
End Date of Care                                                    YYYYMMDD               enddate
                  for this claim.




     October 2011 Version                                                                  ADDP Claims                                                                    Page 8 of 1408
                                                                                          ADDP Claims

                                                                                       Position or SAS
   Data Element                           Definition                         Format                          Values                                        Notes
                                                                                          Variable

                                                                                                                          1 = Other Hispanic
                                                                                                                          2 = US or Canadian Indian Tribe
                                                                                                                          3 = Other Asian
                                                                                                                          4 = Puerto Rican
                                                                                                                          5 = Filipino
                                                                                                                          6 = Mexican
                                                                                                                          7 = Eskimo
                                                                                                                          8 = Aleut
                                                                                                                          9 = Cuban
                                                                                                                          D = Indian
                                                                                                         1-9, D, E, G, H, E = Melanesian
DEERS Ethnicity      Patient's ethnicity code on date of service, from
                                                                               $1          ethnic         J, K, L, Q, S, G = Chinese
Code                 match to DEERS data.
                                                                                                          V, W, X, Y, Z H = Guamanian
                                                                                                                          J = Japanese
                                                                                                                          K = Korean
                                                                                                                          L = Polynesian
                                                                                                                          Q = Pacific Islander NEC
                                                                                                                          S = Latin America w/ Hispanic descent
                                                                                                                          V = Vietnamese
                                                                                                                          W = Micronesian
                                                                                                                          X = Other
                                                                                                                          Y = None
                                                                                                                          Z = Unknown

Extract Date         The date the data was processed.                          $7          extr_dt         dyymmdd
Facial Surface                                                                                                             N = No
                     Indicates facial surface.                                 $1          fac_ind           N or Y
Indicator                                                                                                                  Y = Yes
Facility Practice
                     Facility practice expense RVU.                            7.2        facpervu
Expense RVU
                                                                                                         01, 02, 03, 04,   01 = October
                                                                                                         05, 06, 07, 08,   02 = November
FM                   Fiscal Month of service date.                             $2            fm
                                                                                                          09, 10, 11 or    etc.
                                                                                                               12          12 = September
FY                   Fiscal Year of service date.                              $4            fy             ex: 2009
DEERS Health
                     Code that indicates the medical enrollment plan
Care Delivery                                                                  $3           hcdp                           See HCDP codes .
                     the patient has.
Program Code
Performing
Provider HIPAA       Indicates the provider specialty.                        $10        hipaaspec
Taxonomy
Incisal Surface                                                                                                            N = No
                     Indicates incisal surface.                                $1          inc_ind           N or Y
Indicator                                                                                                                  Y = Yes
Date of last exam.   Date of last exam.                                     YYYYMMDD      lastexam         00000000        Currently not coded.
Claim Line Item
                     The line number of a particular service on the bill.      $4          linenum
Number
Line Item Rejection The reason for the rejection of the line-item within
                                                                               $5          linerej
Reason Code         the claim.




     October 2011 Version                                                                 ADDP Claims                                                              Page 9 of 1408
                                                                                         ADDP Claims

                                                                                      Position or SAS
  Data Element                           Definition                         Format                        Values                                          Notes
                                                                                         Variable
Lingual Surface                                                                                                        N = No
                    Indicates lingual surface.                                $1          ling_ind        N or Y
Indicator                                                                                                              Y = Yes
                                                                                                                       A = Medicare A Only
DEERS Medicare                                                                                                         B = Medicare B Only
                    Indicates patients medicare status.                       $1         medflag        A, B, C or N
Flag                                                                                                                   C = Medicare A and B
                                                                                                                       Z = No Medicare
Mesial Surface                                                                                                         N = No
                    Indicates mesial surface.                                 $1         mes_ind          N or Y
Indicator                                                                                                              Y = Yes
Patient MTF
                    Indicates which MTF the patients lives near.              $4        mtfsvcarea                     See DMIS Information for list of DMIS ID.
Service Area
                                                                                                                       1 = Network provider
Provider Network    Indicates whether or not the provider is a network
                                                                              $1          network        1, 2 or 3     2 = Non-network provider
Status              or non-network provider.
                                                                                                                       3 = Not Eligible
                                                                                                                       1 = this version of the record was received in most recent processing cycle
New Record Flag     New Record Flag                                           $1         new_rec           1 or 0
                                                                                                                       0 = Otherwise
Non-Facility
Practice Expense    Non-Facility Practice Expense RVU.                       7.2          nfpervu
RVU
National Provider   National Provider ID (NPI) number of the individual
                                                                             $14            npi
ID (Ind)            provider rendering dental services.
National Provider   National Provider ID (NPI) number of the provider's
                                                                             $14         npigroup
ID (Group)          group rendering dental services.
Occlusial Surface                                                                                                      N = No
                    Indicates occlusal surface.                               $1         occl_ind         N or Y
Indicator                                                                                                              Y = Yes
Other Carrier       Payments made by Other Health Insurance (OHI)
                                                                             9.2            ohi
Payment             towards the Provider Charges.
Oral Health         A code indicating if this service is part of an Oral                                               N = No
                                                                              $1         oral_ind         N or Y
Initiative Flag     Health Initiative.                                                                                 Y = Yes
                                                                                                                       AA = Spouse
                                                                                                                       AB = Child
                                                                                                                       AC = Foster Child
                                                                                                                       AD = Parent
                                                                                                                       AE = Parent-in-law
                                                                                                                       AF = Stepchild
                                                                                                        AA, AB, AC,
                                                                                                                       AH = Stepparent
                                                                                                        AD, AE, AF,
                                                                                                                       AI = In loco parents
Person Association Code identifying the person association reason                                       AH, AI, AX,
                                                                              $2           parc                        AX = Emergency Contact
Reason Code        code, based on master person index merge.                                            BB, BC, BD,
                                                                                                                       BB = Ward, BC = Former Spouse
                                                                                                        BE, BF, BG,
                                                                                                                       BD = Self
                                                                                                          CA, ZZ
                                                                                                                       BE = Joint marriage spouse
                                                                                                                       BF = Other health insurance subscriber
                                                                                                                       BG = Pre-adoptive child
                                                                                                                       CA = Memeber of household headed by sponsor's
                                                                                                                            former spouse (child, stepchild or ward only)
                                                                                                                       ZZ = unknown
Age                 Patient's age                                              3.         patage
Date Of Birth       Service member‟s birth date.                           yyyymmdd       patdob
First Name          First name of Active Duty Service Member.                 $25        patfname



   October 2011 Version                                                                  ADDP Claims                                                                         Page 10 of 1408
                                                                                          ADDP Claims

                                                                                       Position or SAS
   Data Element                           Definition                         Format                         Values                                         Notes
                                                                                          Variable
Last Name            Last name of Active Duty Service Member.                 $35         patlname
Middle Name          Middle name of Active Duty Service Member.               $25        patmname
                                                                              $1                                         F = Female
Sex                  Service member‟s gender.                                              patsex           F, M or X    M = Male
                                                                                                                         X = Unknown
                      PCM ID on date of service, from match to DEERS
DEERS PCM Id                                                                  $32          pcmid
                     data.
Provider MTF
                     Provider's MTF service area.                              $4        pmtfsvcarea                     See DMIS Information for list of DMIS ID.
Service Area
Prior Placement
                     The date of prior placement.                           YYYYMMDD       prepldt
Date
Residence Prism
                     Indicates which medical clinic a patient lives near.      $4           prism                        See DMIS Information for list of DMIS ID.
Area Id
                                                                                                                           0 = Not Eligible for MHS benefits
                                                                                                                           1 = Direct Care Only
                                                                                                                           2 = Direct Care and MHS Purchased Care
                                                                                                                           3 = Not Eligible, some dependents eligible
                                                                                                                           4 = Transitional Direct Care Only
                                                                                                                           5 = Transitional Direct Care and MHS Purchased Care
                                                                                                         0, 1, 2, 3, 4, 5, 6 = Transitional Direct Care and Medicare A Only
DEERS Medical        Patient's medical privilege code on date of service,
                                                                               $1         privcode       6, 7, 8, A, B, C, 7 = Direct Care and Medicare A Only
Privilege Code       from match to DEERS data.
                                                                                                               M, U        8 = Other
                                                                                                                           A = Direct Care, MHS Purchased Care, Medicare A
                                                                                                                           B = Transitional Direct Care, MHS Purchased Care, Medicare A
                                                                                                                           C = CHAMPUS Only
                                                                                                                           M = TRICARE for Life only
                                                                                                                           U = USFHP/USTF Enrollee
                                                                                                                           Z = unknown
Initial Processing
                     Initial Processing Date (MDR)                          yyyymmdd      procdate
Date
Performing           A unique number assigned to an individual or
                                                                               $9          provid
Provider             organization which performs health care services.
                                                                                                                         025 = General Dentistry
                                                                                                                         032 = Oral Surgery
                                                                                                                         033 = Endodontics
Performing                                                                                                               034 = Orthodontics
Provider Specialty   Code describing the provider‟s specialty.                 $3         provspec                       036 = Pediatric Dentistry
Code                                                                                                                     037 = Periodontics
                                                                                                                         038 = Prosthodontics
                                                                                                                         084 = Multi-Specialty
                                                                                                                         110 = Dental Hygenist
                     The Professional Degree which a doctor receives
Provider Suffix      upon graduation from a college or university (ex:         $3         provsuff
                     DDS, DMD).
Performing
                   The business address Zip code of the provider.              $5          provzip
Provider Zip Code
Provider Catchment
                   Provider's catchment area id.                               $4          pvcatch                       See DMIS Information for list of DMIS ID.
Area Id




   October 2011 Version                                                                   ADDP Claims                                                                         Page 11 of 1408
                                                                                       ADDP Claims

                                                                                    Position or SAS
  Data Element                            Definition                       Format                        Values                                         Notes
                                                                                       Variable
Provider Prism
                     Provider's prism area id.                               $4         pvprism                      See DMIS Information for list of DMIS ID.
Area Id
                                                                                                                     A = Alaska
                                                                                                                     N = North
Provider TNEX                                                                                         A, N, O, S and
                     Provider's TNEX region.                                 $1         pvtnex                       O = OCONUS
Region                                                                                                      W
                                                                                                                     S = South
                                                                                                                     W = West
                                                                                                                     LL = lower left
                                                                                                      LL, LR, UL or LR = lower right
Quadrant             Identifies the quadrant of dental care.                 $2        quadrant
                                                                                                            UR       UL = upper left
                                                                                                                     UR = upper right
                                                                                                                     C = White
                                                                                                                     M = Asian or Pacific Islander
                     Patient's race code on date of service, from match                               C, M, N, R, X, N = Blank
DEERS Race Code                                                              $1          race
                     to DEERS data.                                                                          Z       R = American Indian or Alaskan Native
                                                                                                                     X = Other
                                                                                                                     Z = Unknown
                    Flag defining if the beneficiary is eligible for the
                    Remote Active Duty Dental Program. This derived                                                  1 = Eligible
ADDP Service Area                                                            $4         raddpfl           1 or 0
                    field is based on the patient's DEERS zip code                                                   0 = Not Eligible
                    matched to the service area file.
Person Identifier -                                                         $10
                    Unique Patient Id, EDIPN                                            redi_pn
Raw
                    A unique referral number associated with the
Referral Number                                                             $16         refnum
                    claim.
Claim Rejection
                    The reason for the rejection of the claim.               $5         rejrea
Reason Code
                                                                                                                     1 = Child
DEERS                                                                                                                2 = Self
                     Patient's relationship to sponsor on date of
Relationship to                                                              $1         relcode          1,2,3,4     3 = Spouse or Former Spouse
                     service, from match to DEERS data.
Sponsor                                                                                                              4 = Other
                                                                                                                     Z = Unknown
                                                                                                                     1 = Lost
                     The replacement code representing the reason a
Replacement                                                                                                          2 = Broken
                     specific crown, prosthesis, inlay or onlay is to be     $1         replrea            1-4
Reason                                                                                                               3 = Accident
                     replaced.
                                                                                                                     4 = No longer serviceable
                                                                                                                     A = Early Alert for Guard/Reserve
                                                                                                                     E = TAMP extended for Guard/Reserve
                                                                                                                     O = TAMP original for Guard/Reserve
                                                                                                      A, E, O, M, T,
Reservist Status     Reservist Status                                        $1        res_stat                      M = Mobilization for Guard/Reserve
                                                                                                            I, L
                                                                                                                     T = TAMP for Guard/Reserve
                                                                                                                     I = TAMP for involuntary separation from Active Duty
                                                                                                                     L = TAMP for stop/loss from Active Duty




   October 2011 Version                                                                ADDP Claims                                                                          Page 12 of 1408
                                                                                    ADDP Claims

                                                                                 Position or SAS
  Data Element                          Definition                      Format                        Values                                     Notes
                                                                                    Variable
                                                                                                                  01 = Northeast
                                                                                                                  02 = Mid-Atlantic
                                                                                                                  03 = Southeast
                                                                                                                  04 = Gulf South
                                                                                                                  05 = Heartland
                                                                                                                  06 = Southwest
                                                                                                                  07, 08 = TRICARE Central
                                                                                                   01-16, AK, 00, 09 = Southern California
Residence Region   Patient's residence region.                            $2         resreg          UK, XX or    10 = Golden Gate
                                                                                                       Blank      11 = Northwest
                                                                                                                  12 = TRICARE Pacific
                                                                                                                  13 = Europe
                                                                                                                  14 = Western Pacific/Asia
                                                                                                                  15 = Central/South America & Other OCONUS
                                                                                                                  16 = Unknown
                                                                                                                  AK = Alaska
                                                                                                                  XX or Blank = Unknown
                                                                                                                  A = Alaska
                                                                                                                  N = North
                                                                                                   A, N, O, S and
TNEX Region        Patient's TNEX region.                                 $1         restnex                      O = OCONUS
                                                                                                         W
                                                                                                                  S = South
                                                                                                                  W = West
                   Social Security Number (SSN) of Active Duty            $9
Sponsor SSN -      Service Member as it appears on the claim. A
                                                                                    rsponssn
Raw                derived version of this element is also available,
                   should the feed data be blank.
Work RVU           Work RVU                                              7.2           rvu
                                                                                                                 A SURG = Assistant surgery
                                                                                                     A SURG,
                                                                                                                 ANES = Anesthesia
                                                                                                    ANES, CIO,
                                                                                                                 CIO = Crowns, Inlays, and Onlays
                                                                                                    CONSUL, D
                                                                                                                 CONSUL = Consultation
                                                                                                      DIAG, D
                                                                                                                 D DIAG = Dental Diagnostic
                                                                                                     GENL, D
                                                                                                                 D GENL = Dental General Services
                                                                                                     ORAL, D
                   Identifies the general benefit category of the                                                D ORAL = Dental Oral Surgery
Benefit Category                                                          $5         servcat         PREV, D
                   service provided.                                                                             D PREV = Dental Preventive
                                                                                                     PROS, M
                                                                                                                 D PROS = Dental Prosthetic
                                                                                                     ORAL, M
                                                                                                                 M ORAL = Medical/Surgical Oral Surgery
                                                                                                       REST,
                                                                                                                 M REST = Minor Restorative
                                                                                                      ORTHO,
                                                                                                                 ORTHO = Orthodontic
                                                                                                     PERIO, or
                                                                                                                 PERIO = Periodontic
                                                                                                       SURG
                                                                                                                 SURG = Surgery




   October 2011 Version                                                             ADDP Claims                                                               Page 13 of 1408
                                                                                        ADDP Claims

                                                                                     Position or SAS
  Data Element                           Definition                         Format                       Values                                          Notes
                                                                                        Variable
                                                                                                                     00 = Not Applicable
                                                                                                                     01 = Operation Desert Storm
                   Indicates the contingency operation for which a                                                   02 = Los Angeles Riots
                   Guard or Reserve member is activated or                                                           03 = Haiti
                   receiving TAMP benefits through at the time of                                                    04 = Somalia
                   care. Populated on both sponsor and family                                                        05 = Bosnia
                   member records. This data element does not                                                        06 = Kosovo
Special Operations
                   indicate that the guard or reserve                         $2           soc          08, 09, 10   07 = Southern Watch
Code
                   member went to theater, rather, that the orders                                                   08 = Noble Eagle
                   that activated the member indicated a contingency                                                 09 = Enduring Freedom
                   operation. Use with Reservist Status Code to                                                      10 = Iraqi Freedom
                   indicate the status of the Guard/Reserve member.                                                  98 = Not a special operation
                                                                                                                     99 = Other
                                                                                                                     (Take caution with these values. It is often evident that Iraqi Freedom
                                                                                                                     records are miscoded as 08 or 09.)
                     Code identifying the sponsor SSN, based on
Sponsor SSN -
                     master person index merge if SSN is missing in           $9        sponssn
Derived
                     the source data.
                                                                                                                      A = Army
                                                                                                                      C = Coast Guard
                                                                                                                      F = Air Force
                     A code that represents the branch of service with                                 A, C, F, H, M, H = Commissioned Corps of the Public Health Service
Branch of Service                                                             $1           svc
                     which the Active Duty Service Member is affiliated.                                  N, or O     M = Marine Corps
                                                                                                                      N = Navy
                                                                                                                      O = Commissioned Corps of the National Oceanographic and Atmospheric
                                                                                                                          Administration (NOAA)
                      The Taxpayer Identification Number (TIN) of the
Provider Tax ID                                                               $9          taxid
                      provider.
                      The tooth entered on the pricing grid on the Claim
Tooth Number                                                                              tooth
                      Adjudication screen.                                   $2
                      The amount paid by Third Party Liability (TPL) plan
Third Party Liability                                                        9.2          tpliab
                      carriers towards the Provider Charges.
                                                                                                                     N = No
                                                                                                                     Y = Yes
MMSO Residual
                     Indicates that this is a residual claim.                $1        MMSO_ind           N or Y     Blank = Unknown
Claims Indicator
                                                                                                                     Note: This data element was added in March 2010 and was not coded prior.




   October 2011 Version                                                                 ADDP Claims                                                                          Page 14 of 1408
                                                                                         ADDP Provider

                                                                          Active Duty Dental Plan (ADDP) Provider File
Common File Name: providers.sas7bdat
Dataset Location: /mdr/pub/dental/addp/provider
Update Frequency: Updated monthly                                                                                        Source System: ADDP contractor
Description: Active duty dental providers
                                                                                          Position or SAS
   Data Element                             Definition                          Format                       Values                                       Notes
                                                                                             Variable
                      Last month of feed data that the provider ID was
Delete Month                                                                   YYYYMM        del_mnth
                      present in.
                      A HIPAA unique alphanumeric code structured into
Provider Taxonomy     three distinct levels including provider type,             $10         hipaaprv
                      classification, and area of specialization.
Provider Network      Indicates whether or not the provider is a network or
                                                                                  $1          network
Status                non-network provider (at the date of service).
NPI Individual        National Provider ID (NPI) number of the provider.         $14            npi
NPI Group             National Provider ID (NPI) number of the provider.         $14         npigroup
                      Date this record was added to the MDR dataset
Processing Date                                                                   $8         procdate                    Fill with the date this record was initially added to the MDR dataset.
                      initially.
Provider Street
                      Provider‟s business street address line 1.                 $36         provadd1
Address Line 1
Provider Street
                      Provider‟s business street address line 2.                 $36         provadd2
Address Line 2
Country Code          Provider‟s business country code.                           $3          provctry
Provider Group        The text name of the dental group (if service was
                                                                                 $53        provgrpname
Name                  performed by a provider who is part of a group).
                      A unique number assigned to an individual or
Provider ID                                                                       $9           provid
                      organization which performs health care services.
Individual Provider
                      The text name of the individual provider.                  $53         provname
Name
Provider Specialty    Code describing the provider‟s specialty.                   $3         provspec
Provider SSN          Social Security Number (SSN) of the dental provider.        $9          provssn
State                 Provider‟s business state code.                             $2          provst
Provider Zip Code     Provider Zip Code                                           $9          provzip
                      The Taxpayer Identification Number (TIN) of the
Provider Tax ID                                                                   $9           taxid
                      provider.
Provider Termination                                                                                                     T = provider is terminated during file update process
                     Derived Provider Termination Flag                            $1          term_flg      T or Blank
Flag                                                                                                                     Blank = otherwise




     October 2011 Version                                                                ADDP Provider                                                                 Page 15 of 1408
                                                                                        Ancillary - Lab Rad

                                                                                     Lab-Rad Ancillary Files
Common File Name: fyXX, where XX=05+
Dataset Location: /mdr/pub/ancil/fyXX/labrad.fyXX, where XX=05+
Update Frequency: Updated monthly                                                                                                    Source System: CHCS
                                                                                                                                     Only MEPRS code begin with B, C, D, and FC
Description: Ancillary laboratory and radiology files
                                                                                                     Position or
        Data Element                               Definition                           Format          SAS            Values                                 Notes
                                                                                                      Variable
                               For LAB: Number assigned by CHCS when a
                               specimen is logged into the LAB system.
Accession/Exam Number                                                                      $17         accessno                      Accession Number
                               For RAD: Number assigned by CHCS when a
                               radiology exam is ordered.
                                                                                                                                        A=Active Duty Prime
                                                                                                                                        B=TRICARE Global Remote Overseas Prime Active Duty
                                                                                                                                        D=TRICARE Senior Prime
                                                                                                                                        E=Non-Active Duty Prime
                                                                                                                                        F=TRICARE Global Remote Overseas Prime Active Duty
                                                                                                                                        Family Member
                                                                                                                                        G=TRICARE Plus (CHAMPUS/TFL Eligible)
                                                                                                                   A, B, D, E, F, G, H,
                               Indicates the enrollment status of the beneficiary.                                                      H=TRICARE Overseas Prime Active Duty
ACV                                                                                        $1             acv       J, L, M, Q, R, U,
                               Appended using the Longitudinal VM4.                                                                     J=TRICARE Overseas Prime Active Duty Family Member
                                                                                                                          V, Null
                                                                                                                                        L=TRICARE Plus (not CHAMPUS/TFL Eligible)
                                                                                                                                        M=AD not reported enrolled (added FY05)
                                                                                                                                        Q=AD enrolled to Op Forces
                                                                                                                                        R=TRS
                                                                                                                                        U=USTF/USFHP
                                                                                                                                        V=TRICARE Retired Reserve
                                                                                                                                        Null = Not Enrolled
                                                                                                                     A, B, C, D, E,
                               Indicates the enrollment status of the beneficiary.                                  F, G, H, J, I, L,
ACV derived                                                                                $1             acv1                        See above.
                               Equal to ACV if not missing, else ACV of record.                                     M,N, Q, R, S, U,
                                                                                                                        V, W, Z




   October 2011 Version                                                                Ancillary - Lab Rad                                                               Page 16 of 1408
                                                                                 Ancillary - Lab Rad

                                                                                              Position or
         Data Element                          Definition                         Format         SAS             Values                                     Notes
                                                                                               Variable
                                                                                                                                  HCDPCODE to ACV2 mapping:
                                                                                                                                  A = 106, 128
                                                                                                                                  B = 155
                                                                                                                                  C = 003, 005, 007, 009, 010, 012, 015, 017, 018, 020,
                                                                                                                                      021, 022, 023
                                                                                                                                  D = 120
                                                                                                                                  E = 107, 108, 110, 111, 112, 113, 116, 117, 129, 130,
                                                                                                                                      131, 132, 134, 135, 136, 137
                                                                                                                                  F = 156, 157
                                                                                                                                  G = 140, 142, 144, 146, 147, 149
                                                                                                            A, B, C, D, E, F, G, H = 103, 152
                           Indicates the enrollment status of the beneficiary.
ACV of record                                                                        $1            acv2      H, I, J, K, L, N, P, I = 123, 124, 125, 126
                           Derived from HCDPR that came on record.
                                                                                                               R, S, U, W, Z      J = 104, 153, 154
                                                                                                                                  K = 105
                                                                                                                                  L = 141, 143, 145, 148, 150, 151
                                                                                                                                  N = 001, 002, 004, 006, 008, 011, 013, 014, 016,
                                                                                                                                      019, 024
                                                                                                                                  P = 101
                                                                                                                                  S = 121, 122
                                                                                                                                  U = 109, 114, 115, 118, 119, 133, 138, 139
                                                                                                                                  W = 127
                                                                                                                                  R = 401, 402
                                                                                                                                  Z = All others
Appointment record ID      The appointment identifier number.                       $20           apptno
                                                                                                                            ACT = Active Duty
                                                                                                                            DA = Dependent of Active Duty
                                                                                                                            DCO = Direct Care Only
                                                                                                                            DR = Dependent of Retired
                                                                                                             ACT, DA, DCO, DGR=Dependent of Guard
                                                                                                              DR, DGR, DS,  DS = Dependent of Survivor
                           Category of beneficiary.
Beneficiary Category                                                                 $3           bencat     GRD, IGR, IDG, GRD = Guard / Reserve
                           Appended using longitudinal derivation of VM4.
                                                                                                             NAT, OTH, RET, IGR = Inactive Guard / Reserve
                                                                                                                  UNK       IDG = Inactive Dependent of Guard / Reserve
                                                                                                                            NAT = NATO
                                                                                                                            OTH = Other
                                                                                                                            RET = Retired
                                                                                                                            UNK = Unknown
                                                                                                                                BPA Catchment Area of patient residence based on patient
BPA Catchment Area ID      BPA Catchment Area ID.                                    $4         bpacatch                        zip and sponsor service and the OmniCad matching the
                                                                                                                                service date.
                           The catchment area surrounding an MTF or
                                                                                                                                Derived from merge with Omni-CAD and based on bene zip,
Catchment Area ID          noncatchment area based on beneficiary zip code,          $4           catch         e.g., 0039
                                                                                                                                sponsor service, fy, and fm corresponding to Service Date.
                           sponsor service, FY and FM.
                           DMIS ID of the CHCS Host platform sending the
Host Platform DMIS ID                                                                $4         chcsdmis        e.g., 0039
                           data.




    October 2011 Version                                                         Ancillary - Lab Rad                                                                    Page 17 of 1408
                                                                                    Ancillary - Lab Rad

                                                                                                 Position or
         Data Element                               Definition                       Format         SAS             Values                                   Notes
                                                                                                  Variable
                                                                                                                                  1 = Dependent of Active Duty/Guard
                                                                                                                                  2 = Retired
Beneficiary Category (common)   Broadest category of beneficiary.                       $1          comben            1-4
                                                                                                                                  3 = Dep of Retired or Survivor, Other, Unknown
                                                                                                                                  4 = Active Duty and Guard

Number of Services on record    Raw Number of times CPT code was performed.            2.0           count           0 to 99      See Derived Number of Services (drvcount)

CPT Code                        Procedure Code.                                         $5            cpt
                                                                                                                                  For Lab:
                                                                                                                                   00=test ordered and performed in-house
                                                                                                                                   26=pathologist interpretation, professional component
                                                                                                                                   32=test performed for an outside facility
                                Modifier of the laboratory test or radiology exam                                                  90=test referred to a reference/external facility
Modifier of the CPT code                                                                $2          cptmod      00,26,32,90, TC
                                performed.                                                                                        For Rad:
                                                                                                                                   00 = blank
                                                                                                                                   26 = professional component
                                                                                                                                   32 or TC = technical component

                                                                                                                                    01-19 = Dep Child of Sponsor
                                                                                                                                    20 = Sponsor
                                                                                                                                    30-39 = Spouse/Former Spouse
                                                                                                                                    40-44 = Mother/Step-Mother of Sponsor
                                                                                                                blank, 01-19, 20,
                                                                                                                                    45-49 = Father, Step-Father of Sponsor
                                                                                                                30-39, 40-44, 45-
                                                                                                                                    50-54 = Mother-In-Law of Sponsor
DDS                             DEERS Dependent Suffix.                                 $2            dds      49,50-54, 55-59, 60-
                                                                                                                                    55 -59= Father-In-Law of Sponsor
                                                                                                                69, 75, 90-95, 98,
                                                                                                                                    60-69 = Other Authorized Dep of Sponsor 70-74 Unknown by
                                                                                                                        99
                                                                                                                                    DEERS 75=Pseudo DDS unknown by contractor
                                                                                                                                    90-95 = Bene Authorized by Statute
                                                                                                                                    98 = Service secretary designee
                                                                                                                                    99 = All Other, Not Elsewhere Classified
                                Indicates whether match was made during merge                                                     numeric: 1=DEERS match
DEERS Match Flag                                                                       3.0           deers            1,0
                                to longitudinal VM4.                                                                              0=no match
Date of Birth                   The date a person was born.                             $8            dob          yyyymmdd
                                                                                                                                  For Lab:
                                                                                                                                    For cptmod=90 (referred to a reference/external facility),
                                                                                                                                  drvcount=1; representing MTF workload.
                                Corrected Number of times CPT code was
Derived Number of Services                                                              $2          drvcount          0-99        For Rad:
                                performed.
                                                                                                                                    If CPT code or CPT modifiers indicate bilateral code and the
                                                                                                                                  number of services on record is greater than 1, then
                                                                                                                                  drvcount=count/2.
                                                                                                                                  6th character accommodates ICD-9 extender codes. Will
ICD9 Diagnosis Code 1           Principle Diagnosis.                                    $6            dx1         null or blank
                                                                                                                                  remain blank until the CCE lab/rad is activated.
                                                                                                                                  6th character accommodates ICD-9 extender codes. Will
ICD9 Diagnosis Code 2           Diagnosis Code 2.                                       $6            dx2         null or blank
                                                                                                                                  remain blank until the CCE lab/rad is activated.
                                                                                                                                  6th character accommodates ICD-9 extender codes. Will
ICD9 Diagnosis Code 3           Diagnosis Code 3.                                       $6            dx3         null or blank
                                                                                                                                  remain blank until the CCE lab/rad is activated.




    October 2011 Version                                                            Ancillary - Lab Rad                                                                 Page 18 of 1408
                                                                                       Ancillary - Lab Rad

                                                                                                    Position or
            Data Element                             Definition                         Format         SAS             Values                                    Notes
                                                                                                     Variable
                                                                                                                                      6th character accommodates ICD-9 extender codes. Will
ICD9 Diagnosis Code 4            Diagnosis Code 4.                                         $6            dx4         null or blank
                                                                                                                                      remain blank until the CCE lab/rad is activated.
                                 The identifier that is used to represent the person
EDI-PN                           within a Department of Defense Electronic Data           $10           edipn                         Results of MPI merge procedures.
                                 Interchange.
                                 The DMIS ID of the facility where the member is
Enrollment DMIS ID                                                                         $4          enrdmis        e.g., 0039      Appended using longitudinal derivation of VM4.
                                 enrolled.
HSSC Enrollment Region           HSSC region of Enrollment DMIS.                           $1           enrreg    N, S, W,O,A,blank
                                 Indicates if the procedure was performed in an                                                       Y = Yes
External Indicator                                                                         $1          external          Y,N
                                 external lab.                                                                                        N = No
                                                                                                                                      Derived from the Date/Time used in the ASCII file name from
File Date                        Date file harvested/created in CHCS.                      $8          filedate       yyyymmdd
                                                                                                                                      CHCS.
                                                                                                                                      01-19 = Dep Child of Sponsor
                                                                                                                                      20 = Sponsor
                                                                                                                                      30-39 = Spouse/Former Spouse
                                                                                                                   blank, 01-19, 20, 40 = Mother/Step-Mother of Sponsor
                                                                                                                        30-39,        45 = Father, Step-Father of Sponsor
                                 A DoD-define code which defines the relationship
Family Member Prefix                                                                       $2            fmp      40, 45, 50, 55, 60- 50 = Mother-In-Law of Sponsor
                                 of the patient to the sponsor.
                                                                                                                    66, 69, 90-94,    55 = Father-In-Law of Sponsor
                                                                                                                        98, 99        60-69 = Other Authorized Dep of Sponsor
                                                                                                                                      90-95 = Bene Authorized by Statute
                                                                                                                                      98 = Civilian Emergencies
                                                                                                                                      99 = All Other, Not Elsewhere Classified
Relative value units (facility   Facility Practice Expense RVU of CPT Code,
                                                                                          6.2           fprvu          numeric        Facility Practice Expense RVU
practice)                        derived from merge with CPT Weight Table.
Full Cost                        Full Cost.                                               8.2          fullcost                       Based on MEPRS costs and RVUs.
                                                                                                                  000-013, 017, 018,
                                                                                                                  021, 106-113, 116-
                                                                                                                  119, 121, 122, 128-
DEERS HCDP code                  HCDP Code from DEERS LVM4 match.                          $3         hcdplvm4                        HCDP code in longitudinal derivation of VM4.
                                                                                                                  132, 140, 142-146,
                                                                                                                  150, 152-157, 401-
                                                                                                                     402, 413-414
                                                                                                                  000-013, 017, 018,
                                                                                                                  021, 106-113, 116-
                                 Code to identify the patient's DoD Health Care
                                                                                                                  119, 121, 122, 128- See HCDP Codes worksheet. Only populated if patient is
HCDP of record                   Delivery Program plan coverage on the date of             $3           hcdpr
                                                                                                                  132, 140, 142-146, enrolled on the date of service.
                                 service.
                                                                                                                  150, 152-157, 401-
                                                                                                                     402, 413-414
                                 Indicates whether or not the ancillary came from                                                     Y = Yes
Inpatient indicator                                                                        $1            inpt            Y,N
                                 an inpatient encounter.                                                                              N = No
                                                                                                                                      I = test ordered and performed in-house
                                 Indicates where lab tests were ordered or
Laboratory Flag                                                                            $1           labflag      blank, I,O,E     O = test performed for outside facility
                                 performed.
                                                                                                                                      E = test sent to outside referral lab
M2 Key                           Base62 of the MDR Key.                                    $6           m2key                         Base62 of the MDR Key.
MDR Key                          A numeric number identifying a CHCS entry.               8.0          mdrkey          numeric        Sequential counter of records.



     October 2011 Version                                                              Ancillary - Lab Rad                                                                  Page 19 of 1408
                                                                                             Ancillary - Lab Rad

                                                                                                          Position or
          Data Element                                       Definition                       Format         SAS             Values                                    Notes
                                                                                                           Variable
                                                                                                                                           A = Part A only
                                                                                                                                           B = Part B only
Medicare Eligibility                 Medicare Eligibility.                                       $1          medelg         A, B, C, N
                                                                                                                                           C = Part A & B
                                                                                                                                           N = Not Eligible
MEPRS Parent                         MEPRS Parent of the Treatment DMIS.                         $4         meprdmis        e.g., 0039

Ordering MEPRS Code                  4th level MEPRS code of the requesting location.            $4          meprscd        e.g., AAAA

                                     For LAB: Indicator to specify whether the results                                                     LAB:
                                     were entered directly into CHCS or came from                                                           AP = Anatomic Pathology Order generated on CoPath
                                     CoPath                                                                             blank, 50, 51, 99, RAD:
Record Type Modifier                                                                             $2            mod
                                     For RAD: Modifiers that are used exclusively for                                          AP           50 = bilateral complete
                                     Radiology CPTs, indicating bilateral and/or                                                            51 = bilateral EXAM only
                                     portable procedures.                                                                                   99 = bilateral and portable

MPI Status Flag                      EDI-PN was obtained from MPI file.                          $1          mpiflag         E,blank       E indicates that a blank field was placed

Relative value units (non-facility   Non-facility Practice Expense RVU of CPT Code,
                                                                                                6.2           nprvu          numeric       Non-facility Practice Expense RVU
practice)                            derived from merge with CPT Weight Table.
                                     Denotes whether the patient has Other Health                                                          Y = Yes
OHI Indicator                                                                                    $1            ohi             Y,N
                                     Insurance.                                                                                            N = No
Ordering DMIS ID                     DMIS ID of the requesting location for the order.           $4          orddmis        e.g., 0039
Provider Order Number                CHCS code of the Order Number of the Provider.             $12          orderid
                                                                                                                                           AA = Spouse
                                                                                                                                           AB = Child
                                                                                                                                           AC = Foster Child
                                                                                                                                           AD = Parent
                                                                                                                                           AE = Parent-in-law
                                                                                                                                           AF = Stepchild
                                                                                                                                           AH = Stepparent
                                                                                                                         AA, AB, AC, AD,
                                                                                                                                           AI = In loco parents
                                     Code indicating the beneficiary's relationship to the                              AE, AF, AH AI, BB,
Person Association Reason Code                                                                   $2            parc                        AX = Emergency Contact
                                     sponsor.                                                                            BC, BD, BE, BF,
                                                                                                                                           BB = Ward, BC = Former Spouse
                                                                                                                        BG, CA, ZZ, blank
                                                                                                                                           BD = Self
                                                                                                                                           BE = Joint marriage spouse
                                                                                                                                           BF = Other health insurance subscriber
                                                                                                                                           BG = Pre-adoptive child
                                                                                                                                           CA = Memeber of household headed by sponsor's
                                                                                                                                                former spouse (child, stepchild or ward only)
                                                                                                                                           ZZ = unknown
Patient Age                          Patient's age on date of service.                          3.0           patage         numeric
                                     Code that defines the DoD Beneficiary Status of
Patient Category Code                the person for whom the service has been                    $3           patcat                       See Patient Categories for codes and descriptions.
                                     provided.




    October 2011 Version                                                                     Ancillary - Lab Rad                                                                  Page 20 of 1408
                                                                                     Ancillary - Lab Rad

                                                                                                  Position or
         Data Element                              Definition                         Format         SAS            Values                                    Notes
                                                                                                   Variable
                                                                                                                                   01 = Northeast
                                                                                                                                   02 = Mid-Atlantic
                                                                                                                                   03 = Southeast
                                                                                                                                   04 = Gulf South
                                                                                                                                   05 = Heartland
                                                                                                                                   06 = Southwest
                                                                                                                                   07,08 = TRICARE Central
                                                                                                                                   09 = Southern California
                                                                                                                    01 - 16,       10 = Golden Gate
Beneficiary Residence Region   Beneficiary Region of patient residence.                  $2          patregn
                                                                                                                  AK, XX, Blank    11 = Northwest
                                                                                                                                   12 = TRICARE Pacific
                                                                                                                                   13 = Europe
                                                                                                                                   14 = Western Pacific/Asia
                                                                                                                                   15 = Central/South America & Other
                                                                                                                                       OCONUS
                                                                                                                                   16 = Unknown
                                                                                                                                   AK = Alaska
                                                                                                                                   XX or Blank = Unknown

Beneficiary zip code           Zip Code.                                                 $5           patzip                       NONE if not matched.
                               The identifier that uniquely represents a Primary
PCM ID                                                                                  $18           pcmid                        Appended using longitudinal derivation of VM4.
                               Care Manager.
Parent DMIS                    Parent DMIS Id if the treatment DMIS.                     $4           pdmis         e.g., 0039
                               Reflects PPS policy on which patients and services
PPS Earnings Factor                                                                     5.3           ppsfac          1.000        Set to 1.000
                               earn fees.
                               The prism area surrounding an MTF or
                                                                                                                                   Derived from merge with Omni-CAD and based on bene zip,
PRISM Area ID                  noncatchment area based on beneficiary zip code,          $4           prism         e.g., 0039
                                                                                                                                   sponsor service, fy, and fm corresponding to Service Date.
                               sponsor service, FY and FM.
                                                                                                                                      1 = Direct Care Only
                                                                                                                                      2 = Direct Care and CHAMPUS
                                                                                                                                      4 = Transitional Direct Care Only
                                                                                                                                      5 = Transitional Direct Care and CHAMPUS
                                                                                                                                      6 = Transitional Direct Care and Medicare, not CHAMPUS
                               Code indicating type of eligibility for medical                                  blank, 1, 2, 4, 5, 6, Eligible
Privilege Code                                                                           $1          privcode
                               benefits.                                                                         7, A, B, C, M, U 7 = Direct Care and Medicare, not CHAMPUS Eligible
                                                                                                                                      A = Direct Care and CHAMPUS and Medicare
                                                                                                                                      B = Transitional Direct Care and CHAMPUS and Medicare
                                                                                                                                      C = CHAMPUS Only
                                                                                                                                      M = TRICARE for Life Only
                                                                                                                                      U = USFHP/USTF Enrollee
                                                                                                                                   Lab-Rad Ancillary does not contain inpatient (A MEPRS Code)
Inpatient Record ID            CHCS Inpatient Register Number.                          $12            prn                         data. However, if an inpatient goes to a clinic (B MEPRS
                                                                                                                                   Code), then their data is included.
                                                                                                                                   N = New
                               Flag to indicate the operation to be performed with
Process Flag                                                                             $1          procflag        N,U, C        U = Update
                               record, process flag.
                                                                                                                                   C = Cancel




    October 2011 Version                                                             Ancillary - Lab Rad                                                                 Page 21 of 1408
                                                                                       Ancillary - Lab Rad

                                                                                                    Position or
          Data Element                             Definition                           Format         SAS              Values                                      Notes
                                                                                                     Variable
                               Unique character identifying the ancillary with                                                         L = Laboratory Data
Record Type                                                                                $1          rectype            L,R
                               which the data in this record is associated.                                                            R = Radiology Data
                               The identifier that is used to represent the person
EDI-PN, Raw                    within a Department of Defense Electronic Data             $10           redipn                         EDI-PN on the record.
                               Interchange.
                                                                                                                                       1 = Dependent Child
                                                                                                                                       2 = Sponsor
                               First digit of FMP, which defines whether patient is
                                                                                                                                       3 = Spouse of sponsor
Relationship (to sponsor)      sponsor, spouse, dependent, or other. Children              $1                rel        1,2,3,4
                                                                                                                                       4 = Any other category, such as Parent of sponsor, Other
                               with a FMP first digit of 0 are transformed to rel=1.
                                                                                                                                           eligible dependents, Unknown, Service secretary
                                                                                                                                           designee
                               The sponsor‟s SSN as assigned by the Social
Sponsor SSN, Raw                                                                           $9         rsponssn                         Sponsor SSN on the record.
                               Security Administration.
HSSC Residence Region          HSSC region of Beneficiary zip code.                        $1           rsreg      N, S, W,O,A,blank
Relative value units (total)   Sum of non-facility practice and work RVUs.                6.2            rvu            numeric        The total of Non-Practice RVUs + Work RVUs
                                                                                                                                       (nprvu+ruvwork)
                               Work RVU of CPT Code, derived from merge with
Relative value units (work)                                                               6.2          rvuwork          numeric        Physician or Work Expense RVU
                               CPT Weight Table.
                               For LAB: Specimen collection date.
                               For RAD: If "Exam Only" this is the date that the
Date Of Service                procedure was performed. If "Read Only" or                 8.0          servdate       yyyymmdd         A formatted SAS numeric date.
                               "Complete" this the date that the exam was read
                               by a Radiologist.
                                                                                                                                       M = Male
Gender                         Beneficiary gender.                                         $1            sex            M, F, Z        F = Female
                                                                                                                                       Z = Unknown
                                                                                                                                       00 = Not Applicable
                                                                                                                                       01 = Operation Desert Storm
                               Indicates the contingency operation for which a                                                         02 = Los Angeles Riots
                               Guard or Reserve member is activated or receiving                                                       03 = Haiti
                               TAMP benefits through at the time of care.                                                              04 = Somalia
                               Populated on both sponsor and family member                                                             05 = Bosnia
                               records. This data element does not indicate that                                   00, 01, 02, 03, 04, 06 = Kosovo
Special Operations Code        the guard or reserve                                        $2            soc       05, 06, 07,08, 09, 07 = Southern Watch
                               member went to theater, rather, that the orders                                      10, 98,99, blank 08 = Noble Eagle
                               that activated the member indicated a contingency                                                       09 = Enduring Freedom
                               operation. Use with Reservist Status Code to                                                            10 = Iraqi Freedom
                               indicate the status of the Guard/Reserve member.                                                        98 = Not a special operation
                                                                                                                                       99 = Other
                                                                                                                                       (Take caution with these values. It is often evident that Iraqi
                                                                                                                                       Freedom records are miscoded as 08 or 09.)
                               Indicates whether the patient is considered space
                                                                                                                                       N = ACV of A, B, D, E, F, H, J, M, P, Q
Space Available Flag           available care or not, based on the ACV of the              $1          spaflag        blank, N, Y
                                                                                                                                       Y = all other ACV
                               patient.
                               The sponsor‟s SSN as assigned by the Social
Sponsor SSN                                                                                $9          sponssn                         Results of MPI merge procedures.
                               Security Administration.




    October 2011 Version                                                               Ancillary - Lab Rad                                                                      Page 22 of 1408
                                                                            Ancillary - Lab Rad

                                                                                         Position or
        Data Element                            Definition                   Format         SAS            Values                                     Notes
                                                                                          Variable
                                                                                                                         A = Early Alert
                             Derived Reservist Status Code from Personnel                                                M = Mobilization
Status Code                                                                     $1           status    A, M, O, E, blank
                             Entitlement Condition Type Code.                                                            O = Original TAMP
                                                                                                                         E = Extended TAMP


                                                                                                                          A = Army
                                                                                                                          C = Coast Guard
                                                                                                                          F = Air Force
                                                                                                                          H = Public Health Service
                                                                                                          A, C, F, H,
Sponsor Branch of Service    Code indicating service of sponsor.                $1            svc                         M = Marines
                                                                                                         M, N, O, X, 4
                                                                                                                          N = Navy
                                                                                                               Z
                                                                                                                          O = NOAA
                                                                                                                          X = Other/Unknown
                                                                                                                          4 = Foreign Military
                                                                                                                          Z=Unknown
                                                                                                                            A = Army
                                                                                                                            C = Coast Guard
                                                                                                                            F = Air Force
Sponsor Branch of Service,                                                                             A, C, F, I, M, N, V, M = Marine Corps
                             Code indicating service of sponsor.                $1          svcagg
Aggregate                                                                                                     X, Z          N = Navy
                                                                                                                            V = Navy Afloat
                                                                                                                            X = Other
                                                                                                                            Z = Unknown
Treatment DMIS ID            DMIS ID of the MTF providing the service.          $4          tmtdmis        e.g., 0039

                                                                                                                         A = Alaska
                                                                                                                         N = North
HSSC Treatment Region        HSSC region of Treatment DMIS.                     $1           tmtreg    N, S, W,O,A,blank O = Overseas
                                                                                                                         S = South
                                                                                                                         W = West




    October 2011 Version                                                    Ancillary - Lab Rad                                                               Page 23 of 1408
                                                                                        Ancillary - Lab Rad

                                                                                                     Position or
         Data Element                                 Definition                         Format         SAS             Values                                   Notes
                                                                                                      Variable
                                                                                                                                        A = Army DHP
                                                                                                                                        B = Army Civilian Resource Sharing
                                                                                                                                        C = Coast Guard
                                                                                                                                        D = Army Line Unit
                                                                                                                                        F = Air Force DHP
                                                                                                                                        G = AF Civilian Resource Sharing
                                                                                                                                        I = Inactive
                                                                                                                                        J = US Defense Attache Office (USDAO)
                                                                                                                                        L = AF Line Unit
                                                                                                                   A, B, C, D, F, G, I, M = Managed Care Support Contractor
Treatment Service                  Branch of service for the treatment DMIS.                $1           tmtsvc    J, L, M, N, O, Q, R, N = Navy DHP
                                                                                                                    S, T, V, X, Blank O = Other
                                                                                                                                        Q = Navy Line Unit
                                                                                                                                        R = Navy Civilian Resource Sharing
                                                                                                                                        S = Non-catchment
                                                                                                                                        T = US Family Health Plan (USFHP), FY 1998-2001,
                                                                                                                                             2007-2009
                                                                                                                                        U = US Family Health Plan (USFHP), FY 2002-2006
                                                                                                                                        V = Veterans Admin
                                                                                                                                        X = Administrative
                                                                                                                                        Blank = Unknown

                                   indicates whether beneficiary is an Active Duty or
TRICARE Prime Remote Eligibility                                                                                                      Y = Yes
                                   Guard/Reserve sponsor or family member who is            $1           tprelig          Y,N
Flag                                                                                                                                  N = No
                                   geographically eligible for TRICARE Prime Remote
                                   Indicates whether the Beneficiary Zip Code is in a                                                 Y = zip code designated as TPR site
TRICARE Prime Remote Flag                                                                   $1           tprflag          Y,N
                                   TRICARE Prime Remote area.                                                                         N = zip code is not designated as TPR site
                                                                                                                                      N = North
                                                                                                                                      S = South
Underwritten Region                Region for which this claim is underwritten.             $1          undflag         N,S, W        W = West (excl AK)
                                                                                                                                      A = Alaska
                                                                                                                                      O = OCONUS
Variable Cost                      Variable Cost.                                          8.2          varcost         numeric       Based on MEPRS costs and RVUs.




    October 2011 Version                                                                Ancillary - Lab Rad                                                                 Page 24 of 1408
                                                                                     Appointment Master

                                                                                   Appointment Data File
Common File Name: fyXX.sas7bdat, where XX=02+
Dataset Location: /mdr/pub/appt/detail/fyXX/fyXX, where XX=02+
Update Frequency: Updated monthly and organized into annual files                                                                     Source System: CHCS
Description: Appointment-Level Data Records
     Data Element                                Definition                         Format       SAS Variable         Values                             Notes
                                                                                                                                     A=Active Duty Prime
                                                                                                                                     B=TRICARE Global Remote Overseas Prime Active
                                                                                                                                     Duty
                                                                                                                                     D=TRICARE Senior Prime
                                                                                                                                     E=Non-Active Duty Prime
                                                                                                                                     F=TRICARE Global Remote Overseas Prime Active
                                                                                                                                     Duty Family Member
                                                                                                                                     G=TRICARE Plus (CHAMPUS/TFL Eligible)
                         Indicates the enrollment status of the beneficiary.                                    A, B, D, E, F, G, H,
Alternate Care Value -                                                                                                               H=TRICARE Overseas Prime Active Duty
                                                                                      $1             ACV        J, L, M, Q, R, U, V,
Derivation #2                                                                                                                        J=TRICARE Overseas Prime Active Duty Family
                         Appended using the Longitudinal Enrollment File.                                                Null
                                                                                                                                     Member
                                                                                                                                     L=TRICARE Plus (not CHAMPUS/TFL Eligible)
                                                                                                                                     M=AD not reported enrolled (added FY05)
                                                                                                                                     Q=AD enrolled to Op Forces
                                                                                                                                     R=TRS
                                                                                                                                     U=USTF/USFHP
                                                                                                                                     V=TRICARE Retired Reserve
                                                                                                                                     Null = Not Enrolled
                         Indicates the enrollment status of the beneficiary.                                    A, B, D, E, F, G, H,
Alternate Care Value -
                                                                                      $1            ACV1        J, L, M, Q, R, U, V, See above.
Raw
                         This is the ACV that came on the record from CHCS.                                              Null
Appointment Date         Date of the appointment.                                  yyyymmdd        APPTDT          e.g., 20031113
                         The appointment identifier number. The AIN is the
                         system generated unique appointment identifier for that
Appointment IEN                                                                       $10         APPTIDNO      e.g., 1234567890
                         system. The Appointment Prefix and AIN combine to
                         create a unique identifier.
Duration                 Length of the appointment measured in minutes.              mmm          APPTMIN         e.g., 10, 25, 30

                                                                                                                                      1 = Sick Call
                                                                                                                                      2 = Kept
                                                                                                                                      5 = Walk-in
Appointment Status       Indicates the status of the patient's appointment.           $2          APPTSTAT        1, 2, 5, 6, 7, 10
                                                                                                                                      6 = No show
                                                                                                                                      7 = Tele-consult
                                                                                                                                      10 = Cancelled




 October 2011 Version                                                               Appointment Master                                                             Page 25 of 1408
                                                                                        Appointment Master

     Data Element                                Definition                             Format      SAS Variable        Values                                 Notes

                                                                                                                                     ACUT = Acute Care
                                                                                                                                     APV = Ambulatory Procedure Visit
                                                                                                                                     DROUT = Dr Unavailable
                                                                                                                                     EROOM = Emergency Room
                                                                                                                                     EST = Established Patient
                                                                                                                                     GRP = Group
                                                                                                                                     N-MTF = Non MTF
                                                                                                                                     OPAC = Open Access
Appointment Type        Code indicating the type of appointment.                          $5         APPTTYPE      e.g., T-CON, ACUT
                                                                                                                                     PCM = Primary Care Manager Appointment
                                                                                                                                     PROC = Procedure
                                                                                                                                     ROUT = Routine
                                                                                                                                     SPEC = Specialty
                                                                                                                                     T-CON = Telephone Consult
                                                                                                                                     WELL = Wellness
                                                                                                                                     The $ following the appointment name was (is) used to
                                                                                                                                     denote 'MTF book only' appointments.
                                                                                                                                     ACT = Active Duty
                                                                                                                                     DA = Active Duty Family Member
                                                                                                                                     RET = Retiree
                                                                                                                   ACT, DA, RET, DR, DR = Retiree Family Member
                        Patient's beneficiary classification at the time care was                                   DS, DCO, GRD,    DS = Survivor
Beneficiary Category                                                                      $3          BENCAT
                        provided (Derived from patient category code).                                                   NAT,        DCO = Direct Care Only
                                                                                                                      OTH, UNK       GRD = Guard
                                                                                                                                     NAT = NATO
                                                                                                                                     OTH = Other
                                                                                                                                     UNK = Unknown
Patient Catchment Area Catchment area of residence of patient .                           $4          CATCH            e.g., 0037     See DMIS Information for list of DMIS ID.

                                                                                                                                      01 = Jan     07 = July
                                                                                                                                      02 = Feb    08 = Aug
                                                                                                                                      03 = Mar    09 = Sept
Calendar Month          Calendar month of appointment date.                               $2            CM              01 - 12
                                                                                                                                      04 = Apr    10 = Oct
                                                                                                                                      05 = May    11 = Nov
                                                                                                                                      06 = June    12 = Dec

                                                                                                                                      0 = non-provider
                                                                                                                                      1 = MD
                        Class of provider, as defined by CHAMPUS payment
CMAC Provider Class                                                                       $1           CMAC               0-4         2 = Psychologists
                        policies.
                                                                                                                                      3 = Counselors
                                                                                                                                      4 = Other providers
                                                                                                                                      1 = Dependent of Active Duty/Guard/Reserve
Common Beneficiary                                                                                                                    2 = Retired
                        Broadest category of beneficiaries (available for all files).     $1         COMBEN               1-4
Category                                                                                                                              3 = All Others
                                                                                                                                      4 = Active Duty and Guard

                                                                                                                                      1 = Dependent of Active Duty/Guard/Reserve
Common Beneficiary                                                                                                                    2 = Retired
                        Common beneficiary category from DEERS.                           $1         COMBENL              1-4
Category - LENR                                                                                                                       3 = All Others
                                                                                                                                      4 = Active Duty and Guard



 October 2011 Version                                                                   Appointment Master                                                               Page 26 of 1408
                                                                                     Appointment Master

    Data Element                                 Definition                          Format      SAS Variable         Values                                Notes

Calendar Year           Calendar year of appointment date.                             $4            CY             e.g., 2002

                                                                                                                                       01 - 19 = Dependent Child
                                                                                                                                       20 = Sponsor
                                                                                                                                       30 - 39 = Spouse of sponsor
                                                                                                                     00 - 19, 20,      40 - 44 = Mother of sponsor
                        DEERS specific code indicating the relationship of the                                  30 - 39, 40 - 44, 45 - 45 - 49 = Father of sponsor
DEERS Dependent
                        beneficiary to the sponsor. (Not the same of the family        $2            DDS        49, 50 - 54, 55 - 59, 50 - 54 = Mother-In-Law of sponsor
Suffix
                        member prefix in CHCS).                                                                 60 - 69, 70 - 74, 75, 55 - 59 = Father-In-Law of sponsor
                                                                                                                       98, 99          60 - 69 = Other eligible dependents
                                                                                                                                       70 - 74 = Unknown by DEERS
                                                                                                                                       75 = Pseudo DDS unknown by contractor
                                                                                                                                       98 = Service secretary designee

                                                                                                                                    A=0-4
                                                                                                                                    B = 5 - 14
                                                                                                                                    C = 15 - 17
                                                                                                                                    D = 18 - 24
Age Group               DMIS defined age groups.                                       $1         DMISAGE            A - H, X       E = 25 - 34
                                                                                                                                    F = 35 - 44
                                                                                                                                    G = 45 - 64
                                                                                                                                    H = 65+
                                                                                                                                    X = Unknown
                        Code that identifies the MTF responsible for the patient
Treatment DMIS ID                                                                      $1          DMISID           e.g., 0037      See DMIS Information for list of DMIS ID.
                        appointment.
                        Code indicating enrollment site of beneficiary at the time
Enrollment DMIS ID      of the appointment. Use in conjunction with ACV to             $4         ENRDMIS           e.g., 0037      See DMIS Information for list of DMIS ID.
                        isolate the type of enrollment.
Enrollment DMIS ID
                        Enrollment DMIS ID as received from CHCS.                      $4         ENRDMIS1          e.g., 0037      See DMIS Information for list of DMIS ID.
(Raw)
                                                                                                                                    A=0-4
                                                                                                                                    B = 5 - 14
                                                                                                                                    C = 15 - 17
                                                                                                                                    D = 18 - 24
                                                                                                                                    E = 25 - 34
                                                                                                                                    F = 35 - 44
                                                                                                                                    G = 45 - 64
Expanded Age Group      Broad category of age.                                         $1          EXPAGE             A - L, X
                                                                                                                                    H = 65 - 69
                                                                                                                                    I = 70 - 74
                                                                                                                                    J = 75 - 79
                                                                                                                                    K = 80 - 84
                                                                                                                                    L = 85+
                                                                                                                                    X = All Others




 October 2011 Version                                                                Appointment Master                                                               Page 27 of 1408
                                                                                     Appointment Master

     Data Element                              Definition                            Format      SAS Variable        Values                                Notes

                                                                                                                                    01 = Oct
                                                                                                                                    02 = Nov
                                                                                                                                    03 = Dec
                                                                                                                                    04 = Jan
                                                                                                                                    05 = Feb
                                                                                                                                    06 = Mar
Fiscal Month            Fiscal month of appointment date.                              $2            FM               01 - 12
                                                                                                                                    07 = Apr
                                                                                                                                    08 = May
                                                                                                                                    09 = Jun
                                                                                                                                    10 = Jul
                                                                                                                                    11 = Aug
                                                                                                                                    12 = Sep

                                                                                                                                    01 - 19 = Dependent Child of Sponsor
                                                                                                                                    20 = Sponsor
                                                                                                                                    30 - 39 = Spouse/Former Spouse
                                                                                                                     01 - 19,       40 = Mother/Step-Mother of Sponsor
                        A DoD - define code which defines the relationship of the                                  20, 30 - 39,     45 = Father, Step-Father of Sponsor
Family Member Prefix    patient to the sponsor. This code is unique to the CHCS        $2            FMP            40, 45, 50,     50 = Mother-In-Law of Sponsor
                        Host.                                                                                      55, 60 - 69,     55 = Father-In-Law of Sponsor
                                                                                                                  90 - 95, 98, 99   60 - 69 = Other Authorized Dependent of Sponsor
                                                                                                                                    90 - 95 = Beneficiary Authorized by Statute
                                                                                                                                    98 = Civilian Emergencies
                                                                                                                                    99 = All Other, Not Elsewhere Classified

Fiscal Year             Fiscal year of appointment date.                               $4             FY             e.g., 2002
                                                                                                                000 - 013, 017, 018,
                                                                                                                021, 106 - 113, 116 -
Healthcare Delivery     Code representing the health plan of the beneficiary at
                                                                                       $3        HCDPCODE       119, 121, 122, 128 - See HCDP Codes
Program Code            the time of the appointment.
                                                                                                                132, 140, 142 - 146,
                                                                                                                   150, 152 - 157
Provider Specialty      Primary provider category according to HIPAA defined
                                                                                      $10         HIPAAPRV       e.g., 207RR0522X
(HIPAA)                 codes for the attending provider.
                        Inpatient/Outpatient indicator that the patient had at the                                                  I = Inpatient
Patient Status          time of the encounter. This field is supposed to be called     $1        HOSPSTAT           I, O, Blank     O = Outpatient
                        "PATSTAT", and may change in the future.                                                                    Blank = Outpatient
Host Node Seed          Field indicating the CHCS Host providing data.                 $4        HOSTSEED           e.g., NCA
Provider ID (HIPAA)     HIPAA compliant provider ID.                                  $15         HPROVID        e.g., 1110000960
Appointment Date        Date of the appointment (SAS format).                          8           IAPPTDT          e.g., 16022




 October 2011 Version                                                                Appointment Master                                                              Page 28 of 1408
                                                                                          Appointment Master

     Data Element                                   Definition                            Format      SAS Variable        Values                                  Notes

                                                                                                                                          A = Medicare Part A only
                                                                                                                                          N = Not eligible
                                                                                                                                          AB = Medicare Part A and B
                                                                                                                                          O = Became eligible after 65
                                                                                                                         A, AB, B,        B = Medicare Part B only
                            Code indicating Medicare coverage at the time of
Medicare Eligibility                                                                        $2         MEDELIG        D, E, L, N, O, P,   P = Purchased
                            appointment.
                                                                                                                            Q, S          D = Dual entitlement < 65
                                                                                                                                          Q = General eligible < 65
                                                                                                                                          E = Eligible at age 65
                                                                                                                                          S = Over 65 but not eligible
                                                                                                                                          L = Renal Disease, dual entitlement

                            Summary coding, indicating Medicare status at the time                                                        N = No Medicare eligibility
Medicare Eligibility Flag                                                                   $1         MEDFLAG              N, Y
                            of the appointment.                                                                                           Y = Some Medicare eligibility
                                                                                                                                          See MEPRS Codes 3 for information on 3rd-level
MEPRS 3 Code                Code indicating clinic where appointment occurred.              $3           MEP3         e.g., AAA, BAA
                                                                                                                                          MEPRS codes.
                            Detailed code indicating clinic where appointment                                        e.g., AAAA, AAAB,
MEPRS Code                                                                                  $4         MEPRSCD                         4th-level MEPRS code; specific to the MTF
                            occurred.                                                                                   AAAD, BAAA
Date Last Modified          Date record was last modified in CHCS.                          $8         MODDATE         e.g., 20031113
Patient Age                 Patient's age at the appointment date.                          3           PATAGE            e.g., 65
                            Identifies the beneficiary status of the person being
Patient Category                                                                            $3          PATCAT           e.g., C47        See Patient Categories for codes and descriptions.
                            treated.
Date Of Birth               Date when the patient was born.                                 $8          PATDOB        e.g., 19720718
Patient SSN                 Patient's Social Security Number.                               $9          PATSSN        e.g., 123456789
                            A unique identifier of a person, as assigned by DEERS.
Person Identifier           This is sometimes called the Electronic Data Interchange       $10         PATUNIQ       e.g., 1234567890
                            - Patient Identifier (EDI-PN).
Patient ZIP Code At
                            The postal zip code for the city where the patient resides.     $5          PATZIP          e.g., 22597
Time Of Visit
                                                                                                                                          1 = E1 - E4
                                                                                                                                          2 = E5 - E9
Sponsor Pay Group           Summary pay grade of sponsor.                                   $2          PAYGR               1-5           3 = O1 - O3
                                                                                                                                          4 = O4 - O11
                                                                                                                                          5 = other
                            PRISM Area DMIS ID based on the patient's residence
Patient PRISM Area                                                                          $4           PRISM             0001           See DMIS Information for list of DMIS ID.
                            zip code.
Provider ID (Old)           CHCS Provider ID.                                              $15          PROVID         e.g., FUNKW
                            A code that identifies the health service provider's
                                                                                                                                          See Provider Specialty Codes for DC for codes and
Provider Specialty (Old)    medical specialty. Codes and meanings come from                 $3        PROVSPEC           e.g., 001
                                                                                                                                          descriptions.
                            CHCS.
Patient MCS Region          MCS Region in which patient resides.                            $2        PTMCSREG          01 - 16, AK




  October 2011 Version                                                                    Appointment Master                                                                 Page 29 of 1408
                                                                               Appointment Master

        Data Element                            Definition                     Format      SAS Variable          Values                                   Notes

                                                                                                                                N = North
                                                                                                                                O = Overseas
                        TRICARE Next Generation Region in which patient
Patient Tnex Region                                                              $1        PTTNXREG            N, O, S, W       S = South
                        resides.
                                                                                                                                W = West
                                                                                                                                Blank = Unknown

                                                                                                                                 CD = Cadet
                                                                                                                                 E1 - E4 = Junior Enlisted
                                                                                                          07 , 10 , 11, CD, E1 - E5 - E9 = Senior Enlisted
Sponsor Rank            A code that represents the sponsor's military rank.      $4         RANKPAY        E9, O1 - O9, W1 - O1 - O3 = Junior Officer
                                                                                                                 W5, ZZ          O4 - O9, 10, 11 = Senior Officer
                                                                                                                                 W1 - W5 = Warrant Officer
                                                                                                                                 ZZ = All Others

                                                                                                                                F = Female
Sex                     Patient's gender.                                        $1            SEX            F, M, Blank       M = Male
                                                                                                                                Blank = unknown
                        The sponsor‟s SSN as assigned by the Social Security
Sponsor SSN                                                                      $9         SPONSSN         e.g., 123456789
                        Administration.
                                                                                                                                A = Army
                                                                                                                                B = NOAA
                                                                                                                                C = Coast Guard
                                                                                                                                F = Air Force
Sponsor Branch of                                                                                           A, B, C, F, K, M,
                        Sponsor branch of service.                               $1         SPONSVC                             K = Civilian
Service                                                                                                         N, P, R
                                                                                                                                M = Marines
                                                                                                                                N = Navy
                                                                                                                                P = Public Health Service
                                                                                                                                R = NATO
                                                                                                                                See State & Country Codes for DC for values and
State                   State or country where the patient lives.                $2           STATE             e.g., NY
                                                                                                                                descriptions.

                                                                                                                                A = Army
Summary Sponsor                                                                                                                 F = Air Force
                        Summary Branch of Service of Sponsor.                    $1          SUMSVC            A, F, N, O
Branch of Service                                                                                                               N = Navy
                                                                                                                                O = Other




 October 2011 Version                                                          Appointment Master                                                                   Page 30 of 1408
                                                                                       Appointment Master

     Data Element                                Definition                            Format      SAS Variable       Values                                 Notes

                                                                                                                                     01 = Northeast
                                                                                                                                     02 = Mid-Atlantic
                                                                                                                                     03 = Southeast
                                                                                                                                     04 = Gulf South
                                                                                                                                     05 = Heartland
                                                                                                                                     06 = Southwest
                                                                                                                                     07,08 = TRICARE Central
Treatment MCS Region    MCS Region in which the treatment MTF is located.                $2        TXMCSREG         01 - 15, AK      09 = Southern California
                                                                                                                                     10 = Golden Gate
                                                                                                                                     11 = Northwest
                                                                                                                                     12 = TRICARE Pacific
                                                                                                                                     13 = Europe
                                                                                                                                     14 = Western Pacific/Asia
                                                                                                                                     15 = Central/South America & Other OCONUS
                                                                                                                                     AK = Alaska

                                                                                                                                     A = Army
                                                                                                                                     C = Coast Guard
Treatment Service                                                                                                                    F = Air Force
                        Branch of service for the treating hospital or clinic.           $1           TXSVC       A, C, F, M, N, S
Branch                                                                                                                               M = MCSC
                                                                                                                                     N = Navy
                                                                                                                                     S = Other non DoD

                                                                                                                                     A = Alaska
                                                                                                                                     N = North
Treatment Tnex Region   TRICARE Region in which the treatment MTF is located.            $1        TXTNXREG        A, N, O, S, W     O = Overseas
                                                                                                                                     S = South
                                                                                                                                     W = West
                        Code indicating whether or not the MTF viewed the
                                                                                                                                     C = Countable
Workload Type           appointment as "countable". Inconsistent use across              $1        WKLDTYPE              C
                                                                                                                                     N = Not Countable
                        MTF's.
                        Zip code of residence of patient at the time of service, if
                        available. Otherwise, zip code in patient registry at the
ZIP Code                                                                                 $5            ZIP          e.g., 20169
                        time the data extracted from CHCS. See Zip Code
                        Validity indicator to determine source of zip code.
                        Indicates whether or not the zip code represents the
                                                                                                                                     1 = Zip code is as of appointment data
ZIP Code Validity       patient's zip code at the time of service, or as recorded in     $1          ZIPSTAT            0, 1
                                                                                                                                     0 = from patient registry
                        the patient registry.




 October 2011 Version                                                                  Appointment Master                                                               Page 31 of 1408
                                                                                  Appointment Weekly

                                                             Appointment-Weekly Data File
Common File Name: fyXX.sas7bdat, where XX=08+
Dataset Location: /mdr/pub/apptwkly/basic/fyXX, where XX=08+
Update Frequency: Updated weekly and organized into annual files                                                                   Source System: CHCS
Description: Appointment-Level Data Records
      Data Element                             Definition                          Format       SAS Variable       Values                                 Notes
CHCS Host DMISID         Field indicating the CHCS Host providing data.            Char(4)      CHCSHOST
Patient's EDIPN, Raw     Patient's EDIPN as it comes on the data (raw).            Char(10)      EDIPN_R
Patient Date of Birth                                                                N(8)         PATDOB                       SAS date.
                                                                                                               000 - 013, 017,
                                                                                                               018, 021, 106 -
                                                                                                               113, 116 - 119,
Health Care Delivery
                         HCDP code as it comes on the data.                        Char(3)       CHCSHCDP      121, 122, 128 - See HCDP Codes
Program Code, Raw
                                                                                                               132, 140, 142 -
                                                                                                               146, 150, 152 -
                                                                                                                     157
                                                                                                                                   01 - 19 = Dependent Child
                                                                                                                                   20 = Sponsor
                                                                                                                                   30 - 39 = Spouse of sponsor
                                                                                                                 00 - 19, 20,
                                                                                                                                   40 - 44 = Mother of sponsor
                                                                                                               30 - 39, 40 - 44,
                         DEERS specific code indicating the relationship of                                                        45 - 49 = Father of sponsor
                                                                                                               45 - 49, 50 - 54,
DEERS Dependent Suffix   the beneficiary to the sponsor. (Not the same of the      Char(2)             DDS                         50 - 54 = Mother-In-Law of sponsor
                                                                                                               55 - 59, 60 - 69,
                         family member prefix in CHCS).                                                                            55 - 59 = Father-In-Law of sponsor
                                                                                                               70 - 74, 75, 98,
                                                                                                                                   60 - 69 = Other eligible dependents
                                                                                                                      99
                                                                                                                                   70 - 74 = Unknown by DEERS
                                                                                                                                   75 = Pseudo DDS unknown by contractor
                                                                                                                                   98 = Service secretary designee
Patient Category Code                                                              Char(3)        PATCAT
                         Inpatient/Outpatient indicator that the patient had at                                                    I = Inpatient
Patient Status           the time of the encounter. This field is supposed to      Char(1)        PATSTAT        I, O, blank       O = Outpatient
                         be called "PATSTAT", and may change in the future.                                                        Blank = Outpatient
                                                                                                                                   01 - 19 = Dependent Child of Sponsor
                                                                                                                                   20 = Sponsor
                                                                                                                                   30 - 39 = Spouse/Former Spouse
                                                                                                                  01 - 19,         40 = Mother/Step-Mother of Sponsor
                         A DoD - define code which defines the relationship of                                  20, 30 - 39,       45 = Father, Step-Father of Sponsor
Family Member Prefix     the patient to the sponsor. This code is unique to the    Char(2)             FMP       40, 45, 50,       50 = Mother-In-Law of Sponsor
                         CHCS Host.                                                                             55, 60 - 69,       55 = Father-In-Law of Sponsor
                                                                                                               90 - 95, 98, 99     60 - 69 = Other Authorized Dependent of Sponsor
                                                                                                                                   90 - 95 = Beneficiary Authorized by Statute
                                                                                                                                   98 = Civilian Emergencies
                                                                                                                                   99 = All Other, Not Elsewhere Classified
SADR Status                                                                        Char(1)      SADRSTAT           0, blank
CAPER Status                                                                       Char(1)      CAPERSTAT         1-5, blank
Patient SSN                                                                        Char(11)      PATSSN
CCE Status                                                                         Char(1)       CCESTAT          1-5, blank




October 2011 Version                                                              Appointment Weekly                                                                  Page 32 of 1408
                                                                                       Appointment Weekly

      Data Element                                  Definition                          Format       SAS Variable        Values                                    Notes
                                                                                                                                        1=
                                                                                                                                        2=
                                                                                                                       1-4, CHCS,       3=
                                                                                                                         CHCS II        4=
Source System                                                                           Char(7)        SOURCE
                                                                                                                        PRV GUI,        CHCS =
                                                                                                                          blank         CHCS II =
                                                                                                                                        PRV GUI =
                                                                                                                                        Blank =
                                                                                                                        FEMALE
Patient Gender                                                                          Char(6)             SEX
                                                                                                                         MALE
MEPRS 4 Code                                                                            Char(4)        MEPRS4           eg, BAAA
                             Code that identifies the MTF responsible for the
Treatment DMISID                                                                        Char(4)             MTF                         See DMIS Information for list of DMIS ID.
                             patient appointment.
                             Rank of the sponsor. The ranks are spelled out                                           eg, LANCE
Sponsor Rank                                                                            Char(35)        RANK                            All capitals.
                             completely (eg, MAJOR or LANCE CORPORAL).                                                CORPORAL
Sponsor SSN                                                                             Char(11)      SPONSSN
                             The states are spelled out completely; eg, ALABAMA
Patient State                                                                           Char(35)        STATE        eg, ALABAMA        All capitals. It can also be blank.
                             or APO (ARMY AND AIR FORCE EUROPE).
Patient Zip                  The Patient's zip code at time of encounter.               Char(5)        PATZIP
Enrollment DMISID, Raw       Enrollment DMIS ID as received from CHCS.                  Char(4)       ENRDMIS1         e.g., 0037       See DMIS Information for list of DMIS ID.
                             Patient'sMedicare eligibility. The field is spelled out                                  eg, Medicare
Medicare Eligibility                                                                    Char(26)       MEDELIG                        Not all capitals. It can also be blank.
                             completely.                                                                            Part A and Part B
                                                                                                                    0, A, C, D, F, I,
Location Type                                                                           Char(1)        PCMLOC
                                                                                                                    M, O, P, missing
Appointment Internal Entry
                                                                                        Char(10)       APPTIEN
Number
                                                                                                                        ADMIN,
                                                                                                                       BOOKED,
                                                                                                                       CANCEL,
                                                                                                                     CHECKED-IN,
                                                                                                                    KEPT, LWOBS,
Appointment Status           Indicates the status of the patient's appointment.         Char(10)     APPTSTAT_R                   All capitals.
                                                                                                                    NO-SHOW, OCC-
                                                                                                                    SVC, PENDING,
                                                                                                                     S-CALL, TEL-
                                                                                                                    CON, WALK-IN,
                                                                                                                        missing
                                                                                                                        eg, ACUT
                                                                                                                         ACUTE
Appointment Type             Code indicating the type of appointment.                   Char(6)      APPTTYPE_R
                                                                                                                         ACUT$
                                                                                                                           etc
Appointment Duration                                                                    Char(5)       APPT_DUR
Appointment Date and                                                                                                  eg, 09/01/09
                                                                                        Char(14)      APTDTTM                      mm/dd/yy hh:mm
Time                                                                                                                      11:00
Patient Cancellation                                                                                                  eg, CANCEL
                                                                                        Char(18)     PATCANREA
Reason Code                                                                                                          COMPLETELY
Countable Visit Indicator,                                                                                              COUNT
                                                                                        Char(9)         WKLD
Raw                                                                                                                  NON-COUNT




October 2011 Version                                                                   Appointment Weekly                                                                       Page 33 of 1408
                                                                                   Appointment Weekly

      Data Element                               Definition                         Format       SAS Variable       Values                               Notes
Date and Time                                                                                                    eg, 09/01/09
                                                                                    Char(14)     DTAPMDTTM                      mm/dd/yy hh:mm
Appointment Made                                                                                                     11:00
                                                                                                                   ACUTE,
                                                                                                                 DROUTINE,
                                                                                                                   FUTURE
                                                                                                                  REQUEST,
Access to Care Category                                                             Char(15)       ATC_CAT                      All capitals.
                                                                                                                  ROUTINE,
                                                                                                                 SPECIALTY,
                                                                                                                 WELLNESS,
                                                                                                                    missing
CHCS Provider ID                                                                    Char(9)        PROVID
Provider EDIPN                                                                      Char(10)     PROVEDIPN
                            Primary provider category according to HIPAA                                           e.g.,
Provider Specialty, HIPAA                                                           Char(10)      HIPAAPRV                      See Provider Specialty Codes, HIPAA.
                            defined codes for the attending provider.                                           207RR0522X
                            A code that identifies the health service provider's
                                                                                                                                See Provider Specialty Codes for DC for codes and
Provider Specialty          medical specialty. Codes and meanings come from         Char(3)       PROVSPEC        e.g., 001
                                                                                                                                descriptions.
                            CHCS.
CHCS Provider ID,
                                                                                    Char(9)        PROVID2
Secondary
Provider EDIPN,
                                                                                    Char(10)     PROV2EDIPN
Secondary
Referral Number                                                                     Char(11)       REFNUM
                                                                                                                 SICK-CALL
                                                                                                                TEL-CONSULT
Walk-in Flag                                                                        Char(11)      WALKIN_R                  All capitals.
                                                                                                                  WALK-IN
                                                                                                                   missing
Extract Date                Date data was harvested from the source.                  N(8)         EXTRDT                   SAS date.
                            Date that the processor most recently added/updated
Processing Date                                                                       N(8)         PROCDT                       SAS date.
                            the record.
                                                                                                                                N = newly added record
Change Code                 Describes the record type after processing.             Char(1)       CHGCODE        N, U, Blank    U = record modified by the last processing cycle
                                                                                                                                Blank = record not modified by the last processing cycle




October 2011 Version                                                               Appointment Weekly                                                                Page 34 of 1408
                                                                                  CAPER (Basic&Enhanced)

                                        CAPER Basic/Enhanced (Comprehensive Ambulatory/Provider Encounter Record)
Common File Name: fyXX.sas7bdat, where XX=03+
Dataset Location: For Basic: /mdr/pub/caper/fyXX.sas7bdat, where XX=03+; For Enhanced: /mdr/pub/caper/enhanced/fyXX.sas7bdat, where XX=04+
Update Frequency: Current FY weekly; Prior FY weekly for one quarter (Oct-Dec), April, and October; Previous
                                                                                                             Source System: CHCS / ADS
years annually or as needed.
Description: Patient-Level Comprehensive Ambulatory/Professional Encounter Record
                                                            SAS Variable B=CAPER Basic
Data Element                Definition            Format                                                      Values                                           Notes
                                                                Name       E=CAPER Enh
Actual
Appointment      Placeholder                                   Char(10)    ACTDUR             B/E
Duration
                                                                                                                            A=Active Duty Prime
                                                                                                                            B=TRICARE Global Remote Overseas Prime Active Duty
                                                                                                                            D=TRICARE Senior Prime
                                                                                                                            E=Non-Active Duty Prime
                 Indicates the enrollment status of the                                                                     F=TRICARE Global Remote Overseas Prime Active Duty Family
                 beneficiary from DEERS.                                                                                    Member
                                                                                                                            G=TRICARE Plus (CHAMPUS/TFL Eligible)
                                                                                                            A, B, D, E, F,
Alternate Care   FY03 and back: Appended using the                                                                          H=TRICARE Overseas Prime Active Duty
                                                               Char(1)      ACV                E           G, H, J, L, M,
Value            Longitudinal Enrollment File.                                                                              J=TRICARE Overseas Prime Active Duty Family Member
                                                                                                           Q, R, U, V, Null
                                                                                                                            L=TRICARE Plus (not CHAMPUS/TFL Eligible)
                 FY04+: Appended using the Longitudinal                                                                     M=AD not reported enrolled (added FY05)
                 VM4.                                                                                                       Q=AD enrolled to Op Forces
                                                                                                                            R=TRS
                                                                                                                            U=USTF/USFHP
                                                                                                                            V=TRICARE Retired Reserve
                                                                                                                            Null = Not Enrolled


                                                                                                                            Prime = ACV A, E, H, or J
                                                                                                              Prime,        Overseas Remote = ACV B or F
                 Alternate Care Value Group: based on the                                                   Overseas,       Plus = ACV G or L
ACV Group        ACV, indicates the enrollment status of the   Char(15)   ACVGROUP             E           Plus, Reliant,   Desig Prov = ACV U
                 beneficiary.                                                                               Desig Prov,     Reliant = ACV M or Q; or ACV is any other value (including blanks)
                                                                                                               Other            and Ben Cat Common = 4 then “Reliant”
                                                                                                                            Other = All others


                                                                                                                            1 = Consultation requested
                                                                                                                            2 = Referred to another provider
Administrative   The administrative disposition code as
                                                               Char(5)    ADMDISP             B/E           1, 2, 3, 4, 5   3 = Convalescent leave
Disposition      marked on the encounter.
                                                                                                                            4 = Medical board
                                                                                                                            5 = Medical hold




       October 2011 Version                                                       CAPER (Basic&Enhanced)                                                                 Page 35 of 1408
                                                                                     CAPER (Basic&Enhanced)

                                                                           SAS Variable B=CAPER Basic
Data Element                      Definition                    Format                                           Values                                      Notes
                                                                              Name      E=CAPER Enh
                                                                                                                               A = 0-4
                                                                                                                               B = 5-14
                                                                                                                               C = 15-17
                                                                                                                               D = 18-24
Age Group          Based on patient age.                        Char(1)      AGEGRP               E              A - H, X      E = 25-34
                                                                                                                               F = 35-44
                                                                                                                               G = 45-64
                                                                                                                               H = 65+
                                                                                                                               X = All Others
Ambulatory         Flag to identify ambulatory surgery                                                                         0 = Normal appointment
                                                                Char(1)     AMBSURG              B/E               0, 1
Surgery            appointment.                                                                                                1 = Ambulatory surgery appointment
                   TRICARE Ambulatory Payment
APC, E&M1-         Classification Code associated with CPTJ .                                                              FY07-FY08, assigned by format; FY09+ assigned by APC Grouper .
                                                                              APCJ                            00000-19999,
E&M3; Proc 1-      J=1 to 13, where J=1 to 3 represents the     Char(5)                           E                        See APC Grouper Codes for a list of codes and descriptions.
                                                                                                              T0001-T9999
Proc 10            E&M positions and J=4 to 13 represents                                                                  Populated for FY07+.
                   procedure positions.
                                                                                                                               Populated for FY07+
                                                                                                                               On Facility records (FAC_FLAG =F) only, otherwise 0.
APC Aggregate      Summation of APC E&M 1- E&M3 and                                                                            Equals the sum of APCWT1-APCWT13 subject to multiple procedure
                                                                  N(8)      APCAGGWT              E
Weight             APC Proc 1- Proc 10 weights.                                                                                discouting, UOS and modifier impacts.
                                                                                                                               If APPTINFR=Y, based on completion table rules (See MDR CAPER
                                                                                                                               Enhanced specification).
                                                                                                                               Deleted effective ~Jul/Aug 2011.
APC Aggregate   Summation of APC E&M and APC Proc 1-                                                                           Sum of APCWT1, APCWT4-APCWT7. No discounting.
                                                                  N(8)     APCAGGWT_S             E
Weight per SADR Proc 4 weights.                                                                                                Populated for FY07+

APC Procedure
Edits, E&M1-       Edit codes from APC Grouper associated
E&M3, Proc1-       with APCJ .
                                                                                                                               From TRICARE APC Grouping of CPT procedures J =1 to 13.
Proc 10, as        J=1 to 13, where J=1 to 3 represents the     Char(40)    APCEDITJ              E
                                                                                                                               Populated for FY09+ only.
assigned by the    E&M positions and J=4 to 13 represents
TRICARE APC        procedure positions.
Grouper.
APC Packaging
Flag, E&M1-        Packaging Flag from APC Grouper
E&M3, Proc1-       associated with APCJ .
                                                                                                                               From TRICARE APC Grouping of CPT procedures J =1 to 13,
Proc 10, as        J=1 to 13, where J=1 to 3 represents the     Char(1)     APCPKGJ               E
                                                                                                                               Populated for FY09+ only.
assigned by the    E&M positions and J=4 to 13 represents
TRICARE APC        procedure positions.
Grouper.
APC Procedure      Payment Status Indicator associated with
                                                                                                              A,B,C,E,F,G,H,   FY07-FY08, assigned by format; FY09+ assigned by APC Grouper .
Status Indicator   APCJ
                                                                                                              K,N,P,Q,Q1,Q2    See OPPS Procedure Status Indicators for a list of codes and
(PSI), E&M1-       J =1 to 13, where J =1 to 3 represents the   Char(2)      APCPSIJ              E
                                                                                                              ,Q3,R,S,T,U,V,   descriptions.
E&M3; Proc1-       E&M positions and J =4 to 13 represents
                                                                                                                W,X,Z,TB       Populated for FY07+ only.
Proc 10            procedure positions.




       October 2011 Version                                                          CAPER (Basic&Enhanced)                                                             Page 36 of 1408
                                                                                     CAPER (Basic&Enhanced)

                                                                           SAS Variable B=CAPER Basic
Data Element                      Definition                   Format                                            Values                                          Notes
                                                                              Name      E=CAPER Enh
APC Weight
                   Weight associated with APCJ .                                                                              Multiple procedure discounting, UOS and modifier impacts applied,
(Discounted),
                   J=1 to 13, where J=1 to 3 represents the                                                                   effective ~Jul/Aug 2011.
E&M1-E&M3;                                                     N(8) Z9.4     APCWTJ               E
                   E&M positions and J=4 to 13 represents
Proc1-Proc10
                   procedure positions.                                                                                       Populated for FY07+ only.
                   From Ambulatory Patient Group (APG)
APG E&M                                                        Char(3)        APG1                E             000 - 999     See APG Grouper Codes for descriptions.
                   Grouping of E&M 1 (CPT_1).
                   From Ambulatory Patient Group (APG)
APG Medical                                                    Char(3)        APG2                E             000 - 999     See APG Grouper Codes for descriptions.
                   Grouping of Diagnosis 1 (DX1).
APG - Procedure From Ambulatory Patient Group (APG)
                                                               Char(3)        APG3                E             000 - 999     See APG Grouper Codes for descriptions.
1               Grouping of 1st procedural CPT (CPT_4).

APG - Procedure From Ambulatory Patient Group (APG)
                                                               Char(3)        APG4                E             000 - 999     See APG Grouper Codes for descriptions.
2               Grouping of 2nd procedure CPT (CPT_5).

APG - Procedure From Ambulatory Patient Group (APG)
                                                               Char(3)        APG5                E             000 - 999     See APG Grouper Codes for descriptions.
3               Grouping of 3rd procedural CPT (CPT_6).

APG - Procedure From Ambulatory Patient Group (APG)
                                                               Char(3)        APG6                E             000 - 999     See APG Grouper Codes for descriptions.
4               Grouping of 4th procedural code (CPT_7).

                                                                                                                              The total APG weight of the encounter, found by adding 100% of the
                                                                                                                              highest weight APG to 50% of all other APGs (except that the medical
                                                                                                                              APG and E&M APG are not included except when either is the highest
                                                                                                                              weight APG). Weights are obtained from merge to APG Weight Table
                   The Total discounted APG weight of the
Total APG Weight                                                 N(8)       APGWGT_S              E                           by APG, FY.
                   encounter, based on APG1-APG6.
                                                                                                                              Set to 0 (zero) for non B MEPRS records.

                                                                                                                              If APPTINFR=Y, based on completion table rules (See MDR CAPER
                                                                                                                              Enhanced specification)
Associated      Internal Entry Number (IEN) of the
                                                               Char(10)     APPTIDNO             B/E
Appointment EIN appointment.
Appointment        Identifies records added to the CAPER
                                                                                                                              Y = if from Appointment File (appointment-inferred CAPER)
Inferred CAPER     Enhanced file in the event an appointment   Char(1)      APPTINFR              E                Y, N
                                                                                                                              N = is a reported CAPER
Flag               record exists but a CAPER does not.
                   Identifies records in CAPER Enhanced with
Appointment
                   a match on HOSTDMIS and APPTIDNO in           N(3)       APPTMTCH              E
Record Match
                   the appointment file.
                                                                                                                               C = CHCS
                                                                                                                               A = ADS
Appointment
                   Designates whether the appointment was                                                                      P = CIW
Prefix (Source                                                 Char(1)      APPTPFIX             B/E          2, A, C, G, P, I
                   created in.                                                                                                 G = Provider GUI
System Flag)
                                                                                                                               2 = CHCSII
                                                                                                                               I = Appointment inferred record




       October 2011 Version                                                          CAPER (Basic&Enhanced)                                                               Page 37 of 1408
                                                                           CAPER (Basic&Enhanced)

                                                                   SAS Variable B=CAPER Basic
Data Element                     Definition              Format                                       Values                                   Notes
                                                                      Name      E=CAPER Enh


Appointment                                                                                                        2 = Kept
Status Type with Appointment type status, modified for                                                             5 = Walk-in
                                                         Char(1)    APPTSTAT            E             2, 5, 6, 7
Appointment Data Appointment Data Walk-ins.                                                                        6 =Sick call
Walk-In                                                                                                            7 = Telephone consult




                                                                                                                   2 = Kept
Appointment                                                                                                        5 = Walk-in
                  Appointment type status.               Char(1)    APPTSTAT            B             2, 5, 6, 7
Status Type                                                                                                        6 =Sick call
                                                                                                                   7 = Telephone consult




                                                                                                                   2 = Kept
Appointment                                                                                                        5 = Walk-in
                  Appointment type status.               Char(1)    APPTSTAT1           E             2, 5, 6, 7
Status Type                                                                                                        6 =Sick call
                                                                                                                   7 = Telephone consult



                                                                                                                   ACUT = Acute appointment
                                                                                                                   ACUT$ = Acute appointment
                                                                                                                   APV = Ambulatory Procedure Visit
                                                                                                                   EROOM = Emergency Room
                                                                                                                   EST = Established/follow up
                                                                                                        ACUT,      EST$ = Established/follow up
                                                                                                     ACUT$, APV,   GRP = Group/class appointment
                                                                                                    EROOM, EST,    GRP$ = Group/class appointment
                                                                                                     EST$, GRP,    N-MTF = Non-MTF appointment
                                                                                                    GRP$, N-MTF,   OPAC = Open Access Appointment
                                                                                                       OPAC,       OPAC$ = Open Access Appointment
Appointment Type                                                                                    OPAC$, PCM,    PCM = Initial Primary Care appointment
from Appointment From the appointment data merge.        Char(6)    APPTTYPE            E           PCM$, PROC,    PCM$ = Initial Primary Care appointment
Data                                                                                                   PROC$,      PROC = Procedure appointment
                                                                                                       RNDS*,      PROC$ = Procedure appointment
                                                                                                       ROUT,       RNDS* = Inpatient ward appointment
                                                                                                       ROUTS,      ROUT = Routine appointment
                                                                                                    SPEC, SPEC$,   ROUTS = Routine appointment
                                                                                                    T-CON, WELL,   ROUT$ = Routine appointment
                                                                                                       WELL$       SPEC = Initial Specialty Care appointment
                                                                                                                   SPEC$ = Initial Specialty Care appointment
                                                                                                                   T-CON* = Telephone consult
                                                                                                                   T-CON = Telephone consult
                                                                                                                   WELL = Wellness/Health Promotion Appointment
                                                                                                                   WELL$ = Wellness/Health Promotion Appointment




      October 2011 Version                                                 CAPER (Basic&Enhanced)                                                          Page 38 of 1408
                                                            CAPER (Basic&Enhanced)

                                                    SAS Variable B=CAPER Basic
Data Element                 Definition   Format                                       Values                                   Notes
                                                       Name      E=CAPER Enh

                                                                                                    ACUT = Acute appointment
                                                                                                    ACUT$ = Acute appointment
                                                                                                    APV = Ambulatory Procedure Visit
                                                                                                    EROOM = Emergency Room
                                                                                                    EST = Established/follow up
                                                                                         ACUT,      EST$ = Established/follow up
                                                                                      ACUT$, APV,   GRP = Group/class appointment
                                                                                     EROOM, EST,    GRP$ = Group/class appointment
                                                                                      EST$, GRP,    N-MTF = Non-MTF appointment
                                                                                     GRP$, N-MTF,   OPAC = Open Access Appointment
                                                                                        OPAC,       OPAC$ = Open Access Appointment
                                                                                     OPAC$, PCM,    PCM = Initial Primary Care appointment
Appointment Type
                                          Char(6)   APPTTYPE_R           E           PCM$, PROC,    PCM$ = Initial Primary Care appointment
Raw
                                                                                        PROC$,      PROC = Procedure appointment
                                                                                        RNDS*,      PROC$ = Procedure appointment
                                                                                        ROUT,       RNDS* = Inpatient ward appointment
                                                                                        ROUTS,      ROUT = Routine appointment
                                                                                     SPEC, SPEC$,   ROUTS = Routine appointment
                                                                                     T-CON, WELL,   ROUT$ = Routine appointment
                                                                                        WELL$       SPEC = Initial Specialty Care appointment
                                                                                                    SPEC$ = Initial Specialty Care appointment
                                                                                                    T-CON* = Telephone consult
                                                                                                    T-CON = Telephone consult
                                                                                                    WELL = Wellness/Health Promotion Appointment
                                                                                                    WELL$ = Wellness/Health Promotion Appointment




      October 2011 Version                                 CAPER (Basic&Enhanced)                                                           Page 39 of 1408
                                                                                       CAPER (Basic&Enhanced)

                                                                             SAS Variable B=CAPER Basic
Data Element                        Definition                     Format                                         Values                                  Notes
                                                                                Name      E=CAPER Enh
                                                                                                                               ACUT = Acute appointment
                                                                                                                               ACUT$ = Acute appointment
                                                                                                                               APV = Ambulatory Procedure Visit
                                                                                                                               EROOM = Emergency Room
                                                                                                                               EST = Established/follow up
                                                                                                                    ACUT,      EST$ = Established/follow up
                                                                                                                 ACUT$, APV,   GRP = Group/class appointment
                                                                                                                EROOM, EST,    GRP$ = Group/class appointment
                                                                                                                 EST$, GRP,    N-MTF = Non-MTF appointment
                                                                                                                GRP$, N-MTF,   OPAC = Open Access Appointment
                                                                                                                   OPAC,       OPAC$ = Open Access Appointment
                                                                                                                OPAC$, PCM,    PCM = Initial Primary Care appointment
Appointment Type
                                                                   Char(6)    APPTTYPE              B           PCM$, PROC,    PCM$ = Initial Primary Care appointment
Raw
                                                                                                                   PROC$,      PROC = Procedure appointment
                                                                                                                   RNDS*,      PROC$ = Procedure appointment
                                                                                                                   ROUT,       RNDS* = Inpatient ward appointment
                                                                                                                   ROUTS,      ROUT = Routine appointment
                                                                                                                SPEC, SPEC$,   ROUTS = Routine appointment
                                                                                                                T-CON, WELL,   ROUT$ = Routine appointment
                                                                                                                   WELL$       SPEC = Initial Specialty Care appointment
                                                                                                                               SPEC$ = Initial Specialty Care appointment
                                                                                                                               T-CON* = Telephone consult
                                                                                                                               T-CON = Telephone consult
                                                                                                                               WELL = Wellness/Health Promotion Appointment
                                                                                                                               WELL$ = Wellness/Health Promotion Appointment
                                                                                                                               N = Not an APV
                   Identifies visits to a clinic identified as a
APV Flag                                                           Char(1)      APV                 E               N, Y       Y = APV
                   ambulatory procedure clinic.
                                                                                                                               APV=Y, when MEPRSCD=B**5 or B**7 for TXSVC=A, F, or N.
Ambulatory
Surgical Center    ASC codes for CPT procedures J =1 to 13,
Class (ASC)        where J =1 to 3 represents the E&M
                                                                   Char(2)      ASCJ                E               1-11
Codes, E&M1-       positions and J =4 to 13 represents
E&M3, Procedure    procedure positions.
1-Procedure 10
Assigned           Duration of appointment for the encounter
Appointment        identified in increments of minutes,             N(8)      ASSGNDUR             B/E
Duration           maximum 99999.




      October 2011 Version                                                             CAPER (Basic&Enhanced)                                                         Page 40 of 1408
                                                                                      CAPER (Basic&Enhanced)

                                                                           SAS Variable B=CAPER Basic
Data Element                     Definition                      Format                                                  Values                                           Notes
                                                                              Name      E=CAPER Enh
                                                                                                                                 ACT = Active Duty
                                                                                                                                 DA = Dependent of Active Duty
                                                                                                                                 DCO = Direct Care Only
                                                                                                                      ACT, DA,   DR = Dependent of Retired
                                                                                                                    DCO, DR, DS, DS = Dependent of Survivor
                  Category of beneficiary derived from patient
Beneficiary                                                                                                          GRD, IDG, GRD = Guard/Reserve
                  category code using universal PATCAT           Char(3)      BENCAT                  E
Category                                                                                                             IGR, NAT,   IDG = Dependent of Inactive Guard
                  format table.
                                                                                                                     OTH, RET, IGR = Inactive Guard/Reserve
                                                                                                                        UNK      NAT = NATO
                                                                                                                                 OTH = Other
                                                                                                                                 RET = Retired
                                                                                                                                 UNK = Unknown

                                                                                                                                 ACT = Active Duty Member
                                                                                                                                 DA = Dependent of Active Duty
                                                                                                                                 DCO = Direct Care Only
                                                                                                                                 DGR = Dependent of Guard/Reserve
                                                                                                                                 DR = Dependent of Retired
                                                                                                                      ACT, DA,
                                                                                                                                 DS = Dependent of Survivor
                                                                                                                     DCO, DGR,
Beneficiary                                                                                                                      GRD = Guard
                  Category of beneficiary derived from the                                                          DR, DS, GRD,
Category from                                                    Char(3)     BENCATX                  E                          IDG = Inactive Guard/Reserve Dependent
                  longitudinal LVM4 and BENCAT.                                                                       IDG, IGR,
LVM4                                                                                                                             IGR = Inactive Guard/Reserve
                                                                                                                     NAT, OTH,
                                                                                                                                 NAT = NATO
                                                                                                                     RET, UNK
                                                                                                                                 OTH = Other
                                                                                                                                 RET = Retired
                                                                                                                                 UNK =Unknown

                                                                                                                                        Populated FY04+.

Appointment                                                                                                                             5 = Cancelled by provider
Cancellation      Type of appointment cancellation.              Char(1)     CANCSTAT                B/E                  5, 8, 9       8 = Cancelled by facility
Status Type                                                                                                                             9 = Cancelled by patient
CAPER                                                                      CAPERPROCDAT
                                                                 Char(8)                              E                                 Format yyyymmdd.
Processing Date                                                                  E
                                                                                                                                        O = Original (initial after encounter)
CAPER Status      CAPER record status.                           Char(1)    CAPERSTAT                B/E                   O, U
                                                                                                                                        U = Updated (encounter modified)
Patient
                                                            Char(4)           code (PATZIP sub stringed to 5 digits).
                  Catchment Area DMIS ID based on the patient's residence zipCATCH                   E                                  See DMIS Information for list of DMIS ID.
Catchment Area
                                                                                                                                        1 = Pending - transmitted original encounter to CCE
                                                                                                                                        2 = Received updated encounter from CCE
                                                                                                                                        3 = Released - original billable encounter released from CCE
CCE Encounter                                                                                                                               with no changes
                  Valid CCE encounter record status.             Char(1)     CCESTAT                 B/E                1, 2, 3, 4, 5
Status Flag                                                                                                                             4 = Complete - updated encounter from CCE received and
                                                                                                                                            processed
                                                                                                                                        5 = Uncertified - original billable encounter released from CCE
                                                                                                                                            with no changes




       October 2011 Version                                                          CAPER (Basic&Enhanced)                                                                           Page 41 of 1408
                                                                                      CAPER (Basic&Enhanced)

                                                                           SAS Variable B=CAPER Basic
Data Element                      Definition                   Format                                          Values                                    Notes
                                                                              Name      E=CAPER Enh

                                                                                                                         FY07+, effective ~July/Aug 2011
Change Edit Flag Documents modifications to the record.        Char(10)     CEDITFLG               E
                                                                                                                         See CAPER Change Codes .


Claim Denial                                                                                                             From TRICARE APC Grouping
                                                                Char(1)     CLAIM_DEN              E
Disposition                                                                                                              Populated for FY09+ only
Overall Claim                                                                                                            From TRICARE APC Grouping
                                                                Char(2)     CLAIM_DISP             E
Disposition                                                                                                              Populated for FY09+ only
Clinic State (from Two character state code identifying the
                                                                Char(2)     CLINSTAT               E                     See State & Country Codes for DC for values and descriptions.
DMIS merge)        state where the clinic resides.
                   Two character state code identifying the
Clinic State                                                    Char(2)    CLINSTAT_R             B/E                    See State & Country Codes for DC for values and descriptions.
                   state where the clinic resides.
Clinic Zip Code
                   Zip Code associated with the location of the
(from DMIS                                                      Char(5)      CLINZIP               E
                   clinic.
merge)
Clinic Zip Code    Zip Code associated with the location of the
                                                                Char(10)    CLINZIP_R             B/E                    Hyphens removed.
(Raw)              clinic.
Calendar Month Calendar Month of Encounter Date                 Char(2)        CM                 B/E           1-12
                                                                                                                         1 = Dep Active Duty / Guard
Common
                  Broadest category of beneficiaries                                                                     2 = Retired
Beneficiary                                                    Char(1)       COMBEN                E           1,2,3,4
                  (available for all files).                                                                             3 = Dep of Retired / Survivor / Other / Unknown/Blank/IGR/IDG
Category
                                                                                                                         4 = Active Duty Guard
DX(ICD-9-CM)
                  The ICD-9 code identifying the patient‟s                                                               Left aligned.
Code, Encounter                                                 Char(5)     COMPLAINT             B/E
                  main reason for seeking medical care.                                                                  Decimal place is assumed after the third position.
Chief Complaint
Composite         Workload measure representing combined
                                                                 N(8)        COMPWT                E                     FY12+. Equals APCAGGWT + (36.54/67.41) * TRVUAGG
Weight            APC and RVU weights.
                                                                                                                         Sum of VCCLNSAL, VCOTHLBR, VCLAB, VCRAD, VCOTHANC,
                                                                                                                         VCOTHER, and VCRX. Note: the individual components are already
                  The MTF‟s variable cost (as defined by
                                                                                                                         discounted prior to summing.
Variable Cost     specific Standard Expense Element Code -       N(8)         COST                 E
                  SEEC) of each professional encounter.
                                                                                                                         If APPTINFR=Y, based on completion table rules (See MDR CAPER
                                                                                                                         Enhanced specification).
                                                                                                                         Sum of the component (VCOTHLBR, VCLAB, VCRAD, VCOTHANC,
                                                                                                                         VCOTHER, and VCRX) pieces derived from E&M1 APG and most
                                                                                                                         current cost masters for that FY (not discounted).
                                                                                                                         Set to 0 (zero) for non "B" records and for non-DHP sites (IF TXSVC ≠
Variable Cost,
                  Variable cost for the E&M APG.                 N(8)         COST1                E                     A, N, F).
E&M APG
                                                                                                                         Does not include clinician salary.

                                                                                                                         If APPTINFR=Y, based on completion table rules (See MDR CAPER
                                                                                                                         Enhanced specification).




       October 2011 Version                                                          CAPER (Basic&Enhanced)                                                            Page 42 of 1408
                                                                                   CAPER (Basic&Enhanced)

                                                                         SAS Variable B=CAPER Basic
Data Element                     Definition                    Format                                       Values                                     Notes
                                                                            Name      E=CAPER Enh
                                                                                                                     Sum of all the component (VCOTHLBR, VCLAB, VCRAD, VCOTHANC,
                                                                                                                     VCOTHER, and VCRX) pieces derived from Medical APG and most
                                                                                                                     current cost masters for that FY (not discounted).
                                                                                                                     Set to 0 (zero) for non "B" records and for non-DHP sites (IF TXSVC ≠
Variable Cost,
                 Variable cost for the Medical APG.             N(8)       COST2                E                    A, N, F).
Medical APG
                                                                                                                     Does not include clinician salary.

                                                                                                                     If APPTINFR=Y, based on completion table rules (See MDR CAPER
                                                                                                                     Enhanced specification).
                                                                                                                     Sum of all the component (VCOTHLBR, VCLAB, VCRAD, VCOTHANC,
                                                                                                                     VCOTHER, and VCRX) pieces derived from 1st Procedural APG and
                                                                                                                     most current cost masters for that FY (not discounted).
                                                                                                                     Set to 0 (zero) for non "B" records and for non-DHP sites (IF TXSVC ≠
Variable Cost,
                Variable cost for Procedure 1 APG.              N(8)       COST3                E                    A, N, F).
Procedure 1 APG
                                                                                                                     Does not include clinician salary.

                                                                                                                     If APPTINFR=Y, based on completion table rules (See MDR CAPER
                                                                                                                     Enhanced specification).

                                                                                                                     Sum of all the component (VCOTHLBR, VCLAB, VCRAD, VCOTHANC,
                                                                                                                     VCOTHER, and VCRX) pieces derived from 2nd Procedural APG and
                                                                                                                     most current cost masters for that FY (not discounted).
Variable Cost,                                                                                                       Set to 0 (zero) for non "B" records and for non-DHP sites (IF TXSVC ≠
                Variable cost for Procedure 2 APG.              N(8)       COST4                E
Procedure 2 APG                                                                                                      A, N, F).
                                                                                                                     Does not include clinician salary.

                                                                                                                     If APPTINFR=Y, set to 0 (zero).

                                                                                                                     Sum of all the component (VCOTHLBR, VCLAB, VCRAD, VCOTHANC,
                                                                                                                     VCOTHER, and VCRX) pieces derived from 3rd Procedural APG and
                                                                                                                     most current cost masters for that FY (not discounted).
Variable Cost,                                                                                                       Set to 0 (zero) for non "B" records and for non-DHP sites (IF TXSVC ≠
                Variable cost for Procedure 3 APG.              N(8)       COST5                E
Procedure 3 APG                                                                                                      A, N, F).
                                                                                                                     Does not include clinician salary.

                                                                                                                     If APPTINFR=Y, set to 0 (zero).

                                                                                                                     Sum of all the component (VCOTHLBR, VCLAB, VCRAD, VCOTHANC,
                                                                                                                     VCOTHER, and VCRX) pieces derived from 4th Procedural APG and
                                                                                                                     most current cost masters for that FY (not discounted).
Variable Cost,                                                                                                       Set to 0 (zero) for non "B" records and for non-DHP sites (IF TXSVC ≠
                Variable cost for Procedure 4 APG.              N(8)       COST6                E
Procedure 4 APG                                                                                                      A, N, F).
                                                                                                                     Does not include clinician salary.

                                                                                                                     If APPTINFR=Y, set to 0 (zero).
Count Visit      Indicator that identifies the workload type                                                         0 = Non-count
                                                               Char(1)    COUNTVIS             B/E           0, 1
Indicator        for the encounter visit.                                                                            1 = Count




       October 2011 Version                                                     CAPER (Basic&Enhanced)                                                           Page 43 of 1408
                                                                                         CAPER (Basic&Enhanced)

                                                                              SAS Variable B=CAPER Basic
Data Element                        Definition                      Format                                          Values                                      Notes
                                                                                 Name      E=CAPER Enh
               Evaluation & Management (E&M) Code for
E&M Code 1-E&M the encounter, based on order of entry.
                                                                    Char(5)      CPT_J               B/E          99201-99499 J =1 to 3 represents the E&M positions
Code 3         E&M Codes are CPT Codes in the range of
               99201-99499.
CPT/HCPCS
Code 1-        CPT/HCPCS code for the encounter based
                                                                    Char(5)      CPT_J               B/E                        J =4 to 13 represents procedure positions.
CPT/HCPCS      on the order of entry.
Code 10

E&M Code 1-         Associates the E&M Code with at least one
Diagnosis Pointer - diagnosis. Whole number between 1 and
                                                                    Char(4)     CPTDX_J              B/E            1-4321      J =1 to 3 represents the E&M positions
E&M Code 3-         4321 (each position points to the priority of
Diagonsis Pointer a diagnosis).


CPT/HCPCS
                    Associates a procedure with at least one
Code 1-Diagnosis
                    diagnosis. A maximum number of pointers
Pointer -
                    for up to 4 confirmed diagnoses. Whole          Char(4)     CPTDX_J              B/E            1-9876      J =4 to 13 represents procedure positions.
CPT/HCPCS
                    number between 1 and 9876 (each position
Code 10-
                    points to a diagnosis).
Diagnosis Pointer

CPT/HCPCS
Code 1-Min of
Anesthesia -        Minutes of anesthesia applied during the
                                                                     N(8)      CPTMIN_J              B/E                        J =4 to 13 represents procedure positions.
CPT/HCPCS           associated procedure. Placeholder.
Code 10-Min of
Anesthesia
E&M Code 1-
                  E&M Code Modifier associated with the
Modifier 1 - E&M                                                    Char(2)   CPTMOD1_J              B/E                        J =1 to 3 represents the E&M positions
                  specific E&M Code.
Code 3-Modifier 1
CPT/HCPCS
Code 1-Modifier 1
                  First entered Modifier to the associated
- CPT/HCPCS                                                         Char(2)   CPTMOD1_J              B/E                        J =4 to 13 represents procedure positions.
                  CPT/HCPCS code.
Code 10-Modifier
1
E&M Code 1-
                  E&M Code Modifier associated with the
Modifier 2 - E&M                                                    Char(2)   CPTMOD2_J              B/E                        J =1 to 3 represents the E&M positions
                  specific E&M Code.
Code 3-Modifier 2
CPT/HCPCS
Code 1-Modifier 2
                  Second entered Modifier to the associated
- CPT/HCPCS                                                         Char(2)   CPTMOD2_J              B/E                        J =4 to 13 represents procedure positions.
                  CPT/HCPCS code.
Code 10-Modifier
2
E&M Code 1-
                  E&M Code Modifier associated with the
Modifier 3 - E&M                                                    Char(2)   CPTMOD3_J              B/E                        J =1 to 3 represents the E&M positions
                  specific E&M Code.
Code 3-Modifier 3



       October 2011 Version                                                              CAPER (Basic&Enhanced)                                                              Page 44 of 1408
                                                                                      CAPER (Basic&Enhanced)

                                                                             SAS Variable B=CAPER Basic
Data Element                        Definition                     Format                                         Values                                        Notes
                                                                                Name      E=CAPER Enh
CPT/HCPCS
Code 1-Modifier 3
                  Third entered Modifier to the associated
- CPT/HCPCS                                                        Char(2)   CPTMOD3_J            B/E                           J =4 to 13 represents procedure positions.
                  CPT/HCPCS code.
Code 10-Modifier
3
E&M Code 1-         Associates the E&M Code with at least one
Provider Pointers - provider. Whole number between 1 and
                                                                   Char(5)   CPTPROV_J            B/E             1-54321       J =1 to 3 represents the E&M positions
E&M Code 3-         54321 (each position points to one
Provider Pointers provider).

CPT/HCPCS           Correlates to a provider associated with the
Code 1-Provider     specified Procedure. A maximum number
Linkage -           of provider pointers for linkage to a
                                                                   Char(5)   CPTPROV_J            B/E              0-432        J =4 to 13 represents procedure positions.
CPT/HCPCS           procedure is three. Whole number
Code 10-Provider    between 0 and 432 (each position points to
Linkage             a provider).

E&M Code 1-
Units of Service[1] Multiplier used for prolonged services for
(Raw) - E&M         the specific E&M Code. Whole number             N(8)     CPTUNITS_J           B/E             1, 2, 3, 4    J =1 to 3 represents the E&M positions
Code 3-Units of     between 1 and 4.
Service (Raw)
CPT/HCPCS
Code 1-Units of     A multiplier indicating how many of a
Service (Raw) -     particular procedure/service was given
                                                                    N(8)     CPTUNITS_J           B/E              1-999        J =4 to 13 represents procedure positions.
CPT/HCPCS           during the encounter. A whole number
Code 10-Units of    between 1 and 999.
Service (Raw)
Units of Service,
                    A corrected multiplier indicating how many
E&M1-E&M3,                                                                                                                      J =1 to 3 represents the E&M positions and J =4 to 13 represents
                    of a particular procedure/service was given     N(8)      CPTUOS_J             E               1-999
CPT/HCPCS1-                                                                                                                     procedure positions.
                    during the encounter.
CPT/HCPCS10
                                                                                                               2002 + (Basic)
Calendar Year       Calendar Year of Encounter Date                Char(4)       CY               B/E             2003+
                                                                                                                (Enhanced)
                                                                                                                                 01 - 19 = Dependent Child
                                                                                                                                 20 = Sponsor
                                                                                                                                 30 - 39 = Spouse of sponsor
                                                                                                                                 40 - 44 = Mother of sponsor
                 DEERS specific code indicating the                                                              01 - 19, 20,
                                                                                                                                 45 - 49 = Father of sponsor
                 relationship of the beneficiary to the                                                         30 - 39, 40 -
                                                                                                                                 50 - 54 = Mother-In-Law of sponsor
DEERS            sponsor. (Not the same of the family                                                          44, 45 - 49, 50 -
                                                                   Char(2)      DDS                E                             55 - 59 = Father-In-Law of sponsor
Dependent Suffix member prefix in CHCS).                                                                       54, 55 - 59, 60 -
                                                                                                                                 60 - 69 = Other eligible dependents
                                                                                                               69, 70 - 74, 75,
                                                                                                                                 70 - 74 = Unknown by DEERS
                    As found in the merge to the MPI.                                                                 98
                                                                                                                                 75 = Pseudo DDS unknown by contractor
                                                                                                                                 98 = Service secretary designee
                                                                                                                                 Blank if no DDS
                                                                                                                                 Populated through FY08.



       October 2011 Version                                                           CAPER (Basic&Enhanced)                                                                 Page 45 of 1408
                                                                                           CAPER (Basic&Enhanced)

                                                                              SAS Variable B=CAPER Basic
Data Element                        Definition                      Format                                             Values                                         Notes
                                                                                 Name      E=CAPER Enh
Deployment          Identifies the country of deployment.
                                                                    Char(2)   DEPLOYCNTRY              B/E                           No values currently entered.
Country             Placeholder.
Deployment
                    Identifier for deployment related illness and
Related                                                             Char(1)   DEPLOYCOND               B/E                           No values currently entered.
                    condition code. Placeholder.
Illness/Condition
Deployed            Identifies the deployment relationship.
                                                                    Char(1)   DEPLOYRELN               B/E                           No values currently entered.
Relationship        Placeholder.

                                                                                                                                     1 = Released without limitations
                                                                                                                                     2 = Released with work duty limitations
                                                                                                                                     3 = Sick at home/quarters
                                                                                                                                     4 = Immediate referral
                                                                                                                                     5 = Left without being seen
                    The disposition code as marked on the                                                                            6 = Left against medical advice
                    outpatient and rounds encounters.                                                                                7 = Admitted
                                                                                                                                     8 = Expired
                    Note: The numeric codes are only for
                    outpatient and the alpha codes are for                                                                           A = Transferred to another hospital
                                                                                                                    1-8, A, B, C, D,
                    inpatient encounters. Values of A - G only                                                                       B = Transferred to skilled nursing facility (SNF)
Disposition Code                                                    Char(1)     DISPCODE               B/E           E, F, G, H, M,
                    apply to encounters when the Inpatient                                                                           C = Transferred to another clinical service
                                                                                                                      O, R, S, U
                    Indicator = 1. Disposition Code types H, M,                                                                      D = Continued stay
                    O, R, S, and U will only apply to non-                                                                           E = Left against medical advice
                    privileged provider T-Con encounters and                                                                         F = Discharged home
                    are currently used by only a small number                                                                        G = Expired
                    of sites.                                                                                                        H = Advice Assessment
                                                                                                                                     M = Medication Refill Forwarded
                                                                                                                                     O = Other Not Elsewhere Classified
                                                                                                                                     R = Referred for Appointment
                                                                                                                                     S = Released to Self Care
                                                                                                                                     U = Referred to ER

                    The Defense Medical Information System
Treatment DMIS
                    (DMIS) identification number that identifies    Char(4)       DMISID               B/E                           See DMIS Information for list of DMIS ID.
ID
                    the clinic where the patient was treated.
DX (ICD-9-CM)                                                                                                                        Left aligned.
Code #1 - DX    International Classification of Diseases, 9th                      DXJ                                               Decimals are included in the code.
                                                                    Char(7)                            B/E
(ICD-9-CM) Code edition (ICD-9) entered diagnosis code.                       where J =1 to 10                                       Decimals removed from code and DX Extenders added following blank
#10                                                                                                                                  immediately after code. Effective ~Jul/Aug 2011.
DX (ICD-9-CM)
Code #1-DOD
Extender - DX                                                                    DXEXTJ
                ICD-9 extender code.                                Char(1)                            B/E                           Deleted, effective ~Jul/Aug 2011.
(ICD-9-CM) Code                                                               where J =1 to 10
#10-DOD
Extender




       October 2011 Version                                                              CAPER (Basic&Enhanced)                                                                      Page 46 of 1408
                                                                                           CAPER (Basic&Enhanced)

                                                                               SAS Variable B=CAPER Basic
Data Element                        Definition                      Format                                           Values                                           Notes
                                                                                  Name      E=CAPER Enh
                                                                                                                                    1 = Infections & Parasites
                                                                                                                                    2 = Neoplasms
                                                                                                                                    3 = Endocrine & Metabolism
                                                                                                                                    4 = Blood
                                                                                                                                    5 = Mental
                                                                                                                                    6 = Nerves and Senses
                                                                                                                                    7 = Circulatory System
                                                                                                                                    8 = Respiratory System
                                                                                                                                    9 = Digestive System
                    Use first three characters of Diagnosis 1
Diagnosis Group                                                     Char(2)        DXGRP                E               1-19        10 = Genitourinary
                    (DX1).
                                                                                                                                    11 = Pregnancy and Childbirth
                                                                                                                                    12 = Skin
                                                                                                                                    13 = Musculoskeletal
                                                                                                                                    14 = Congenital Anomalies
                                                                                                                                    15 = Perinatal
                                                                                                                                    16 = Ill-Defined
                                                                                                                                    17 = Injury & Poisoning
                                                                                                                                    18 = Supplementary Classifications
                                                                                                                                    19 = Unknown

DX (ICD-9-CM)
Code #1-Priority - The level of priority of the diagnosis for the                 DXPRIJ
                                                                    Char(1)                            B/E          1, 2, 3, 4, U   1, 2, 3, 4, or U (unconfirmed).
DX (ICD-9-CM)      visit.                                                      where J =1 to 10
Code #10-Priority
                   Unique patient identifier supplied by the
Unique Person      Defense Manpower Data Center (DMDC).
                                                                    Char(10)       EDIPN                E
Identifier (EDIPN) The Electronic Data Interchange Person
                   Number (EDI_PN).
                   Unique patient identifier supplied by the
Patient Identifier Defense Manpower Data Center (DMDC).
                                                                    Char(10)      EDIPN_R              B/E
(EDIPN), Raw       The Electronic Data Interchange Person
                   Number (EDI_PN).
Modified
Appointment        Removed slashes from ENCDATE_R                   Char(8)      ENCDATE               B/E          yyyymmdd
(Encounter) Date
Raw Appointment
                 The date of the appointment.                       Char(8)     ENCDATE_R              B/E          yyyymmdd
(Encounter) Date
                FY03 and before: Enrollment DMIS ID as
                appended using the Longitudinal
Enrollment DMIS
                Enrollment File.                                    Char(4)      ENRDMIS                E                           See DMIS Information for list of DMIS ID.
ID
                FY04+: Enrollment DMIS ID as appended
                using the Longitudinal VM4.
Enrollment DMIS Enrollment DMIS ID as received from
                                                                    Char(4)     ENRDMIS_R              B/E                          See DMIS Information for list of DMIS ID.
ID Raw          CHCS.




       October 2011 Version                                                                CAPER (Basic&Enhanced)                                                               Page 47 of 1408
                                                                                    CAPER (Basic&Enhanced)

                                                                           SAS Variable B=CAPER Basic
Data Element                        Definition                   Format                                        Values                                            Notes
                                                                              Name      E=CAPER Enh
                From merge to the DMISID Index based on
Enrollment DMIS ENRDMIS, set to MOD_REG from
                                                                 Char(2)     ENRREG              E                           See DMIS Information for list of DMIS ID.
ID Region       corresponding entry in the DMIS ID index
                table
End of Record   End of record flag.                              Char(5)      EOR               B/E             ZZZZZ
                                                                                                                              1 = Hispanic
                                                                                                                              2 = SE Asian
Ethnic             The language or cultural group that patient                                                                3 = Filipino
                                                                 Char(1)    ETHNICGR            B/E          1, 2, 3, 4, 9, Z
Background         claims.                                                                                                    4 = Other Asian Pacific Islander
                                                                                                                              9 = Other
                                                                                                                              Z = Unknown

                                                                                                                             A = 0-4
                                                                                                                             B = 5-14
                                                                                                                             C = 15-17
                                                                                                                             D = 18-24
                                                                                                                             E = 25-34
                                                                                                                             F = 35-44
Age Group
                   Broadest category of age group.               Char(1)     EXPAGE              E              A - L, X     G = 45-64
Common
                                                                                                                             H = 65-69
                                                                                                                             I = 70-74
                                                                                                                             J = 75-79
                                                                                                                             K = 80-84
                                                                                                                             L = 85+
                                                                                                                             X = All Others

CAPER Extract
                   The date the CAPER was extracted.             Char(8)    EXTRDATE            B/E           yyyymmdd
Date
                                                                                                                             FAC_FLAG='F' for any of the following:
                                                                                                                             - All A MEPRS
                                                                                                                             - B**5, B**7
                                                                                                                             - BIA
                                                                                                                             - 0124 (NMC Portsmouth) and B**6
Facility/Non-      Indicates whether the care was provided in
                                                                 Char(1)    FAC_FLAG             E                F, N       - Resource sharing DMISID (Branch of Service/Authority Code
Facility Flag      a facility or non-facility setting.
                                                                                                                               in ('B' 'G' 'R' 'V' '1' '2' '3'))
                                                                                                                             - Selected CPT codes (See CPT Codes Designated Facility .)
                                                                                                                             Else FAC_FLAG='N'

                                                                                                                             Effective ~Jul/Aug 2011, ='R' for Resource sharing DMISID
                                                                                                                             Based $/Organizational Work RVU, per SADR (OWRVU_S) by Cost
                                                                                                                             Parent DMISID.
                                                                                                                             Set to 0 (zero) for non "B" records and for non-DHP sites (IF TXSVC ≠
Full Cost,
                   Clinician Salary portion of full cost.         N(8)      FCCLNSAL             E                           A, N, F).
Clinician Salary
                                                                                                                             If APPTINFR=Y, based on completion table rules (See MDR CAPER
                                                                                                                             Enhanced specification).




       October 2011 Version                                                         CAPER (Basic&Enhanced)                                                                Page 48 of 1408
                                                                                  CAPER (Basic&Enhanced)

                                                                       SAS Variable B=CAPER Basic
Data Element                       Definition                 Format                                       Values                                     Notes
                                                                          Name      E=CAPER Enh
                                                                                                                    Based on $ by Cost Parent DMISID and APG; it is the sum of the cost
                                                                                                                    for the highest weight APG, and half of the cost of all other APGs after
                                                                                                                    the lower weighted of E&M or Medical APG is dropped.
Full Cost,
                   Laboratory portion of full cost.            N(8)       FCLAB                E                    Set to 0 (zero) for non "B" records and for non-DHP sites (IF TXSVC≠
Laboratory
                                                                                                                    A, N, F).

                                                                                                                    If APPTINFR=Y, based on completion table rules (See MDR CAPER
                                                                                                                    Enhanced specification).
                                                                                                                     Sum of FCCLNSAL, FCOTHLBR, FCLAB, FCRAD, FCOTHANC,
                   APG-based full cost, based on the MTF-
                                                                                                                    FCOTHER, and FCRX. Note: the individual components are already
                   wide average (across all work centers in
Full Cost                                                      N(8)      FCOST                 E                    discounted prior to summing.
                   that MTF) for APG full costs.
                                                                                                                    If APPTINFR=Y, based on completion table rules (See MDR CAPER
                                                                                                                    Enhanced specification).
                                                                                                                    Sum of the component (FCOTHLBR, FCLAB, FCRAD, FCOTHANC,
                                                                                                                    FCOTHER, and FCRX) pieces derived from E&M1 APG and most
                                                                                                                    current cost masters for that FY (not discounted).
                                                                                                                    Set to 0 (zero) for non "B" records and for non-DHP sites (IF TXSVC ≠
Full Cost, E&M
                   Full cost for the E&M APG.                  N(8)      FCOST1                E                    A, N, F).
APG
                                                                                                                    Does not include clinician salary.

                                                                                                                    If APPTINFR=Y, based on completion table rules (See MDR CAPER
                                                                                                                    Enhanced specification).
                                                                                                                    Sum of the component (FCOTHLBR, FCLAB, FCRAD, FCOTHANC,
                                                                                                                    FCOTHER, and FCRX) pieces derived from E&M1 APG and most
                                                                                                                    current cost masters for that FY (not discounted).
                                                                                                                    Set to 0 (zero) for non "B" records and for non-DHP sites (IF TXSVC ≠
Full Cost, Medical
                   Full cost for the Medical APG.              N(8)      FCOST2                E                    A, N, F).
APG
                                                                                                                    Does not include clinician salary.

                                                                                                                    If APPTINFR=Y, based on completion table rules (See MDR CAPER
                                                                                                                    Enhanced specification).
                                                                                                                    Sum of the component (FCOTHLBR, FCLAB, FCRAD, FCOTHANC,
                                                                                                                    FCOTHER, and FCRX) pieces derived from E&M1 APG and most
                                                                                                                    current cost masters for that FY (not discounted).
                                                                                                                    Set to 0 (zero) for non "B" records and for non-DHP sites (IF TXSVC ≠
Full Cost,
                Full cost for Procedure 1 APG.                 N(8)      FCOST3                E                    A, N, F).
Procedure 1 APG
                                                                                                                    Does not include clinician salary.

                                                                                                                    If APPTINFR=Y, based on completion table rules (See MDR CAPER
                                                                                                                    Enhanced specification).
                                                                                                                    Sum of the component (FCOTHLBR, FCLAB, FCRAD, FCOTHANC,
                                                                                                                    FCOTHER, and FCRX) pieces derived from E&M1 APG and most
                                                                                                                    current cost masters for that FY (not discounted).
Full Cost,                                                                                                          Set to 0 (zero) for non "B" records and for non-DHP sites (IF TXSVC ≠
                Full cost for Procedure 2 APG.                 N(8)      FCOST4                E
Procedure 2 APG                                                                                                     A, N, F).
                                                                                                                    Does not include clinician salary.

                                                                                                                    If APPTINFR=Y, set to 0 (zero).



       October 2011 Version                                                       CAPER (Basic&Enhanced)                                                           Page 49 of 1408
                                                                            CAPER (Basic&Enhanced)

                                                                    SAS Variable B=CAPER Basic
Data Element                        Definition             Format                                    Values                                     Notes
                                                                       Name      E=CAPER Enh
                                                                                                              Sum of the component (FCOTHLBR, FCLAB, FCRAD, FCOTHANC,
                                                                                                              FCOTHER, and FCRX) pieces derived from E&M1 APG and most
                                                                                                              current cost masters for that FY (not discounted).
Full Cost,                                                                                                    Set to 0 (zero) for non "B" records and for non-DHP sites (IF TXSVC ≠
                Full cost for Procedure 3 APG.              N(8)      FCOST5             E
Procedure 3 APG                                                                                               A, N, F).
                                                                                                              Does not include clinician salary.

                                                                                                              If APPTINFR=Y, set to 0 (zero).
                                                                                                              Sum of the component (FCOTHLBR, FCLAB, FCRAD, FCOTHANC,
                                                                                                              FCOTHER, and FCRX) pieces derived from E&M1 APG and most
                                                                                                              current cost masters for that FY (not discounted).
Full Cost,                                                                                                    Set to 0 (zero) for non "B" records and for non-DHP sites (IF TXSVC ≠
                Full cost for Procedure 4 APG.              N(8)      FCOST6             E
Procedure 4 APG                                                                                               A, N, F).
                                                                                                              Does not include clinician salary.

                                                                                                              If APPTINFR=Y, set to 0 (zero).
                                                                                                               Based on $ by Cost Parent DMISID and APG; it is the sum of the cost
                                                                                                              for the highest weight APG, and half of the cost of all other APGs after
                                                                                                              the lower weighted of E&M or Medical APG is dropped.
Full Cost, Other
                   Other ancillary portion of full cost.    N(8)     FCOTHANC            E                    Set to 0 (zero) for non "B" records and for non-DHP sites (IF TXSVC ≠
Ancillary
                                                                                                              A, N, F).

                                                                                                              If APPTINFR=Y, based on completion table rules (See MDR CAPER
                                                                                                              Enhanced specification).
                                                                                                               Based on $ by Cost Parent DMISID and APG; it is the sum of the cost
                                                                                                              for the highest weight APG, and half of the cost of all other APGs after
                                                                                                              the lower weighted of E&M or Medical APG is dropped.

Full Cost, Other   Other portion of full cost.              N(8)     FCOTHER             E                    Set to 0 (zero) for non "B" records and for non-DHP sites (IF TXSVC ≠
                                                                                                              A, N, F).

                                                                                                              If APPTINFR=Y, based on completion table rules (See MDR CAPER
                                                                                                              Enhanced specification).
                                                                                                               Based on $ by Cost Parent DMISID and APG; it is the sum of the cost
                                                                                                              for the highest weight APG, and half of the cost of all other APGs after
                                                                                                              the lower weighted of E&M or Medical APG is dropped.
Full Cost, Other
                   Other Labor portion of full cost.        N(8)     FCOTHLBR            E                    Set to 0 (zero) for non "B" records and for non-DHP sites (IF TXSVC ≠
Labor
                                                                                                              A, N, F).

                                                                                                              If APPTINFR=Y, based on completion table rules (See MDR CAPER
                                                                                                              Enhanced specification).




       October 2011 Version                                                CAPER (Basic&Enhanced)                                                           Page 50 of 1408
                                                                                        CAPER (Basic&Enhanced)

                                                                             SAS Variable B=CAPER Basic
Data Element                        Definition                    Format                                            Values                                         Notes
                                                                                Name      E=CAPER Enh
                                                                                                                                   Based on $ by Cost Parent DMISID and APG; it is the sum of the cost
                                                                                                                                  for the highest weight APG, and half of the cost of all other APGs after
                                                                                                                                  the lower weighted of E&M or Medical APG is dropped.
Full Cost,
                    Radiology portion of full cost.                 N(8)       FCRAD                 E                            Set to 0 (zero) for non "B" records and for non-DHP sites (IF TXSVC ≠
Radiology
                                                                                                                                  A, N, F).

                                                                                                                                  If APPTINFR=Y, based on completion table rules (See MDR CAPER
                                                                                                                                  Enhanced specification).
                                                                                                                                   Based on $ by Cost Parent DMISID and APG; it is the sum of the cost
                                                                                                                                  for the highest weight APG, and half of the cost of all other APGs after
                                                                                                                                  the lower weighted of E&M or Medical APG is dropped.
Full Cost,
                    Pharmacy portion of full cost.                  N(8)        FCRX                 E                            Set to 0 (zero) for non "B" records and for non-DHP sites (IF TXSVC ≠
Pharmacy
                                                                                                                                  A, N, F).

                                                                                                                                  If APPTINFR=Y, based on completion table rules (See MDR CAPER
                                                                                                                                  Enhanced specification).
Beneficiary First
                                                                  Char(20)    FIRSTNAME              E
Name
Fiscal Month        Fiscal month of encounter date.               Char(2)        FM                 B/E              01-12

                                                                                                                                 01-19 = Dependent children of sponsor
                                                                                                                                 20 = Sponsor
                                                                                                                                 30-39 = Spouse of sponsor
                                                                                                                  01-19,20,30- 40-44 = Mother of sponsor
                                                                                                                    39,40,45,    45-49 = Father of sponsor
Family Member       A DoD - define code which defines the
                                                                  Char(2)       FMP                 B/E          50,55,60-69,90- 50-54 = Mother-in-law of sponsor
Prefix              relationship of the patient to the sponsor.
                                                                                                                  95,97,98, or 55-59 = Father-in-law of sponsor
                                                                                                                       99.       60-69 = Other dependents
                                                                                                                                 90-95 = Beneficiary authorized by statute
                                                                                                                                 98 = Civilian Humanitarian
                                                                                                                                 99 = All others not elsewhere classified


RVU, Raw Facility                                                                                                                 J =1 to 13, where J =1 to 3 represents the E&M positions and J =4 to 13
Practice Expense, Raw MHS updated Facilty Practice                                                                                represents procedure positions.
E&M1-E&M3 and Expense RVU of CPT J , derived from                   N(8)       FPRVUJ                E
Procedure 1-      merge with CPT Weight Table.                                                                                    If APPTINFR=Y, based on completion table rules (See MDR CAPER
Procedure 10                                                                                                                      Enhanced specification).
                                                                                                                 2003 + (Basic)
Fiscal Year         Fiscal Year of Encounter Date                 Char(4)        FY                 B/E             2004+
                                                                                                                  (Enhanced)
Health Care
                 A 3-digit HCDP code followed by a space
Delivery Program                                                  Char(3)    HCDPCODE_R             B/E                           See HCDP Codes worksheet.
                 or four spaces if not applicable or unknown.
Code
HCDP Code from
                                                                  Char(3)     HCDPLVM                E                            From merge to LVM.
LVM4




       October 2011 Version                                                            CAPER (Basic&Enhanced)                                                                   Page 51 of 1408
                                                                                           CAPER (Basic&Enhanced)

                                                                               SAS Variable B=CAPER Basic
Data Element                        Definition                    Format                                             Values                                        Notes
                                                                                  Name      E=CAPER Enh
                                                                                                                                  1 = Inpatient
Patient Hospital    An indicator of that the patient had at the
                                                                   Char(1)      HOSPSTAT               B/E             0, 1       0 = Outpatient
Status              time of the encounter. Codes as follows:
                                                                                                                                  Blank = Outpatient
                    Apply the CHCS host reference format,
CHCS Host                                                          Char(4)      HOSTDMIS               B/E                        Apply the CHCS host reference format, using SITEID as the lookup key.
                    using SITEID as the lookup key.
                                                                                                                                  AA = Auto accident
Injury
                    The first injury cause code entered by the                                                      AA, AP, EM,   AP = Another party responsible
Related/Cause                                                      Char(2)      INJCODE1               B/E
                    user during encounter completion.                                                                   OA        EM = Employment
Code 1
                                                                                                                                  OA = Other accident
                                                                                                                                  AA = Auto accident
Injury
                    The second injury cause code entered by                                                         AA, AP, EM,   AP = Another party responsible
Related/Cause                                                      Char(2)      INJCODE2               B/E
                    the user during encounter completion.                                                               OA        EM = Employment
Code 2
                                                                                                                                  OA = Other accident
                                                                                                                                  AA = Auto accident
Injury
                    The third injury cause code entered by the                                                      AA, AP, EM,   AP = Another party responsible
Related/Cause                                                      Char(2)      INJCODE3               B/E
                    user during encounter completion.                                                                   OA        EM = Employment
Code 3
                                                                                                                                  OA = Other accident
Date of Injury,
                    The approximate date the injury occurred.      Char(8)       INJDATE               B/E          yyyymmdd
CCYYMMDD
Injury Geographic Geographic location of accident available
                                                                   Char(5)     INJGEOGLOC              B/E
Location          when Injury Cause Code is “AA”.
Injury Place of     The location/place description of where the
                                                                    Char(54)     INJPOA                B/E                        This is a free text field.
Accident            injury occurred.
                    Place of employment at the time of the
Injury Place of
                    injury if the injury occurred due to a function Char(54)     INJPOE                B/E                        This is a free text field.
Employment
                    or action of the employment.
                                                                                                                                  0 = No injury
Injury Related      Injury related indicator for the encounter.    Char(1)       INJREL                B/E             0, 1
                                                                                                                                  1 = Yes - injury
                    An indicator based upon the identification
Inpatient                                                                                                                         0 = Outpatient
                    of the appointment as being related to the     Char(1)       INPAPPT               B/E             0, 1
Appointment                                                                                                                       1 = Inpatient related
                    inpatient episode of acre.
                                                                                                                                  0 = Not billable
Medical Insurance An indicator that identifies the billable
                                                                   Char(1)       INSBILL               B/E            0, 1, 2     1 = Insurance billable
Billable          insurance type.
                                                                                                                                  2 = Medical Services Account (MSA) billable
                                                                                                                                  Total Raw Work RVU, without modifiers, with discounting (100% for
                    Total MHS updated Work CPT RVUs, with                                                                         highest of RRVUB1-RRVUB13, 50% for remaining).
RVU, Individual
                    discounting (100% for highest, 50% for           N(8)        IWRVU                  E                         If APPTINFR=Y, based on completion table rules (See MDR CAPER
Work
                    remaining) based on all 13 CPT codes.                                                                         Enhanced specification).
                                                                                                                                  Deleted ~~Jul/Aug 2011.
                                                                                                                                  Total Raw Work RVU, without modifiers, with discounting (100% for
                    Total MHS updated Work CPT RVUs, with
                                                                                                                                  highest of RRVUB1 and RRVUB4-RRVUB7, 50% for remaining).
RVU, Individual     discounting (100% for highest, 50% for
                                                                     N(8)        IWRVU_S                E                         If APPTINFR=Y, based on completion table rules (See MDR CAPER
Work per SADR       remaining) based on E&M1 and
                                                                                                                                  Enhanced specification).
                    Procedures 1-4 only.
                                                                                                                                  Deleted ~~Jul/Aug 2011
Beneficiary Last
                                                                  Char(26)      LASTNAME                E
Name




       October 2011 Version                                                            CAPER (Basic&Enhanced)                                                                Page 52 of 1408
                                                                                          CAPER (Basic&Enhanced)

                                                                               SAS Variable B=CAPER Basic
Data Element                        Definition                      Format                                            Values                                         Notes
                                                                                  Name      E=CAPER Enh
                    Tracks record status through process and
                                                                                                                                    Blank = Records exist in Master
                    relative to the last record of the particular
M2 Code                                                             Char(1)      M2CODE               B/E                           U = Record changed and represents update to Master
                    key saved in the CAPER-Enhanced,
                                                                                                                                    N = Record is new, not before seen in Master.
                    Master, MDR.
                                                                                                                                     A = Annulled
                                                                                                                                     D = Divorced
                                                                                                                                     I = Interlocutory
                    Indicates the legal status of a person as it                                                   A, D, I, L, M, S, L = Legally separated
Marital Status                                                      Char(1)      MARITAL              B/E
                    relates to marriage.                                                                                W, Z         M = Married
                                                                                                                                     S = Single, never married
                                                                                                                                     W = Widowed
                                                                                                                                     Z = Unknown
                                                                                                                                     At this time, only populated when a patients receives care at their
                    The Group Identifier to which the patient is
MCP Group ID                                                        Char(19)      MCPID               B/E                            enrollment MTF or an MTF that shares a CHCS box with their
                    enrolled.
                                                                                                                                     enrollment site.
                                                                                                                                    For FY05+ only:
Major Diagnostic
                    Derived based on Diagnosis 1.                   Char(2)       MDC                  E                            See Major Diagnostic Category worksheet for codes and descriptions.
Category
                                                                                                                                    This field is left blank if APPTINFR=‟Y‟.

                                                                                                                                    A = A from MEDELIG
                                                                                                                                    B = B, B1, B2, B3 from MEDELIG
                                                                                                                                    C = AB, D, L, Q, R, E, O, P, blank and RECAGE >= 65 from MEDELIG
Medicare                                                                                                              A, B, AB,
                    The beneficiary‟s Medicare coverage.            Char(2)      MEDELIG              B/E                           N = all others
Eligibility Field                                                                                                      spaces
                                                                                                                                    Populated for FY03+ only.

                                                                                                                                    This field is fed to the M2.

                                                                                                                                    A = A from MEDELIG
Medicare                                                                                                                            B = B, B1, B2, B3 from MEDELIG
Eligibility         Medicare Eligibility Derived from MEDELIG       Char(1)     MEDELIG2               E             A, B, C, N     C = AB, D, L, Q, R, E, O, P, blank and RECAGE >= 65 from MEDELIG
Aggregate                                                                                                                           N = all others
                                                                                                                                    Populated for FY03+ only.
                                                                                                                                    For FY04:
                                                                                                                                    For APPTINFR=Y or N:

                                                                                                                                    N if MELIGAPT field is N or S.
                                                                                                                                    If MELIGAPT is blank then assign
                                                                                                                                    N if patient age is < 65
                                                                                                                                    Y if patient age is >= 65
Medicare            Indicates whether or not the patient is                                                                         Otherwise, assign value Y
                                                                    Char(1)     MEDFLAG                E                Y, N
Eligibility Flag    eligible for Medicare.
                                                                                                                                    For FY05+:
                                                                                                                                    For APPTINFR=Y or N:
                                                                                                                                    Y if MELIGAPT is A, AB, or B.
                                                                                                                                    If MELIGAPT is blank then assign
                                                                                                                                    N if patient age is < 65
                                                                                                                                    Y if patient age is >= 65
                                                                                                                                    Otherwise, assign value N




        October 2011 Version                                                              CAPER (Basic&Enhanced)                                                                   Page 53 of 1408
                                                                                        CAPER (Basic&Enhanced)

                                                                              SAS Variable B=CAPER Basic
Data Element                        Definition                     Format                                          Values                                       Notes
                                                                                 Name      E=CAPER Enh

                                                                                                                                A = Medicare Part A only
                                                                                                                                N = Not eligible
                                                                                                                                AB = Medicare Part A and B
                                                                                                                                O = Became eligible after 65
Medicare                                                                                                           A, AB, B,
                                                                                                                                B = Medicare Part B only
Eligibility as                                                                                                   D, E, L, N, O,
                 From the appointment data merge.                  Char(2)     MELIGAPT              E                          P = Purchased
Reported in the                                                                                                        P,
                                                                                                                                D = Dual entitlement < 65
Appointment Data                                                                                                     Q, S
                                                                                                                                Q = General eligible < 65
                                                                                                                                E = Eligible at age 65
                                                                                                                                S = Over 65 but not eligible
                                                                                                                                L = Renal Disease, dual entitlement

                                                                                                                                A = Inpatient Care
                                                                                                                                B = Outpatient Care
                                                                                                                                C = Dental Care
                   First character of the MEPRS code for the
MEPRS1 Code                                                        Char(1)      MEPR1                E                          D = Ancillary Services
                   clinic performing the patient care.
                                                                                                                                E = Support Services
                                                                                                                                F = Special Programs
                                                                                                                                G = Medical Readiness
                   First two characters of the MEPRS code for
MEPRS2 Code                                                        Char(2)      MEPR2                E                          See MEPRS Codes 2 for information .
                   the clinic performing the patient care.
                   First three characters of the MEPRS code
MEPRS3 Code                                                        Char(3)      MEPR3                E                          See MEPRS Codes 3 for information
                   for the clinic performing the patient care.
Treatment          MEPRS code for the clinic performing the
                                                                   Char(4)     MEPRSCD              B/E                         MEPRS4 Codes and definitions are unique to each MTF
MEPRS Code         patient care.
Multi-Service
                                                                   Char(3)       MSMA                E                          MSMA of Treatment DMIS ID (from DMISID Index) matching FY.
Market Area
Treatment Parent   DMIS ID for the parent facility of the clinic
                                                                   Char(4)     MTF_PAR              B/E                         See DMIS Information for list of DMIS ID.
DMIS ID            where the patient received treatment.


Treatment Parent Raw DMIS ID for the parent facility of the                                                                     See DMIS Information for list of DMIS ID.
                                                                   Char(4)     MTF_PAR_R             E
DMIS ID, Raw     clinic where the patient received treatment.                                                                   Effective ~~Jul/Aug 2011.


                   DMIS ID of the inpatient treatment MTF
Inpatient DMISID
                   and Register Number associated with a
& Patient Register                                                 Char(11)    MTF_PRN              B/E
                   RNDS appointment (i.e., inpatient ward
Number
                   appointment).
Interim Plus       Sum of non-provider affected Practice                                                                        FY07+: Effective ~~Jul/Aug 2011.
Enhanced           Expense RVUs for all CPT after multiple
Practice Expense procedure discounting, UOS and modifier             N(8)       NPERVU               E
                                                                                                                                If APPTINFR=Y, based on completion table rules (See MDR CAPER
RVU (Non-          impacts applied.                                                                                             Enhanced specification).
Provider Affected




       October 2011 Version                                                             CAPER (Basic&Enhanced)                                                              Page 54 of 1408
                                                                                           CAPER (Basic&Enhanced)

                                                                                SAS Variable B=CAPER Basic
Data Element                         Definition                       Format                                        Values                                   Notes
                                                                                   Name      E=CAPER Enh
Non-Provider
Affected Practice   Based on Facility Flag, non-provider
                                                                                                                             J=1 to 13, where J=1 to 3 represents the E&M positions and J=4 to 13
Expense RVU;        affected Practice Expense RVUs for each
                                                                       N(8)      NPERVUJ                E                    represents procedure positions.
E&M Code 1-3,       CPT after multiple procedure discounting,
                                                                                                                             FY07+: Effective ~~Jul/Aug 2011.
CPT/HCPCS           UOS and modifier impacts applied.
Code 1-10
RVU, Raw Non-
                                                                                                                             J =1 to 13, where J =1 to 3 represents the E&M positions and J=4 to 13
Facility Practice
                    Raw MHS updated Non-Facilty Practice                                                                     represents procedure positions.
Expense, E&M1-
                    Expense RVU of CPT J , derived from                N(8)       NPRVUJ                E
E&M3 and
                    merge with CPT Weight Table.                                                                             If APPTINFR=Y, based on completion table rules (See MDR CAPER
Procedure 1-
                                                                                                                             Enhanced specification).
Procedure 10
Interim Plus
Enhanced Total
RVU (Non-           Sum of non-provider affected Work and
                                                                       N(8)       NTRVU                 E                    FY07+: Effective ~~Jul/Aug 2011.
Provider Affected   Practice Expense RVUs
Total RVU
Aggregate)
Non-Provider
                                                                                                                             J =1 to 13, where J =1 to 3 represents the E&M positions and J =4 to 13
Affected Total
                    Sum of non-provider affected Work and                                                                    represents procedure positions.
RVU; E&M Code                                                          N(8)       NTRVUJ                E
                    Practice Expense RVUs for each CPT
1-3, CPT/HCPCS
                                                                                                                             FY07+: Effective ~June 2011.
Code 1-10
Interim Plus
Enhanced Work       Sum of non-provider affected Work RVUs                                                                   FY07+: Effective ~June 2011.
RVU (Non-           for all CPT after multiple procedure
                                                                       N(8)       NWRVU                 E
Provider Affected   discounting, UOS and modifier impacts                                                                    If APPTINFR=Y, based on completion table rules (See MDR CAPER
Work RVU            applied.                                                                                                 Enhanced specification).
Aggregate)
Non-Provider
                                                                                                                             J =1 to 13, where J =1 to 3 represents the E&M positions and J =4 to 13
Affected Work  Non-provider affected Work RVUs for each
                                                                                                                             represents procedure positions.
RVU; E&M Code CPT after multiple procedure discounting,                N(8)       NWRVUJ                E
1-3, CPT/HCPCS UOS and modifier impacts applied.
                                                                                                                             FY07+: Effective ~June 2011.
Code 1-10

Patient OHI         An indicator that identifies if the patient has                                                          0 = No OHI
                                                                      Char(1)       OHI                B/E           0, 1
Indicator           Other Health Insurance (OHI) identified.                                                                 1 = Yes has OHI
                                                                                                                             Derived by multiplying discounted Individual Work RVUs by the number
                    Individual Work RVUs multiplied by the
RVU,                                                                                                                         of non-generic providers.
                    number of non-generic providers, based on
Organizational                                                         N(8)       OWRVU                 E                    If APPTINFR=Y, based on completion table rules (See MDR CAPER
                    all 13 procedures.
Work                                                                                                                         Enhanced specification).
                                                                                                                             Deleted effective ~June 2011.
                    Individual Work RVUs multiplied by the                                                                   Total Raw Work RVU, without modifiers, with discounting (100% for
RVU,
                    number of non-generic providers, based on                                                                highest of RRVUB1 and RRVUB4-RRVUB7, 50% for remaining).
Organizational                                                         N(8)      OWRVU_S                E
                    only E&M1 and Procedures 1-4.                                                                            If APPTINFR=Y, based on completion table rules (See MDR CAPER
Work Per SADR
                                                                                                                             Enhanced specification).




       October 2011 Version                                                               CAPER (Basic&Enhanced)                                                          Page 55 of 1408
                                                                                   CAPER (Basic&Enhanced)

                                                                         SAS Variable B=CAPER Basic
Data Element                     Definition                    Format                                       Values                                   Notes
                                                                            Name      E=CAPER Enh
Provider PE RVU
Aggregate;
                                                                                                                     FY07+: Effective ~June 2011.
Appointment     Sum of Provider-affected Practice Expense
                                                                N(8)      PK PERVU              E                    K =1 to 5, where K represents Appointment Provider and Additional
Provider,       RVUs associated with each Provider.
                                                                                                                     Providers 1-4.
Additional
Providers 1-4
Provider PE RVU;                                                                                                     J =1 to 13, where J =1 to 3 represents the E&M positions and J =4 to 13
Appt Provider,                                                                                                       represents procedure positions.
Additional
                 Provider-affected Practice Expense RVUs
Providers1-4 and                                                N(8)      PK PERVUJ             E                    K=1 to 5, where K represents Appointment Provider and Additional
                 associated with Provider K for each CPT.
E&M Code 1-3,                                                                                                        Providers 1-4.
CPT/HCPCS
Code 1-10                                                                                                            FY07+: Effective ~Jul/Aug 2011.
Provider Total
RVU Aggregate;                                                                                                       FY07+: Effective ~Jul/Aug 2011.
Appointment        Sum of Provider-affected Total RVUs
                                                                N(8)       PK TRVU              E
Provider,          associated with each Provider.                                                                    K =1 to 5, where K represents Appointment Provider and Additional
Additional                                                                                                           Providers 1-4.
Providers 1-4
Provider Total
                                                                                                                     J =1 to 13, where J =1 to 3 represents the E&M positions and J =4 to 13
RVU; Appt
                                                                                                                     represents procedure positions.
Provider,
Additional         Provider-affected Total RVUs associated
                                                                N(8)      PK TRVUJ              E                    K=1 to 5, where K represents Appointment Provider and Additional
Providers1-4 and   with Provider K for each CPT.
                                                                                                                     Providers 1-4.
E&M Code 1-3,
CPT/HCPCS
                                                                                                                     FY07+: Effective ~Jul/Aug 2011.
Code 1-10
Provider Work
RVU Aggregate;                                                                                                       FY07+: Effective ~Jul/Aug 2011.
Appointment        Sum of Provider-affected Work RVUs
                                                                N(8)       PK WRVU              E
Provider,          associated with each Provider.                                                                    K =1 to 5, where K represents Appointment Provider and Additional
Additional                                                                                                           Providers 1-4.
Providers 1-4
Provider Work
                                                                                                                     J =1 to 13, where J =1 to 3 represents the E&M positions and J =4 to 13
RVU; Appt
                                                                                                                     represents procedure positions.
Provider,
Additional         Provider-affected Work RVUs associated
                                                                N(8)      PK WRVUJ              E                    K=1 to 5, where K represents Appointment Provider and Additional
Providers1-4 and   with Provider K for each CPT.
                                                                                                                     Providers 1-4.
E&M Code 1-3,
CPT/HCPCS
                                                                                                                     FY07+: Effective ~Jul/Aug 2011.
Code 1-10
Person
Association                                                    Char(2)      PARC                E
Reason Code
                   Parent DMIS ID of treatment DMIS ID (from
Parent DMIS ID
                   Master Hierarchical Table) matching FY;     Char(4)    PARCOST               E                    See DMIS Information for list of DMIS ID.
(Cost)
                   used in costing.




      October 2011 Version                                                         CAPER (Basic&Enhanced)                                                         Page 56 of 1408
                                                                                   CAPER (Basic&Enhanced)

                                                                           SAS Variable B=CAPER Basic
Data Element                       Definition                   Format                                        Values                                           Notes
                                                                              Name      E=CAPER Enh
                   Service-designated parent of Enrollment
Parent DMIS ID
                   DMIS ID (from Master Hierarchical Table)     Char(4)      PARENR             E                           See DMIS Information for list of DMIS ID.
(Enrollment)
                   matching fiscal year.
Parent DMIS ID     MEPRS Parent of Treatment DMIS ID
                                                                Char(4)     PARMEPRS            E                           See DMIS Information for list of DMIS ID.
(MEPRS)            (from Master Hierarchical Table) matching.

Patient Age        Computed using ENCDATE and PATDOB.             N(8)       PATAGE             E
                   Identifies the beneficiary status of the
Patient Category                                                Char(3)      PATCAT             E                           See Patient Categories for codes and descriptions.
                   person being treated.
Patient Category   Identifies the beneficiary status of the
                                                                Char(5)     PATCAT_R           B/E                          See Patient Categories for codes and descriptions.
Raw                person being treated.
Patient Date of    Date when the person was born
                                                                Char(8)      PATDOB            B/E           yyyymmdd
Birth              (YYYYMMDD).
                                                                                                                           N = North
                 HSSC Region, based on Patient Zip and                                                                     S = South
Beneficiary HSSC “World” Region in the Omni-CAD File. (If                                                   N, S, W, O, A, W = West
                                                                Char(1)     PATHSSC             E
Region           patient Zip is not usable, the treatment MTF                                                   Blank      O = OCONUS
                 Zip code is used in its place.)                                                                           A = Alaska
                                                                                                                           Blank = All other, or not defined
                   Concatenate:
                   LAST, FIRST MIDDLE, CADENCY (e.g.,
Beneficiary Name                                                Char(74)    PATNAME             E
                   SMITH, WILLIAM ROBERT, JR).

                                                                                                                           C = Caucasoid (White)
                                                                                                                           M = Mongoloid (Yellow)
Patient Race       Attribute describing a person's racial                                                   C, M, N, R, X, N = Negroid (Black)
                                                                Char(1)     PATRACE            B/E
Code               category.                                                                                      Z        R = Western Hemisphere Indians (Red)
                                                                                                                           X = Other
                                                                                                                           Z = Unknown
                                                                                                                          01 = Northeast
                                                                                                                          02 = Mid-Atlantic
                                                                                                                          03 = Southeast
                                                                                                                          04 = Gulf South
                                                                                                                          05 = Heartland
                                                                                                                          06 = Southwest
                                                                                                                          07, 08 = TRICARE Central
                   Health Service Region, based on Patient
                                                                                                                          09 = Southern California
                   Zip and “World” Region in the Omni-CAD
Patient Health                                                                                                01 - 16,    10 = Golden Gate
                   File (If patient Zip is not usable, the      Char(2)     PATREGN             E
Service Region                                                                                              AK, XX, Blank 11 = Northwest
                   treatment MTF Zip code is used in its
                                                                                                                          12 = TRICARE Pacific
                   place.)
                                                                                                                          13 = Europe
                                                                                                                          14 = Western Pacific/Asia
                                                                                                                          15 = Central/South America & Other
                                                                                                                              OCONUS
                                                                                                                          16 = Unknown
                                                                                                                          AK = Alaska
                                                                                                                          XX or Blank = Unknown




      October 2011 Version                                                        CAPER (Basic&Enhanced)                                                                Page 57 of 1408
                                                                                     CAPER (Basic&Enhanced)

                                                                          SAS Variable B=CAPER Basic
Data Element                      Definition                   Format                                           Values                                     Notes
                                                                             Name      E=CAPER Enh
                                                                                                                           F = female
Patient Gender     A code used to denote a patient's gender.   Char(1)      PATSEX               B/E             F, M
                                                                                                                           M = male
Patient Social
                   SSN for the patient.                        Char(9)      PATSSN               B/E
Security Number
                   Patient Status as Reported in the
Patient Status                                                 Char(1)      PATSTAT               E
                   Appointment Data
Modified Patient
                   Removed hyphens from PATZIP_R               Char(9)      PATZIP               B/E
Zip Code
                   The postal zip code for the city where a
Patient Zip Code   person is located. For OCONUS locations,                                                                This field may contain hyphens. See PATZIP for the field with no
                                                             Char(10)      PATZIP_R              B/E
(Raw)              the value could be an APO, FPO or country                                                               hyphens.
                   zip code.
Payment Flag                                                 Char(1)       PAYMENT                E                        Placeholder
PCM EDIPN          PCM‟s EDI_PN value assigned by DEERS.       Char(10)    PCMEDIPN              B/E
PCM Group Tax      The Tax Identifier of the PCM Group to
                                                               Char(10)     PCMGRP               B/E
ID                 which the patient is enrolled.
Primary Care
                   Unique Identifier for the PCM provider
Manager Provider                                               Char(10)      PCMID               B/E
                   assigned to the patient.
ID
NED Primary     The National Enrollment Database (NED)
                                                               Char(18)    PCMID_NED             B/E
Care Manager ID PCM Identifier for the patient‟s PCM.
PCM ID           PCM ID from the LVM merge                     Char(18)    PCMIDLVM               E
Primary Care
                                                                                                                           00 = Direct Care PCM
Manager Location CHAMPUS location code of PCM.                 Char(2)      PCMLOC               B/E             00, 01
                                                                                                                           01 = Contractor PCM
CD
Primary Care
                 NPI for the PCM assigned to the patient.      Char(10)     PCMNPI               B/E
Manager NPI
                                                                                                                           1 = Individual providers
PCM NPI Type       The NPI entity type.                        Char(1)    PCMNPITYPE             B/E              1, 2
                                                                                                                           2 = Organizational providers
                                                                                                                             C = MCSC Internal Provider Identifier
                                                                                                                             D = Drug Enforcement Agency (DEA) Number
                                                                                                                             E = DEERS EDI_PN
                   Type code to identify what type of NED
NED PCM Type                                                                                                  C, D, E, H, L, H = HIPAA Provider Identifier
                   Primary Care Manager ID is contained in     Char(1)    PCMTYPE_NED            B/E
Code                                                                                                             P, S, T     L = Legacy Value
                   the NED PCM ID.
                                                                                                                             P = Pseudo PCM
                                                                                                                             S = Social Security Number
                                                                                                                             T = Tax Identifier

                                                                                                                           Deleted, effective ~Jul/Aug 2011.
                                                                                                                           If FAC_FLAG=‟F‟ then Raw MHS-updated Facility Practice Expense
                                                                                                                           RVUs, without modifiers (FPRVUBJ), summed for all CPT codes.
                   Raw MHS updated Practice Expense RVUs
                                                                                                                           Else Raw MHS-updated Non-Facility Practice Expense RVUs, without
RVU, Simple PE     summed for all 13 CPT codes. Based on         N(8)       PERVU                 E
                                                                                                                           modifiers (NPRVUBJ), summed for all CPT codes.
                   the Facility Flag
                                                                                                                           If APPTINFR=Y, based on completion table rules (See MDR CAPER
                                                                                                                           Enhanced specification).




       October 2011 Version                                                          CAPER (Basic&Enhanced)                                                             Page 58 of 1408
                                                                                     CAPER (Basic&Enhanced)

                                                                          SAS Variable B=CAPER Basic
Data Element                      Definition                    Format                                        Values                                     Notes
                                                                             Name      E=CAPER Enh
                                                                                                                         Deleted, effective ~Jul/Aug 2011.
                                                                                                                         For APPTINFR=‟N‟:
                                                                                                                         If FAC_FLAG=‟F‟ then Raw MHS-updated Facility Practice Expense
                                                                                                                         RVUs, without modifiers (FPRVUBJ), summed for all E&M and Proc1-4
                  Raw MHS updated Practice Expense RVUs                                                                  (CPT1 and CPT4-7) codes.
RVU, Simple PE
                  summed for E&M 1 and Procedures 1-4            N(8)      PERVU_S                E                      Else if FAC_FLAG=‟N‟ then Raw MHS-updated Non-facility Practice
per SADR
                  only. Based on the Facility Flag                                                                       Expense RVU, without modifiers (NPRVUBJ), summed for E&M1 and
                                                                                                                         Proc1-4 (CPT1 and CPT4-7).

                                                                                                                         If APPTINFR=Y, based on completion table rules (See MDR CAPER
                                                                                                                         Enhanced specification).
                                                                                                                         If FAC_FLAG=F or R then PERVUJ = FPRVUJ
RVU, Practice
                                                                                                                         Else PERVUJ = NPRVUJ .
Expense, E&M1-
                  Raw MHS updated Practice Expense RVU                                                                   Note: If APPTINFR=Y, then inferred FPRVUJ and NPRVUJ must be
E&M3 and                                                         N(8)       PERVUJ                E
                  for each procedure code.                                                                               applied first.
Procedure 1-
                                                                                                                         J =1 to 13, where J =1 to 3 represents the E&M positions and J =4 to 13
Procedure 10
                                                                                                                         represents procedure positions.
Aggregate PE                                                                                                             FY07+: Effective ~Jul/Aug 2011.
RVU (Provider-  Sum of all Provider-affected Practice
                                                                 N(8)      PERVUAGG               E
Affected PE RVU Expense RVUs for all Providers                                                                           If APPTINFR=Y, based on completion table rules (See MDR CAPER
Aggregate)                                                                                                               Enhanced specification).

Provider Affected
Aggregate                                                                                                                J=1 to 13, where J=1 to 3 represents the E&M positions and J=4 to 13
Practice Expense Sum of all Provider-affected Practice                                                                   represents procedure positions.
                                                                 N(8)      PPERVUJ                E
RVU; E&M Code Expense RVUs for each CPT
1-3, CPT/HCPCS                                                                                                           FY07+: Effective ~Jul/Aug 2011.
Code 1-10

PPS Enrollment
                                                                Char(4)     PPS_EPS               E                      Joined to the DMIS Table by FY and Enrollment Site (ENRDMIS).
Parent Site
PPS Treatment
                                                                Char(4)     PPS_TPS               E                      Joined to the DMIS Table by FY and Tmt DMIS ID (DMIS ID).
Parent Site
                  The PRISM area represents roughly a 20-                                                                Assigned in MDR processing, the code indicating PRISM (Provider
PRISM Service     mile area surrounding stand-alone MTFs.                                                                Requirement Integrated Specialty Model) Area of residence. Records
                                                                Char(4)      PRISM                E
Area              If patient zip is not usable, the treatment                                                            are assigned to PRISM areas based on beneficiary zip code, sponsor
                  MTF zip code is used in its place.                                                                     service, and discharge date.
                  Date record was last updated during
Processing Date                                                 Char(8)    PROCDATE               B           yyyymmdd
                  processing




      October 2011 Version                                                           CAPER (Basic&Enhanced)                                                           Page 59 of 1408
                                                                                         CAPER (Basic&Enhanced)

                                                                              SAS Variable B=CAPER Basic
Data Element                         Definition                    Format                                         Values                                     Notes
                                                                                 Name      E=CAPER Enh
                                                                                                                           PC = Primary Care
                                                                                                                           ORTHO = Orthopedics
                                                                                                                           MH = Mental Health
                                                                                                                           OBGYN = Obstetrics/Gynecology
                                                                                                                           OPTOM = Optometry
                                                                                                                           IMSUB = Internal Medicine Subspecialty
Product Line                                                       Char(7)      PRODLINE              E
                                                                                                                           ER = Emergency Room
                                                                                                                           SURG = General Surgery
                                                                                                                           SURGSUB = Surgical Subspecialty
                                                                                                                           ENT = Otolaryngology
                                                                                                                           DERM = Dermatology
                                                                                                                           OTHER = Other
Appointment          Classification code for the appointment
                                                                   Char(30)    PROVCLAS1             B/E                   Locally defined variable with a wide and inconsistent variety of values.
Provider Class       provider.
Referring Provider   DMIS ID of the clinic location from which
                                                                   Char(4)    PROVDMISREF            B/E
DMISID               the provider referred the patient.
Appointment
                     Provider‟s EDI_PN as assigned by DEERS. Char(10)          PROVEDIPN1            B/E
Provider EDIPN

Additional
Provider 1 EDIPN - Additional Provider‟s EDI_PN as assigned                   PROVEDIPNJ
                                                                   Char(10)                          B/E
Additional         by DEERS.                                                  where J =2 to 5
Provider 4 EDIPN

Referring Provider   Providers EDI_PN value as assigned by
                                                                   Char(10)   PROVEDIPNREF           B/E
EDIPN                DEERS.
Appointment          HIPAA Provider Taxonomy Code entered
Provider HIPAA       on the encounter for the appointment          Char(10)    PROVHIPAA1            B/E
Taxonomy             provider.

Additional
Provider 1 HIPAA
Taxonomy -       HIPAA Provider Taxonomy Code entered                         PROVHIPAAJ
                                                               Char(10)                              B/E
Additional       on the encounter for the additional provider.                where J =2 to 5
Provider 4 HIPAA
Taxonomy

                                                                                                                           Entered by MTF staff, the Provider ID normally consists of eight
Appointment          Unique provider identifier for the provider                                                           characters of the provider‟s last name and first initial of first name, or
                                                                   Char(9)      PROVID1              B/E
Provider ID          rendering care.                                                                                       some combination of last name A-numeric characters to arrive at a
                                                                                                                           unique identifier (unique to the CHCS site).
Additional                                                                                                                 Entered by MTF staff, the Provider ID normally consists of eight
Provider 1 ID -                                                                 PROVIDJ                                    characters of the provider‟s last name and first initial of first name, or
                   Unique provider identifier.                     Char(10)                          B/E
Additional                                                                    where J =2 to 5                              some combination of last name A-numeric characters to arrive at a
Provider 4 ID                                                                                                              unique identifier (unique to the MTF).
Referring Provider The Provider ID of the HCDP referring the
                                                                   Char(9)     PROVIDREF              B
ID, Raw            patient for specialty care or consult.




       October 2011 Version                                                              CAPER (Basic&Enhanced)                                                             Page 60 of 1408
                                                                                        CAPER (Basic&Enhanced)

                                                                            SAS Variable B=CAPER Basic
Data Element                        Definition                   Format                                          Values                                  Notes
                                                                               Name      E=CAPER Enh
Assigned MEPRS
               The assigned MEPRS work center that the
Code for
               appointment provider is assigned to.              Char(4)     PROVMEPR1              B/E
Appointment
               Placeholder.
Provider

Assigned MEPRS
Code for
                    The assigned MEPRS work center that the
Additional Prov 1 -                                                          PROVMEPRJ
                    respective additional provider is assigned   Char(4)                            B/E
Assigned MEPRS                                                               where J =2 to 5
                    to. Placeholder.
Code for
Additional Prov 4

Assigned MTF for    The DMIS ID of the MTF that the
Appointment         appointment provider is assigned to,         Char(4)      PROVMTF1              B/E                   See DMIS Information for list of DMIS ID.
Provider            Placeholder.
Assigned MTF for
Additional
                    The DMIS ID of the MTF that the respective
Provider 1 -                                                                  PROVMTFJ
                    additional provider is assigned to,          Char(4)                            B/E                   See DMIS Information for list of DMIS ID.
Assigned MTF for                                                             where J =2 to 5
                    Placeholder.
Additional
Provider 4
Appointment
                    NPI number for the appointment provider.     Char(10)     PROVNPI1              B/E
Provider NPI
Additional
Provider 1 NPI -                                                              PROVNPIJ
                    NPI for additional provider.                 Char(10)                           B/E
Additional                                                                   where J =2 to 5
Provider 4 NPI
                   The National Provider Identifier (NPI)
Referring Provider
                   unique to all providers across all CHCS       Char(10)    PROVNPIREF             B/E
NPI
                   systems.
Appointment                                                                                                               1 = Individual providers
                  The NPI entity type.                           Char(1)    PROVNPITYPE1            B/E           1, 2
Provider NPI Type                                                                                                         2 = Organizational providers

Additional
Provider 1 NPI
                                                                            PROVNPITYPEJ                                  1 = Individual Providers
Type - Additional   The NPI entity type.                         Char(1)                            B/E           1, 2
                                                                             where J =2 to 5                              2 = Organizational Providers
Provider 4 NPI
Type

Referring Provider                                                          PROVNPITYPERE                                 1 = Individual providers
                   The NPI entity type.                          Char(1)                            B/E           1, 2
NPI Type                                                                          F                                       2 = Organizational providers




       October 2011 Version                                                             CAPER (Basic&Enhanced)                                                        Page 61 of 1408
                                                                                        CAPER (Basic&Enhanced)

                                                                             SAS Variable B=CAPER Basic
Data Element                        Definition                    Format                                            Values                                        Notes
                                                                                Name      E=CAPER Enh
                                                                                                                                 1 = Attending provider
                                                                                                                                 2 = Assisting provider
                                                                                                                                 3 = Supervising provider
                                                                                                                                 4 = Nurse
Appointment
                    The role of the appointment provider.         Char(1)    PROVROLE1              B/E                1-9       5 = Para-professional
Provider Role
                                                                                                                                 6 = Operating Provider #1
                                                                                                                                 7 = Surgeon
                                                                                                                                 8 = Anesthesia
                                                                                                                                 9 = GME
                                                                                                                                 1 = Attending provider
                                                                                                                                 2 = Assisting provider
                                                                                                                                 3 = Supervising provider
Additional
                                                                                                                                 4 = Nurse
Provider 1 Role -                                                            PROVROLEJ
                    The role of the additional provider.          Char(1)                           B/E                1-9       5 = Para-professional
Additional                                                                   where J =2 to 5
                                                                                                                                 6 = Operating Provider #1
Provider 4 Role
                                                                                                                                 7 = Surgeon
                                                                                                                                 8 = Anesthesia
                                                                                                                                 9 = GME

Appointment        A code that identifies the health service
Provider Specialty provider's medical specialty. Codes and        Char(3)    PROVSPEC1              B/E          CHCS codes. See Provider Specialty Codes for DC for codes and descriptions.
Code               meanings come from CHCS (938 values).
Additional
Provider 1
                    A code that identifies the health service
Specialty Code -                                                             PROVSPECJ
                    provider's medical specialty. Codes and       Char(3)                           B/E          CHCS codes. See Provider Specialty Codes for DC for codes and descriptions.
Additional                                                                   where J =2 to 5
                    meanings come from CHCS (938 values).
Provider 4
Specialty Code
                                                                                                                                  AD = Active Duty
                                                                                                                                  CI = Civilian
Appointment
                    The provider military status at the time of                                                   AD, CI, NG, NG = National Guard
Provider Military                                                 Char(13)    PROVSTAT1             B/E
                    the extract date.                                                                             PV, RC, RS PV = Private sector contracts
Status
                                                                                                                                  RC = Recalled to Active Duty
                                                                                                                                  RS = Reserves
                                                                                                                                  AD = Active Duty
Additional
                                                                                                                                  CI = Civilian
Provider 1 Military
                    The provider military status at the time of               PROVSTATJ                           AD, CI, NG, NG = National Guard
Status - Additional                                               Char(3)                           B/E
                    the extract date.                                        where J =2 to 5                      PV, RC, RS PV = Private sector contracts
Provider 4 Military
                                                                                                                                  RC = Recalled to Active Duty
Status
                                                                                                                                  RS = Reserves
                                                                                                                                  B = Fee basis
                                                                                                                                  C = Certification & Accreditation (C&A)
Appointment
                                                                                                                                  F = Full time
Provider Type                                                     Char(1)    PROVTYPE1              B/E          B, C, F, H, P, T
                                                                                                                                  H = House staff
Code
                                                                                                                                  P = Partnership
                                                                                                                                  T = Part time




       October 2011 Version                                                             CAPER (Basic&Enhanced)                                                              Page 62 of 1408
                                                                                         CAPER (Basic&Enhanced)

                                                                              SAS Variable B=CAPER Basic
Data Element                       Definition                      Format                                           Values                                      Notes
                                                                                 Name      E=CAPER Enh
Provider Affected
                                                                                                                                 J=1 to 13, where J=1 to 3 represents the E&M positions and J=4 to 13
Aggregate Total
                   Sum of all Provider-affected Total RVUs                                                                       represents procedure positions.
RVU; E&M Code                                                       N(8)        PTRVUJ                E
                  for each CPT
1-3, CPT/HCPCS
                                                                                                                                 FY07+: Effective ~Jul/Aug 2011.
Code 1-10

Provider Affected
                                                                                                                                 J=1 to 13, where J=1 to 3 represents the E&M positions and J=4 to 13
Aggregate Work
                   Sum of all Provider-affected Work RVUs                                                                        represents procedure positions.
RVU; E&M Code                                                       N(8)        PWRVUJ                E
                  for each CPT
1-3, CPT/HCPCS
                                                                                                                                 FY07+: Effective ~Jul/Aug 2011.
Code 1-10
                                                                                                                               CD = Cadet
                                                                                                                               EJ=Enlisted, Junior
                                                                                                                               ES=Enlisted, Senior
Sponsor Rank                                                                                                      CD,EJ,ES,OJ, OJ=Officer, Junior
                                                                   Char(2)     RANKGRP                E
Group                                                                                                              OS,WO,XX OS=Officer, Senior
                                                                                                                               WO=Warrant Officer
                                                                                                                               XX=Other (students, civil servants, unknowns (e.g., those without
                                                                                                                               distinction as to whether officer or enlisted
                                                                                                                               CD = Cadet
                   A code that represents the patient's military
Sponsor                                                                                                            E1-E10, O1- E1 - E10 = Enlisted
                   rank. Codes and meanings come from              Char(3)     RANKPAY                E
Rank/Paygrade                                                                                                         O11      O1 - O11 = Officer
                   CHCS (231 codes).
                                                                                                                               W1 - W5 = Warrant Officer
                                                                                                                               CD = Cadet
                   A code that represents the patient's military
Military                                                                                                           E1-E10, O1- E1 - E10 = Enlisted
                   rank. Codes and meanings come from              Char(4)    RANKPAY_R              B/E
Grade/Rank                                                                                                            O11      O1 - O11 = Officer
                   CHCS (231 codes).
                                                                                                                               W1 - W5 = Warrant Officer
Reason for         A free text field to describe the reason the
                                                                   Char(78)     REASON               B/E
Appointment        patient has for seeking care.
                 The Referral Number automatically
Referral Number,
                 assigned by the system when a referral is Char(11)             REF_NO                B
Raw
                 created through the Managed Care Module.
Referring Provider The Provider ID of the HCDP referring the
                                                                   Char(9)    REF_PROV_R              E                          Same as PROVIDREF in CAPER Basic. Renamed in Enhanced.
ID, Raw            patient for specialty care or consult.
                 The Referral Number automatically
Referral Number,
                 assigned by the system when a referral is Char(11)            REFNUM_R               E                          Same as REF_NO in CAPER Basic. Renamed in Enhanced.
Raw
                 created through the Managed Care Module.

Referring Provider
[from Referral     From the Referral file.                         Char(14)    REF_PROV               E
Database]
Referral Number
[from Referral     From the Referral file.                         Char(11)     REFNUM                E
Database]




       October 2011 Version                                                              CAPER (Basic&Enhanced)                                                              Page 63 of 1408
                                                                              CAPER (Basic&Enhanced)

                                                                    SAS Variable B=CAPER Basic
Data Element                    Definition                Format                                        Values                                       Notes
                                                                       Name      E=CAPER Enh
                                                                                                                     Deleted, effective ~Jul/Aug 2011.

                                                                                                                     Raw MHS updated Work RVU, without modifiers (RRVUBJ) summed
RVU, Simple       Raw MHS updated Work RVUs summed
                                                           N(8)        RRVU                E                         for all CPT codes.
Work              for all 13 CPT codes.
                                                                                                                     If APPTINFR=Y, based on completion table rules (See MDR CAPER
                                                                                                                     Enhanced specification).
                                                                                                                     Deleted effective ~Jul/Aug 2011.

                                                                                                                     Raw MHS updated Work RVU, without modifiers (RRVUBJ) summed
RVU, Simple       Raw MHS updated Work RVUs summed
                                                           N(8)       RRVU_S               E                         for E&M1 and Proc1-4 (CPT1 and CPT4-7).
Work per SADR     for E&M 1 and Procedures 1-4 only.
                                                                                                                     If APPTINFR=Y, based on completion table rules (See MDR CAPER
                                                                                                                     Enhanced specification).
                                                                                                                     Raw MHS-updated Work RVU for CPT procedures J =1 to 13, where
RVU, Raw Work,                                                                                                       J =1 to 3 represents the E&M positions and J =4 to 13 represents
               Raw MHS updated Work RVU of CPT J ,
E&M1-E&M3 and                                                                                                        procedure positions.
               derived from merge with CPT Weight          N(8)       RRVUJ                E
Procedure 1-
               Table.
Procedure 10                                                                                                         If APPTINFR=Y, based on completion table rules (See MDR CAPER
                                                                                                                     Enhanced specification).
                                                                                                                     A = Army
                                                                                                                     C = Coast Guard
                                                                                                                     F = Air Force
                                                                                                                     H = Public Health Service
                                                                                                       A, C, F, H,   M = Marines
Recoded Sponsor
                                                          Char(1)    RSPONSVC              E            M, N, O,     N = Navy
Service
                                                                                                          X, 4       O = NOAA
                                                                                                                     X = Other/Unknown
                                                                                                                     4 = Foreign Military

                                                                                                                     This field is fed to the M2.

                                                                                                                     For APPTINFR=N: After unit of service adjustments: Sum of Practice
                                                                                                                     Expense RVU, with modifiers, chosen based on designation as facility
RVU, Enhanced                                                                                                        or non-facility care, multiplied by the units of service, computed as:
                 Based on all 13 procedure codes.          N(8)      RVU_EPE               E
Practice Expense                                                                                                     ∑(PERVUJ *CPTUOS_J ) for all J CPT Codes.
                                                                                                                     If APPTINFR=Y, based on completion table rules (See MDR CAPER
                                                                                                                     Enhanced specification).

                                                                                                                     For APPTINFR=N: After unit of service adjustments: Sum of Practice
                                                                                                                     Expense RVU, with modifiers, chosen based on designation as facility
RVU, Enhanced                                                                                                        or non-facility care, multiplied by the units of service, computed as:
Practice Expense Based on E&M1 and Procedures 1-4 only.    N(8)      RVU_EPE_S             E                         ∑(PERVUJ*CPTUOS_J ) for all E&M1 and Proc 1-4 (CPT_1 and CPT_4-
per SADR                                                                                                             CPT_7).
                                                                                                                     If APPTINFR=Y, based on completion table rules (See MDR CAPER
                                                                                                                     Enhanced specification).
RVU, Enhanced
                  Based on all 13 procedure codes.         N(8)       RVU_ET               E                         Sum of RVU_EW and RVU_EPE for both APPTINFR Y and N.
Total




      October 2011 Version                                                    CAPER (Basic&Enhanced)                                                               Page 64 of 1408
                                                                                      CAPER (Basic&Enhanced)

                                                                          SAS Variable B=CAPER Basic
Data Element                       Definition                   Format                                          Values                                        Notes
                                                                             Name      E=CAPER Enh
RVU, Enhanced
                    Based on E&M1 and Procedures 1-4 only.       N(8)      RVU_ET_S                E                         Sum of RVU_EW_S and RVU_EPE_S for both APPTINFR Y and N.
Total per SADR
                                                                                                                             For APPTINFR=N: After unit of service adjustments: The Work RVU,
                                                                                                                             with modifiers, per code multiplied by the units of service; computed as:
RVU, Enhanced                                                                                                                ∑(RRVUJ *CPTUOS_J ) for all J CPT Codes
                    Based on all 13 procedure codes.             N(8)       RVU_EW                 E
Work
                                                                                                                             If APPTINFR=Y, based on completion table rules (See MDR CAPER
                                                                                                                             Enhanced specification).

                                                                                                                             For APPTINFR=N: After unit of service adjustments: The Work RVU,
                                                                                                                             with modifiers, per code multiplied by the units of service; computed as:
RVU, Enhanced                                                                                                                ∑(RRVUJ *CPTUOS_J ) for all E&M1 and Proc 1-4 (CPT_1 and CPT_4-
                    Based on E&M1 and Procedures 1-4 only.       N(8)      RVU_EW_S                E
Work per SADR                                                                                                                CPT_7)
                                                                                                                             If APPTINFR=Y, based on completion table rules (See MDR CAPER
                                                                                                                             Enhanced specification).
Sponsor Service
Aggregate from                                                  Char(1)    SAGGLVM                 E
LVM
Scope of Care       Placeholder.                                Char(1)     SCOPE                 B/E
                                                                                                                             If APV=Y and any of the APGs is of OR intensity (see Table A2.4 in
                                                                                                                             CAPER Enhanced Specification) then SDS=Y.‟
Same Day
                                                                Char(1)       SDS                  E              N,Y        Else SDS=N.
Surgery Flag
                                                                                                                             This field is left blank for APPTINFR=Y.

Skill Type;
Appointment                                                                                                                  K =1 to 5 represents Appointment Provider and Additional Providers 1 to
Provider,                                                       Char(2)     SKILLK                 E           1, 1R,2,3,4   4.
Additional                                                                                                                   FY07+: Effective ~June 2011.
Providers 1-4
Site Identifier from
                     Appears in the raw source filename after
Filename of Raw                                                 Char(8)      SITEID               B/E
                     the first dot character
Feed
Reservist Special
                                                                Char(2)      SOC                   E
Operation Code




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                                                                                     CAPER (Basic&Enhanced)

                                                                          SAS Variable B=CAPER Basic
Data Element                      Definition                    Format                                           Values                                        Notes
                                                                             Name      E=CAPER Enh
                                                                                                                              00= Not Applicable
                   Indicates the contingency operation for                                                                    01= Operation Desert Storm
                   which a Guard or Reserve member is                                                                         02= Los Angeles Riots
                   activated or receiving TAMP benefits                                                                       03=Haiti
                   through at the time of care. Populated on                                                                  04=Somalia
                   both sponsor and family member records.                                                                    05=Bosnia
Special            This data element does not indicate that                                                                   06=Kosovo
Operations Code    the guard or reserve                         Char(2)      SOC_R               B/E          00 - 10, 98, 99 07=Southern Watch
(Raw)              member went to theater, rather, that the                                                                   08=Noble Eagle
                   orders that activated the member indicated                                                                 09=Enduring Freedom
                   a contingency operation. Use with                                                                          10=Iraqi Freedom
                   Reservist Status Code to indicate the                                                                      98=Not a special operation
                   status of the Guard/Reserve member.                                                                        99=Other
                                                                                                                              (Take caution with these values. It is often evident that Iraqi Freedom
                                                                                                                              records are miscoded as 08 or 09.)
Sponsor Social
                                                                Char(9)    SPONSSN                E
Security Number
Sponsor Social     Social Security Number (SSN) of the
                                                                Char(9)    SPONSSN_R             B/E
Security Number    sponsor as received from CHCS.
Source
                                                                Char(8)   SRCPROCDATE             E
Processing Date
                                                                                                                             A=Army
                                                                                                                             C=Coast Guard
                                                                                                                             D=Office of the Secretary of Defense
Sponsor Service                                                                                               A, C, D, F, H, F=Air Force
                                                                Char(1)     SSVCLVM               E
from DEERS                                                                                                       M, N, O     H=The Commissioned Corps of the Public Health Service
                                                                                                                             M=Marine Corps
                                                                                                                             N=Navy
                                                                                                                             O=Other
                   DoD specific injury codes using NATO
DoD Specific
                   Standardization Agreement (STANAG)           Char(3)     STANAG               B/E            000 - 999     See Injury Codes for Descriptions
Injury Code
                   codes. Placeholder
                                                                                                                             A = Early Alert for Guard/Reserve
                                                                                                                             E = TAMP extended for Guard/Reserve
                                                                                                                             O = TAMP original for Guard/Reserve
Reservist Status                                                                                              A, E, O, M, T,
                                                                Char(1)     STATUS                E                          M = Mobilization for Guard/Reserve
Code                                                                                                                I, L
                                                                                                                             T = TAMP for Guard/Reserve
                                                                                                                             I = TAMP for involuntary separation from Active Duty
                                                                                                                             L = TAMP for stop/loss from Active Duty
Telemedicine/Re
                   Identifier for telemedicine and remote
mote Consult                                                    Char(1)     TELEMED              B/E
                   consult encounters. Placeholder.
Code
                                                                                                                              From merge to TPOC Rate table corresponding to encounter date fiscal
Third Party
                                                                 N(8)         TPC                 E                           year and the first three characters of MEPRS code, and zero-filled if
Collection Rate
                                                                                                                              there is no match.
TPR Eligibility
                                                                Char(1)     TPRELIG               E                N, Y
Flag




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                                                                                 CAPER (Basic&Enhanced)

                                                                       SAS Variable B=CAPER Basic
Data Element                     Definition                  Format                                         Values                                    Notes
                                                                          Name      E=CAPER Enh
                                                                                                                       FY07+: Effective ~June 2011.
RVU, Raw Total
(based on                                                                                                              J =1 to 13, where J =1 to 3 represents the E&M positions and J=4 to 13
FAC_FLAG);         Sum of raw Practice Expense and Work                                                                represents procedure positions.
                                                              N(8)       TRVUJ                E
E&M Code 1-3,      RVU for each CPT                                                                                    For APPTINFR=N:
CPT/HCPCS                                                                                                              If FAC_FLAG=F or R then TRVUJ = sum of RRVUJ and FPRVUJ
Code 1-10                                                                                                              Else TRVUJ = sum of RRVUJ and NPRVUJ.

Aggregate Total
                   Sum of Provider-affected Aggregate Work                                                             FY07+: Effective ~June 2011.
RVU (Provider-
                   and Practice Expense RVUs for all          N(8)      TRVUAGG               E                        If APPTINFR=Y, based on completion table rules (See MDR CAPER
Affected Total
                   Providers.                                                                                          Enhanced specification).
RVU Aggregate)
                                                                                                                        N = North
                                                                                                                        W = West
Tmt DMIS ID                                                                                                             S = South
                                                             Char(1)     TXHSSC               E           A, N, O, S, W
HSSC Region                                                                                                             A = AK
                                                                                                                        O = OCONUS
                                                                                                                        blank = unknown
                                                                                                                        01 = Northeast
                                                                                                                        02 = Mid-Atlantic
                                                                                                                        03 = Southeast
                                                                                                                        04 = Gulf South
                                                                                                                        05 = Heartland
                                                                                                                        06 = Southwest
                                                                                                                        07, 08 = TRICARE Central
                                                                                                             01 - 15,
Treatment Region                                             Char(2)     TXREG                E                         09 = Southern California
                                                                                                                AK
                                                                                                                        10 = Golden Gate
                                                                                                                        11 = Northwest
                                                                                                                        12 = TRICARE Pacific
                                                                                                                        13 = Europe
                                                                                                                        14 = Western Pacific/Asia
                                                                                                                        15 = Central/South America & Other OCONUS
                                                                                                                        AK = Alaska




      October 2011 Version                                                       CAPER (Basic&Enhanced)                                                             Page 67 of 1408
                                                                CAPER (Basic&Enhanced)

                                                     SAS Variable B=CAPER Basic
Data Element                  Definition   Format                                           Values                                       Notes
                                                        Name      E=CAPER Enh
                                                                                                           A = Army DHP
                                                                                                           B = Army Civilian Resource Sharing
                                                                                                           C = Coast Guard
                                                                                                           D = Army Line Unit
                                                                                                           F = Air Force DHP
                                                                                                           G = AF Civilian Resource Sharing
                                                                                                           I = Inactive
                                                                                                           J = US Defense Attache Office (USDAO)
                                                                                          A, B, C, D, F, L = AF Line Unit
Treatment                                                                                G, I, J, L, M, N, M = Managed Care Support Contractor
                                           Char(1)     TXSVC                 E
Service                                                                                  O, Q, R, S, T, N = Navy DHP
                                                                                           V, X, Blank O = Other
                                                                                                           Q = Navy Line Unit
                                                                                                           R = Navy Civilian Resource Sharing
                                                                                                           S = Non-catchment
                                                                                                           T = US Family Health Plan (USFHP)
                                                                                                           V = Veterans Admin
                                                                                                           X = Administrative
                                                                                                           Blank = Unknown

Underwritten                                                                                            FY04+. N, S, W: CONUS Managed Care Support contractor (North,
                                           Char(1)    UNDFLAG                E              N, S, W
Region                                                                                                  South, West) for patient
                                                                                                        Based $/Organizational Work RVU, per SADR (OWRVU_S) by Cost
                                                                                                        Parent DMISID.
                                                                                                        Set to 0 (zero) for non "B" records and for non-DHP sites (IF TXSVC ≠
Variable Cost,
                                            N(8)      VCCLNSAL               E                          A, N, F).
Clinician Salary
                                                                                                        If APPTINFR=Y, based on completion table rules (See MDR CAPER
                                                                                                        Enhanced specification).
                                                                                                        Based on $ by Cost Parent DMISID and APG; it is the sum of the cost
                                                                                                        for the highest weight APG, and half of the cost of all other APGs after
                                                                                                        the lower weighted of E&M or Medical APG is dropped.
Variable Cost,
                                            N(8)        VCLAB                E                          Set to 0 (zero) for non "B" records and for non-DHP sites (IF TXSVC≠
Laboratory
                                                                                                        A, N, F).

                                                                                                        If APPTINFR=Y, based on completion table rules (See MDR CAPER
                                                                                                        Enhanced specification).
                                                                                                        Based on $ by Cost Parent DMISID and APG; it is the sum of the cost
                                                                                                        for the highest weight APG, and half of the cost of all other APGs after
                                                                                                        the lower weighted of E&M or Medical APG is dropped.
Variable Cost,
                                            N(8)      VCOTHANC               E                          Set to 0 (zero) for non "B" records and for non-DHP sites (IF TXSVC≠
Other Ancillary
                                                                                                        A, N, F).

                                                                                                        If APPTINFR=Y, based on completion table rules (See MDR CAPER
                                                                                                        Enhanced specification).




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                                                                                 CAPER (Basic&Enhanced)

                                                                       SAS Variable B=CAPER Basic
Data Element                    Definition                    Format                                      Values                                    Notes
                                                                          Name      E=CAPER Enh
                                                                                                                   Based on $ by Cost Parent DMISID and APG; it is the sum of the cost
                                                                                                                   for the highest weight APG, and half of the cost of all other APGs after
                                                                                                                   the lower weighted of E&M or Medical APG is dropped.
Variable Cost,
                                                               N(8)     VCOTHER               E                    Set to 0 (zero) for non "B" records and for non-DHP sites (IF TXSVC≠
Other
                                                                                                                   A, N, F).

                                                                                                                   If APPTINFR=Y, based on completion table rules (See MDR CAPER
                                                                                                                   Enhanced specification).

                                                                                                                   Based on $ by Cost Parent DMISID and APG; it is the sum of the cost
                                                                                                                   for the highest weight APG, and half of the cost of all other APGs after
                                                                                                                   the lower weighted of E&M or Medical APG is dropped.
Variable Cost,
                                                               N(8)     VCOTHLBR              E                    Set to 0 (zero) for non "B" records and for non-DHP sites (IF TXSVC≠
Other Labor
                                                                                                                   A, N, F).

                                                                                                                   If APPTINFR=Y, based on completion table rules (See MDR CAPER
                                                                                                                   Enhanced specification).

                                                                                                                   Based on $ by Cost Parent DMISID and APG; it is the sum of the cost
                                                                                                                   for the highest weight APG, and half of the cost of all other APGs after
                                                                                                                   the lower weighted of E&M or Medical APG is dropped.
Variable Cost,
                                                               N(8)      VCRAD                E                    Set to 0 (zero) for non "B" records and for non-DHP sites (IF TXSVC≠
Radiology
                                                                                                                   A, N, F).

                                                                                                                   If APPTINFR=Y, based on completion table rules (See MDR CAPER
                                                                                                                   Enhanced specification).
                                                                                                                   Based on $ by Cost Parent DMISID and APG; it is the sum of the cost
                                                                                                                   for the highest weight APG, and half of the cost of all other APGs after
                                                                                                                   the lower weighted of E&M or Medical APG is dropped.
Variable Cost,
                                                               N(8)       VCRX                E                    Set to 0 (zero) for non "B" records and for non-DHP sites (IF TXSVC≠
Pharmacy
                                                                                                                   A, N, F).

                                                                                                                   If APPTINFR=Y, based on completion table rules (See MDR CAPER
                                                                                                                   Enhanced specification).
Aggregate Work
                                                                                                                   FY07+: Effective ~Jul/Aug 2011.
RVU (Provider-   Sum of Provider-affected Work RVUs for all
                                                               N(8)     WRVUAGG               E                    If APPTINFR=Y, based on completion table rules (See MDR CAPER
Affected Work    Provider
                                                                                                                   Enhanced specification).
RVU Aggregate)




       October 2011 Version                                                      CAPER (Basic&Enhanced)                                                           Page 69 of 1408
                                                                                    Case Management

                                                                        Case Management
Common File Name: cm.sas7bdat
Dataset Location: /mdr/pub/casemgmt/
Update Frequency: Weekly                                                                                      Source System: CHCS
Description: Each record represents a case episode for a patient in case management, with a case manager, at a particular acuity level. Only includes patients in
case management in FY08 or later, and only where the MTF has reported case management data per UBU guielines

      Data Element                            Definition                          Format     SAS Variable       Values                                   Notes

Unique Person Identifier   Electronic Data Interchange - Patient Identifier       Char(10)      edi_pn      e.g., 1234567890

                           Code that identifies the MTF responsible for the
Treatment DMISID                                                                  Char(4)       dmisid      e.g. 0001, 0002 See DMIS Information for list of DMIS ID.
                           treatment of the patient during the episode of care.
Acuity Level               Acuity level of patient                                Char(1)        acuity        1,2,3,4,5
Provider ID 1              Identifier of primary care manager.                    Char(9)        cm_id
Provider ID 2              Identifier of additional case manager                  Char(9)       cm2_id
Provider ID 3              Identifer of additional case manager.                  Char(9)       cm3_id
                           Date case manager first reported patient in
Case Begin Date                                                                   Char(8)       begdate      e.g, 20010112     YYYYMMDD
                           associated acuity level
                           Date care manager indicated acuity level has
Case End Date                                                                     Char(8)       enddate      e.g, 20010112     YYYYMMDD
                           ended
                           Encounter date of the most recent SADR
Last Encounter Date                                                               Char(8)      last_encdt    e.g, 20010112     YYYYMMDD
                           contributing to the case
                           Transmission date of the most recent SADR
Last Activity Date                                                                Char(8)        txdate      e.g, 20010112     YYYYMMDD
                           contributing to the case
Extract Date               Date of the case management file extract date          Char(7)        extrdt       e.g. d090709
Fiscal Year                Fiscal year fo the last encounter date of the case     Char(4)          fy          e.g. 2008
Patient DOB                Date when the patient was born                         Char(8)       patdob       e.g, 20010112     YYYYMMDD
Patient Gender             Patient's gender                                       Char(1)       patsex           F or M
Sponsor Social Security    The sponsor‟s SSN as assigned by the Social
                                                                                  Char(9)       sponssn
Number                     Security Administration
                           Indication of whether or not a given case record
Good Standing Flag                                                                Char(1)         gs             Y or N
                           has met the coding guidelines
                                                                                                                              A = Army
                                                                                                                              C = Coast Guard
                                                                                                                              F = Air Force
DEERS Sponsor Service      Code indicating service of sponsor as reported in                                A, C, F, M, N, V, M = Marine Corps
                                                                                  Char(1)      dsponsvc
Aggregate                  DEERS                                                                                  X, Z        N = Navy
                                                                                                                              V = Navy Afloat
                                                                                                                              X = Other
                                                                                                                              Z = Unknown
                           The DMIS ID of the facility where the member is                                  e.g. 0001, 0002,
DEERS Enrollment Site                                                             Char(4)       denrsite                      See DMIS Information for list of DMIS ID.
                           enrolled                                                                                etc.




  October 2011 Version                                                             Case Management                                                                    Page 70 of 1408
                                                                                 Case Management

                                                                                                                          A=Active Duty Prime
                                                                                                                          B=TRICARE Global Remote Overseas Prime Active Duty
                                                                                                                          D=TRICARE Senior Prime
                                                                                                                          E=Non-Active Duty Prime
                                                                                                                          F=TRICARE Global Remote Overseas Prime Active Duty
                                                                                                                          Family Member
                                                                                                                          G=TRICARE Plus (CHAMPUS/TFL Eligible)
                                                                                                        A, B, D, E, F, G,
                             Code that indicates the enrollment status of the                                             H=TRICARE Overseas Prime Active Duty
DEERS Alternate Care Value                                                      Char(1)        acv      H, J, L, M, Q, R,
                             beneficiary as reported in DEERS                                                             J=TRICARE Overseas Prime Active Duty Family Member
                                                                                                            U, V, Null
                                                                                                                          L=TRICARE Plus (not CHAMPUS/TFL Eligible)
                                                                                                                          M=AD not reported enrolled (added FY05)
                                                                                                                          Q=AD enrolled to Op Forces
                                                                                                                          R=TRS
                                                                                                                          U=USTF/USFHP
                                                                                                                          V=TRICARE Retired Reserve
                                                                                                                          Null = Not Enrolled

                                                                                                                       ACT = Active Duty
                                                                                                                       RET = Retirees
                                                                                                                       GRD = Medically Eligible Guard/Reserve
                                                                                                                       IGR = Inactive Guard/Reserve
                                                                                                        ACT, RET, GRD,
                                                                                                                       DA = Dependents of Active Duty
                                                                                                          IGR, DA, DR,
DEERS Beneficiary Category Category of beneficiary as reported in DEERS         Char(3)      bencat                    DR = Dependents of Retiree
                                                                                                         DS, DGR, IDG,
                                                                                                                       DS = Dependent Survivor
                                                                                                            OTH, Z
                                                                                                                       DGR = Dependent of Medically Eligible Guard/Reserve
                                                                                                                       IDG = Dependent of Inactive Guard
                                                                                                                       OTH = Other
                                                                                                                       Z = Unknown

                                                                                                                             1 = Direct Care Only
                                                                                                                             2 = Direct Care and CHAMPUS
                                                                                                                             4 = Transitional Direct Care Only
                                                                                                                             5 = Transitional Direct Care and CHAMPUS
                             Code indicating type of eligibility for medical                            1, 2, 4, 5, 6, 7, A, 6 = Transitional Direct Care and Medicare, not CHAMPUS
DEERS Privilege Code                                                            Char(1)      privcode
                             benefits.                                                                        C, M, U            Eligible
                                                                                                                             7 = Direct Care and Medicare, not CHAMPUS Eligible
                                                                                                                             C = CHAMPUS Only
                                                                                                                             M = TRICARE for Life only
                                                                                                                             U = USFHP/USTF Enrollee
DEERS Zip Code               Zip code of beneficiary as recorded in DEERS.      Char(5)      deerszip     e.g., 01234




  October 2011 Version                                                           Case Management                                                                  Page 71 of 1408
                                                                             Case Management

                                                                                                                   A = Army DHP
                                                                                                                   B = Army Civilian Resource Sharing
                                                                                                                   C = Coast Guard
                                                                                                                   D = Army Line Unit
                                                                                                                   F = Air Force DHP
                                                                                                                   G = AF Civilian Resource Sharing
                                                                                                                   I = Inactive
                                                                                                                   J = US Defense Attache Office (USDAO)
                                                                                                                   L = AF Line Unit
                          Code indicating branch of service of enrollment
Enrollment Site Service                                                     Char(1)      enrsvc        e.g. A      M = Managed Care Support Contractor
                          site.
                                                                                                                   N = Navy DHP
                                                                                                                   O = Other
                                                                                                                   Q = Navy Line Unit
                                                                                                                   R = Navy Civilian Resource Sharing
                                                                                                                   S = Non-catchment
                                                                                                                   T = US Family Health Plan (USFHP)
                                                                                                                   V = Veterans Admin
                                                                                                                   X = Administrative
                                                                                                                   Blank = Unknown
Enrollment Site MSMA      Enrollment DMIS ID multi-service market area      Char(3)     enrmsma
                                                                                                                    01 = Northeast
                                                                                                                    02 = Mid-Atlantic
                                                                                                                    03 = Southeast
                                                                                                                    04 = Gulf South
                                                                                                                    05 = Heartland
                                                                                                                    06 = Southwest
                                                                                                                    07, 08 = TRICARE Central
                                                                                                   01 - 15, AK, 16, 09 = Southern California
Enrollment HSSC Region    Enrollment DMIS ID region                         Char(2)      enrhssc
                                                                                                     00, UK, XX     10 = Golden Gate
                                                                                                                    11 = Northwest
                                                                                                                    12 = Hawaii
                                                                                                                    13 = TRICARE Europe
                                                                                                                    14 = TRICARE Pacific
                                                                                                                    15 = TRICARE Latin America
                                                                                                                    AK = Alaska
                                                                                                                    UK, XX, 00, 16 = Unknown




  October 2011 Version                                                       Case Management                                                               Page 72 of 1408
                                                                             Case Management

                                                                                                            A = Army DHP
                                                                                                            B = Army Civilian Resource Sharing
                                                                                                            C = Coast Guard
                                                                                                            D = Army Line Unit
                                                                                                            F = Air Force DHP
                                                                                                            G = AF Civilian Resource Sharing
                                                                                                            I = Inactive
                                                                                                            J = US Defense Attache Office (USDAO)
                                                                                                            L = AF Line Unit
                         Branch of service associated with the catchment
Catchment Area Service                                                      Char(1)     catchsvc   e.g. A   M = Managed Care Support Contractor
                         area
                                                                                                            N = Navy DHP
                                                                                                            O = Other
                                                                                                            Q = Navy Line Unit
                                                                                                            R = Navy Civilian Resource Sharing
                                                                                                            S = Non-catchment
                                                                                                            T = US Family Health Plan (USFHP)
                                                                                                            V = Veterans Admin
                                                                                                            X = Administrative
                                                                                                            Blank = Unknown
                                                                                                            A = Army DHP
                                                                                                            B = Army Civilian Resource Sharing
                                                                                                            C = Coast Guard
                                                                                                            D = Army Line Unit
                                                                                                            F = Air Force DHP
                                                                                                            G = AF Civilian Resource Sharing
                                                                                                            I = Inactive
                                                                                                            J = US Defense Attache Office (USDAO)
                                                                                                            L = AF Line Unit
PRISM Area Service       Branch of service associated with the PRISM area   Char(1)     prismsvc   e.g. A   M = Managed Care Support Contractor
                                                                                                            N = Navy DHP
                                                                                                            O = Other
                                                                                                            Q = Navy Line Unit
                                                                                                            R = Navy Civilian Resource Sharing
                                                                                                            S = Non-catchment
                                                                                                            T = US Family Health Plan (USFHP)
                                                                                                            V = Veterans Admin
                                                                                                            X = Administrative
                                                                                                            Blank = Unknown




 October 2011 Version                                                        Case Management                                                        Page 73 of 1408
                                                                                 Case Management

                                                                                                                          A = Army DHP
                                                                                                                          B = Army Civilian Resource Sharing
                                                                                                                          C = Coast Guard
                                                                                                                          D = Army Line Unit
                                                                                                                          F = Air Force DHP
                                                                                                                          G = AF Civilian Resource Sharing
                                                                                                                          I = Inactive
                                                                                                                          J = US Defense Attache Office (USDAO)
                                                                                                                          L = AF Line Unit
                           Branch of service associated with the MTF Service
MTF Service Area Service                                                        Char(1)     svcareasvc        e.g. A      M = Managed Care Support Contractor
                           Area
                                                                                                                          N = Navy DHP
                                                                                                                          O = Other
                                                                                                                          Q = Navy Line Unit
                                                                                                                          R = Navy Civilian Resource Sharing
                                                                                                                          S = Non-catchment
                                                                                                                          T = US Family Health Plan (USFHP)
                                                                                                                          V = Veterans Admin
                                                                                                                          X = Administrative
                                                                                                                          Blank = Unknown
                           The Catchment Area associated with the                                        e.g. 0001, 0002,
Catchment Area ID                                                               Char(4)       catch                       See DMIS Information for list of DMIS ID.
                           beneficiary residence zip code                                                       etc.
                           The PRISM area associated with the beneficary                                 e.g. 0001, 0002,
PRISM Area ID                                                                   Char(4)       prism                       See DMIS Information for list of DMIS ID.
                           residence zip code                                                                   etc.
                           MTF Service Area associated with the beneficiary                              e.g. 0001, 0002,
MTF Service Area                                                                Char(4)     mtfsvcarea                    See DMIS Information for list of DMIS ID.
                           residence zip code                                                                   etc.
                                                                                                                          A = Alaska
                                                                                                                          N = North
                           TRICARE Next Generation Region associated with                                 N, S, W, O, A
TNEX Region                                                                     Char(1)      tnexreg                      O = Overseas
                           the beneficiary residence zip code                                               and blank
                                                                                                                          S = South
                                                                                                                          W = West
                                                                                                                          01 = Northeast
                                                                                                                          02 = Mid-Atlantic
                                                                                                                          03 = Southeast
                                                                                                                          04 = Gulf South
                                                                                                                          05 = Heartland
                                                                                                                          06 = Southwest
                                                                                                                          07, 08 = TRICARE Central
                                                                                                         01 - 15, AK, 16, 09 = Southern California
Traditional Region         Region associated with the beneficiary zip code      Char(2)        reg
                                                                                                           00, UK, XX     10 = Golden Gate
                                                                                                                          11 = Northwest
                                                                                                                          12 = Hawaii
                                                                                                                          13 = TRICARE Europe
                                                                                                                          14 = TRICARE Pacific
                                                                                                                          15 = TRICARE Latin America
                                                                                                                          AK = Alaska
                                                                                                                          UK, XX, 00, 16 = Unknown
                           Indicates whether the Beneficiary Zip Code is in a
TPR Flag                                                                        Char(1)       tprflag        Y or N
                           TRICARE Prime Remote area.
                           Flag that indicates whether the record contains a
Death Code                                                                      Char(1)      dthcode        Y or blank
                           death
Death Date                 Date of recorded death                               Char(8)      dthdate     e.g, 20010112    YYYYMMDD




  October 2011 Version                                                           Case Management                                                                  Page 74 of 1408
                       Case Management




                                 Return to the
                                   Table of
                                   Contents




October 2011 Version   Case Management           Page 75 of 1408
                                                                                           Casualty

                                                                                  CASUALTY DEATH FILE

Common File Name: casdeath.sas7bdat
Dataset Location: /mdr/pub/death/cas/
Update Frequency: Updated monthly                                                                                              Source System: WHS Casualty Office
Description: Active duty deaths
                                                                                            Position or SAS
 Data Element                              Definition                           Format                           Values                                      Notes
                                                                                               Variable
Member Name     Last, First, Middle name of individual.                         Char(35)         name
Sponsor SSN     Social security number of active duty member.                    Char(9)       sponssn
Date of Birth   Date of birth of individual.                                    SAS Date          dob
                                                                                                              See Death Rank
Rank            Military rank of individual.                                    Char(5)           rank                         See Death Rank Table.
                                                                                                                   Table
DDS             DEERS Dependent Suffix.                                          Char(2)          dds               20         Set to '20' for all files received from casualty feed.
Death Date      Date of recorded death.                                         SAS Date        dthdate
Source          Source of death information.                                     Char(1)        source              C          Set to 'C' for all files received from casualty feed.
Death Code      Flag that indicates whether the record contains a death.         Char(1)        dthcode             Y          Set to 'Y' for all files received from casualty feed.
                First digit of DDS, which defines whether patient is sponsor,
Relationship                                                                    Char(1)               rel           2          Set to '2' for all files received from casualty feed.
                spouse, dependent, or other.




   October 2011 Version                                                                    Casualty                                                                       Page 76 of 1408
                                                                                           Casualty (restricted)

                                                              CASUALTY DEATH FILE (Restricted)
Common File Name: casdeath.sas7bdat
Dataset Location: /mdr/restricted_death/cas/d[yymmdd]/, where [yymmdd] is the date of the source feed.
Update Frequency: Updated monthly                                                                                                                 Source System: WHS Casualty Office
Description: Active duty deaths
                                                                                                             Position or SAS
       Data Element                                   Definition                               Format                               Values                                  Notes
                                                                                                                Variable
Member Name                Last, First, Middle name of individual.                            Char(35)            name
Sponsor SSN                Social security number of active duty member.                       Char(9)             sponssn
Date of Birth              Date of birth of individual.                                      SAS Date                dob
                                                                                                                                See Death Rank
Rank                       Military rank of individual.                                        Char(5)               rank                         See Death Rank Table.
                                                                                                                                     Table
DDS                        DEERS Dependent Suffix.                                             Char(2)               dds              20          Set to '20' for all files received from casualty feed.
Death Date                 Date of recorded death.                                           SAS Date              dthdate
Source                     Source of death information.                                       Char(1)              source              C          Set to 'C' for all files received from casualty feed.
                                                                                                                                                    A = Accident
                                                                                                                                                    L = Beleaguered
                                                                                                                                                    B = Besieged
                                                                                                                                                    C = Captured
                                                                                                                                                    D = Detained
                                                                                                                                                    R = DWRIA
                                                                                                                                                    H = Homicide
                                                                                                                               A, L, B, C, D, R, H,
                                                                                                                                                    I = Illness
Cause of Death             Cause of Death.                                                     Char(1)             dthcause    I, N, K, M, G, P, S,
                                                                                                                                                    N = Interned
                                                                                                                                       U, W
                                                                                                                                                    K = Killed in Action
                                                                                                                                                    M = Missing
                                                                                                                                                    G = Missing in Action
                                                                                                                                                    P = Pending
                                                                                                                                                    S = Self-Inflicted
                                                                                                                                                    U = Undetermined
                                                                                                                                                    W = Wounded in Action

Death Code                 Flag that indicates whether the record contains a death.            Char(1)             dthcode             Y          Set to 'Y' for all files received from casualty feed.

                           First digit of DDS, which defines whether patient is sponsor,
Relationship                                                                                   Char(1)               rel               2          Set to '2' for all files received from casualty feed.
                           spouse, dependent, or other




    October 2011 Version                                                                   Casualty (restricted)                                                                    Page 77 of 1408
                                                                      Completion Factors - SADR

                                                              Direct Care Completion Factors (SADR)

Common File Name: sadr.compfac.fyXX.txt.Z, where 'XX' is the two digit fiscal year - ranging from '99+
Dataset Location: /mdr/pub/sadr/compfac/
Update Frequency: Updated monthly                                                                                      Data Source System: MDR
Description: '!' delimited files
                                                                                            Position or SAS
              Data Element                      Definition                     Format                         Values                  Notes
                                                                                               Variable
Completion Factor                                                              Dec (9,7)
Fiscal Month                                                                   Char (2)                       1 - 12
Fiscal Year                                                                    Char (4)                        2001
MEPRS                                                                          Char (3)                        BAA
Treatment DMIS ID                                                              Char (4)




   October 2011 Version                                               Completion Factors - SADR                                           Page 78 of 1408
                                                                     Completion Factors - SIDR

                                                           Direct Care Completion Factors (SIDR)
Common File Name: sidr.compfac.fyXX.txt.Z, where 'XX' is the two digit fiscal year - ranging from '99+
Object Class Location: /mdr/pub/sidr/compfac/
Update Frequency: Updated monthly                                                                                 Data Source System: MDR
Description:
                                                                                      Position or SAS
          Data Element                     Definition                  Format                            Values                    Notes
                                                                                         Variable
Cost/Workload Completion Factor                                        Dec (9,7)

Disposition Completion Factor                                          Dec (9,7)

Fiscal Month                                                           Char (2)                          1 - 12

Fiscal Year                                                            Char (4)                           2001

Treatment DMIS ID                                                      Char (4)




  October 2011 Version                                              Completion Factors - SIDR                                               Page 79 of 1408
                       Completion Factors - SIDR



                                    Return to the
                                      Table of
                                      Contents




October 2011 Version   Completion Factors - SIDR    Page 80 of 1408
                                                                                                                            CPT Table

                                                                                                                            CPT Table
Common File Name: rvu.cy<XX>/rvumast.sas7bdat, where XX=03+
Dataset Location: Master Table: SAS Data Set: /mdr/ref/rvu.cy<yy>/rvumast.sas7bdat Text file:/mdr/ref/rvu.cy<yy>.txt
Update Frequency: Shortly after January 1st, preliminary tables are delivered for                                                use for that calendar year. Near June 1st, the final weight
                                                                                                                                                                                                   Source System: MHS, Modified Ingenix
tables for the current and previous years (if altered) are delivered for use in both the annual retrofits of data and all subsequent routine data processing.


Description: SAS data sets and PROC FORMAT constructs for application of CPT RVUs and related fields to MDR files reporting CPT procedure codes.
                                                                                                                                                                           Included in
                                                                                                                                               Position or
Data Element                                                                 Definition                                      Format                                     DC       PC       Anc                       Notes
                                                                                                                                              SAS Variable
                                                  Code used for reporting medical services and
CPT/HCPCS Code                                                                                                                Char(5)                PROC                X                     X
                                                  procedures.
                                                  Code used to indicate that a service or procedure
Modifier                                          was altered by specific circumstances but not                               Char(2)                 MOD                                      X
                                                  changed in its definition or code.
                                                  Reflects the relative value or cost of the provider‟s
Direct Care Work RVUs                                                                                                        NNN.NN                WORKDC                X                     X
                                                  time and skill, with global reduction where applicable.

                                                  Reflects the relative value or cost of the provider‟s
                                                  rent, staff, supplies, equipment and other overhead
Direct Care Facility Practice
                                                  associated with the service when provided in a                             NNN.NN              PEXPFADC                X                     X
Expense RVUs
                                                  hospital, ambulatory surgery center or skilled nursing
                                                  facility, with global reduction where applicable.
                                                  Reflects the relative value or cost of the provider‟s
                                                  rent, staff, supplies, equipment and other overhead
Direct Care Non-Facility Practice
                                                  associated with the service when provided in the                           NNN.NN              PEXPNFDC                X                     X
Expense RVUs
                                                  physician‟s office, with global reduction where
                                                  applicable.
                                                  Reflects the relative risk or professional liability
Direct Care Malpractice Expense
                                                  associated with the service, with global reduction                         NNN.NN              MALEXPDC                X
RVUs
                                                  where applicable.
                                                  For trending purposes, CY06 Direct Care Work RVUs
                                                  are used for all CY07+ tables. For codes without
Direct Care Historical Work RVU                   CY06 weights, the current weight is used. For CY06                         NNN.NN                 HISTDC               X
                                                  and prior years, this field contains Direct Care work
                                                  weights for that year.
                                                  The number of days for which related services are
                                                  included in the global work. If not a global procedure,
Global Days                                                                                                                     NNN                 GLOBAL
                                                  this field is blank in the ASCII file and missing in the
                                                  SAS Data Set.
                                                  Reflects the relative value or cost of the provider‟s
Purchased Care Work RVUs                                                                                                     NNN.NN                WORKPC
                                                  time and skill.




    October 2011 Version                                                                                                    CPT Table                                                                                    Page 81 of 1408
                                                                                            CPT Table

                                                                                                                        Included in
                                                                                                         Position or
Data Element                                           Definition                           Format                     DC   PC   Anc   Notes
                                                                                                        SAS Variable
                                   Reflects the relative value or cost of the provider‟s
                                   rent, staff, supplies, equipment and other overhead
Purchased Care Facility Practice
                                   associated with the service when provided in a           NNN.NN       PEXPFAPC
Expense RVUs
                                   hospital, ambulatory surgery center or skilled nursing
                                   facility.
                                   Reflects the relative value or cost of the provider‟s
Purchased Care Non-Facility        rent, staff, supplies, equipment and other overhead
                                                                                            NNN.NN       PEXPNFPC
Practice Expense RVUs              associated with the service when provided in the
                                   physician‟s office.
Purchased Care Malpractice         Reflects the relative risk or professional liability
                                                                                            NNN.NN       MALEXPPC
Expense RVUs                       associated with the service.
                                   For trending purposes, CY06 Purchased Care Work
                                   RVUs are used for all CY07+ tables. For codes
Purchased Care Historical Work
                                   without CY06 weights, the current weight is used. For    NNN.NN        HISTPC
RVU
                                   CY06 and prior years, this field contains Purchased
                                   Care work weights for that year.
                                   Outpatient Prospective Payment System code
Payment Status Indicators                                                                    Char(1)        PSI        X    X
                                   identifying payment and discounting rules.
                                   Maximum number of units that can be credited for a
                                   CPT code. If there is no defined limit, the value is
Unit of Service Limits                                                                        NNN         UOSLIM       X    X
                                   set to blank in the ASCII file and missing in the SAS
                                   data set.
                                   ASC Payment Group. Populated for FY07+ only.
Ambulatory Surgical Center Class   CY06 has 9 defined groups; CY07+ has 56 defined           Char(2)        ASC        X    X
                                   groups.




   October 2011 Version                                                                     CPT Table                                      Page 82 of 1408
                                                                             CSS

                                                                CSS (Customer Satisfaction Survey)
Common File Names: dodMMYY.sas7bdat (US sites), dodlMMYY (Latin America Sites), and dodeMMYY (Europe Sites),
                               where 'MM' is the 2-digit calendar month and 'YY' is the 2-digit calendar year.
Dataset Location: /mdr/pub/css/cyYY/css.cyYY.cmMM/, where 'MM' is the 2-digit calendar month and 'YY' is the 2-digit calendar year.
Update Frequency: Updated monthly                                                                               Data Source System: TMA Contractor Priv Src
Description: Each record is a survey response. Europe files available beginning May 1998. Latin America files available beginning January 2000.
                                                                             Position or SAS
      Data Element                            Definition          Format                            Values                                      Notes
                                                                                Variable
                                                                                                                    A=0-4         E = 25 - 34
                                                                                                A, B, C, D, E, F,   B = 5 - 14    F = 35 - 44
Age Group                Age Group of Respondent.                CHAR (1)       AGEGRP
                                                                                                      G, H          C = 15 - 17   G = 45 - 64
                                                                                                                    D = 18 - 24   H = 65+

Appointment Date         Appointment Date.                       CHAR (7)      APPTDATE          e.g. 01/2004       MM/YYYY

                                                                                                                    1 = Dependent of Active Duty/Guard
                                                                                                                    2 = Retired
Ben Cat Common           Broadest category of beneficiaries.     CHAR (1)       COMBEN            1, 2, 3, or 4     3 = Dependent of Retired or Survivor, Other, Unknown
                                                                                                                    4 = Active Duty and Guard.
                                                                                                                    Note: Not coded prior to December 2001.

                                                                                                                ACT = Active Duty
                                                                                                                RET = Retired
                                                                                                                GRD = Guard/Reserve
                                                                                               ACT, RET, GRD,
                                                                                                                DA = Family of Active Duty
Beneficiary Group        Beneficiary Group.                      CHAR (4)       BENEGRP        DA, DR, DS, OTH,
                                                                                                                DR = Family of Retired
                                                                                                     UNK
                                                                                                                DS = Survivor
                                                                                                                OTH = Other
                                                                                                                UNK = Unknown

Clinic Name              Clinic Name.                            CHAR (50)     CLINNAME                             No Transformation.

                                                                                                                    01 = January
                                                                                                                    02 = February
                                                                                                                    03 = March
                                                                                                                    04 = April
                                                                                                                    05 = May
                                                                                                                    06 = June
CM                       Calendar Month of Appointment.          CHAR (2)          CM               12-Jan          07 = July
                                                                                                                    08 = August
                                                                                                                    09 = September
                                                                                                                    10 = October
                                                                                                                    11 = November
                                                                                                                    12 = December.
                                                                                                                    Note: Not coded prior to December 2001.

                                                                                                 1997 - current
CY                       Calendar Year of Appointment.           CHAR (4)          CY                               Note: Not coded prior to December 2001.
                                                                                                     year




  October 2011 Version                                                       CSS                                                                           Page 83 of 1408
                                                                                        CSS

                                                                                        Position or SAS
      Data Element                           Definition                      Format                            Values                                       Notes
                                                                                           Variable
                                                                                                                              01 - 19 = Dependent Child of Sponsor
                                                                                                                              20 = Sponsor
                                                                                                                              30 - 39 = Spouse/Former Spouse
                                                                                                                              40 = Mother/Step-Mother of Sponsor
                                                                                                             01 - 19, 20,
                                                                                                                              45 = Father, Step-Father of Sponsor
                                                                                                           30 - 39, 40, 45,
Family Member Prefix     Family Member Prefix.                               CHAR (2)         FMP                             50 = Mother-In-Law of Sponsor
                                                                                                           50, 55, 60 - 69,
                                                                                                                              55 = Father-In-Law of Sponsor
                                                                                                           90 - 95, 98, 99
                                                                                                                              60 - 69 = Other Authorized Dependent of Sponsor
                                                                                                                              90 - 95 = Beneficiary Authorized By Statute
                                                                                                                              98 = Civilian Emergency
                                                                                                                              99 = All others, not elsewhere classified

                                                                                                                              01 = October
                                                                                                                              02 = November
                                                                                                                              03 = December
                                                                                                                              04 = January
                                                                                                                              05 = February
                                                                                                                              06 = March
FM                       Fiscal Month of Appointment.                        CHAR (2)         FM               12-Jan         07 = April
                                                                                                                              08 = May
                                                                                                                              09 = June
                                                                                                                              10 = July
                                                                                                                              11 = August
                                                                                                                              12 = September.
                                                                                                                              Note: Not coded prior to December 2001.

                                                                                                           1997 - current
FY                       Fiscal Year of Appointment.                         CHAR (4)         FY                              Note: Not coded prior to December 2001.
                                                                                                               year
                                                                                                                              M = Male
Gender                   Gender of Respondent.                               CHAR (1)      GENDER               M, F
                                                                                                                              F = Female

Intermediate Command     Intermediate Command.                               CHAR (2)      COMMID           e.g. A1, A2       No Derivation.

                         Code that indicates the eligibility status of the                                                    N = if patient is Active Duty or age is < 65
Medicare Flag            beneficiary for Medicare Service. Determined        CHAR (1)     MEDFLAG               Y, N          Y = if Non-Active Duty patient age >= 65
                         by the patient's age on date of care.                                                                Note: Not coded prior to December 2001.
                                                                                                                          See MEPRS Codes 3 for standardized tri-service 3rd level
MEPRS 3 Code             MEPRS 3 Code.                                       CHAR (3)      MEPRS3             e.g. BAA
                                                                                                                          codes.
                                                                                                                          See MEPRS Codes 3 for standardized tri-service 3rd level
MEPRS 4 Code             MEPRS 4 Code.                                       CHAR (4)      MEPRS4         e.g. BAAA, BAAB codes. Most 4th level MEPRS codes are unique to the
                                                                                                                          reporting facility.
                         CSS Parent DMIS ID (roll-up is CSS Survey
Parent DMIS ID                                                               CHAR (4)      PDMISID            e.g. 0001     See DMIS Information. Note: Not coded prior to December 2001.
                         specific).
                                                                                                                              1 = Urgent care
                                                                                                                              2 = Routine care
Q1                       Q1 Main purpose for visit.                          NUM (8)          Q1             1, 2, 3 or 4
                                                                                                                              3 = Check-up
                                                                                                                              4 = Specialty care




  October 2011 Version                                                                  CSS                                                                              Page 84 of 1408
                                                                    CSS

                                                                    Position or SAS
      Data Element                          Definition    Format                         Values                              Notes
                                                                       Variable
                                                                                                        1 = Dr. ___
Q2                      Q2 Provider seen.                 NUM (8)         Q2              1 or 2
                                                                                                        2 = Other Provider
                                                                                                        1 = Poor
                                                                                                        2 = Fair
Q3A                     Q3A Friendliness Rating.          NUM (8)         Q3A         1, 2, 3, 4 or 5   3 = Good
                                                                                                        4 = Very good
                                                                                                        5 = Excellent
                                                                                                        1 = Poor
                                                                                                        2 = Fair
Q3B                     Q3B Attention Rating.             NUM (8)         Q3B         1, 2, 3, 4 or 5   3 = Good
                                                                                                        4 = Very good
                                                                                                        5 = Excellent

                                                                                                        1 = Poor
                                                                                                        2 = Fair
Q3C                     Q3C Thoroughness Rating.          NUM (8)         Q3C         1, 2, 3, 4 or 5   3 = Good
                                                                                                        4 = Very good
                                                                                                        5 = Excellent

                                                                                                        1 = Poor
                                                                                                        2 = Fair
Q3D                     Q3D Explanation Rating.           NUM (8)         Q3D         1, 2, 3, 4 or 5   3 = Good
                                                                                                        4 = Very good
                                                                                                        5 = Excellent

                                                                                                        1 = Poor
                                                                                                        2 = Fair
Q3E                     Q3E Interest Rating.              NUM (8)         Q3E         1, 2, 3, 4 or 5   3 = Good
                                                                                                        4 = Very good
                                                                                                        5 = Excellent

                                                                                                        1 = Poor
                                                                                                        2 = Fair
Q3F                     Q3F Advice Rating.                NUM (8)         Q3F         1, 2, 3, 4 or 5   3 = Good
                                                                                                        4 = Very good
                                                                                                        5 = Excellent

                                                                                                        1 = Poor
                                                                                                        2 = Fair
Q3G                     Q3G Amount of time w/ Dr. ___ .   NUM (8)         Q3G         1, 2, 3, 4 or 5   3 = Good
                                                                                                        4 = Very good
                                                                                                        5 = Excellent

                                                                                                        1 = Poor
                                                                                                        2 = Fair
Q3H                     Q3H Helped by care.               NUM (8)         Q3H         1, 2, 3, 4 or 5   3 = Good
                                                                                                        4 = Very good
                                                                                                        5 = Excellent




 October 2011 Version                                               CSS                                                              Page 85 of 1408
                                                                        CSS

                                                                        Position or SAS
      Data Element                          Definition        Format                          Values                                         Notes
                                                                           Variable

                                                                                                               1 = Poor
                                                                                                               2 = Fair
Q3I                      Q3I Care met needs.                  NUM (8)         Q3I          1, 2, 3, 4 or 5     3 = Good
                                                                                                               4 = Very good
                                                                                                               5 = Excellent

                                                                                                               1 = Poor
                                                                                                               2 = Fair
Q3J                      Q3J Overall quality.                 NUM (8)         Q3J          1, 2, 3, 4 or 5     3 = Good
                                                                                                               4 = Very good
                                                                                                               5 = Excellent


                                                                                                               1 = Definitely not
                                                                                                               2 = Probably not
Q4                       Q4 Would you recommend Dr. ___.      NUM (8)         Q4            1, 2, 3 or 4
                                                                                                               3 = Probably yes
                                                                                                               4 = Definitely yes


                                                                                                               1 = Completely dissatisfied
Q5                       Q5 Satisfaction with care.           NUM (8)         Q5                1-7            ...
                                                                                                               7 = Completely satisfied


                                                                                                               1 = Same
                                                                                                               2=1
                                                                                                               3=2-3
                                                                                                               4=4-7
Q6                       Q6 Days: Appointment made to seen.   NUM (8)         Q6                1-8
                                                                                                               5 = 8 - 14
                                                                                                               6 = 15 - 30
                                                                                                               7 = 30+
                                                                                                               8 = Walk in


                                                                                                               1 = Poor
                                                                                                               2 = Fair
Q7                       Q7 Waiting time of appointment.      NUM (8)         Q7           1, 2, 3, 4 or 5     3 = Good
                                                                                                               4 = Very good
                                                                                                               5 = Excellent


                                                                                                               Minutes:
                                                                                                               1 = Did not wait
                                                                                                               2 = 1 - 15
Q8                       Q8 Wait past appointment time.       NUM (8)         Q8          1, 2, 3, 4, 5 or 6   3 = 16 - 30
                                                                                                               4 = 31 - 45
                                                                                                               5 = 46 - 60
                                                                                                               6 = 60+




  October 2011 Version                                                  CSS                                                                          Page 86 of 1408
                                                                         CSS

                                                                         Position or SAS
       Data Element                        Definition          Format                         Values                                       Notes
                                                                            Variable

                                                                                                             1 = Poor
                                                                                                             2 = Fair
Q9                      Q9 Minutes waiting.                    NUM (8)         Q9          1, 2, 3, 4 or 5   3 = Good
                                                                                                             4 = Very good
                                                                                                             5 = Excellent

                                                                                                             1 = Poor
                                                                                                             2 = Fair
Q10A                    Q10A Making appointment by phone.      NUM (8)         Q10A        1, 2, 3, 4 or 5   3 = Good
                                                                                                             4 = Very good
                                                                                                             5 = Excellent

                                                                                                             1 = Poor
                                                                                                             2 = Fair
Q10B                    Q10B Access to medical care.           NUM (8)         Q10B        1, 2, 3, 4 or 5   3 = Good
                                                                                                             4 = Very good
                                                                                                             5 = Excellent

                                                                                                             1 = Poor
                                                                                                             2 = Fair
Q10C                    Q10C Obtaining referral (spec care).   NUM (8)         Q10C        1, 2, 3, 4 or 5   3 = Good
                                                                                                             4 = Very good
                                                                                                             5 = Excellent
                                                                                                             1 = Poor
                                                                                                             2 = Fair
Q11                     Q11 Length of time to return call.     NUM (8)         Q11         1, 2, 3, 4 or 5   3 = Good
                                                                                                             4 = Very good
                                                                                                             5 = Excellent

                                                                                                             1 = Completely dissatisfied
Q12                     Q12 Overall satisfaction.              NUM (8)         Q12             1-7           ...
                                                                                                             7 = Completely satisfied

                                                                                                             1 = Poor
                                                                                                             2 = Fair
Q13A                    Q13A Pharmacy Rating.                  NUM (8)         Q13A        1, 2, 3, 4 or 5   3 = Good
                                                                                                             4 = Very good
                                                                                                             5 = Excellent

                                                                                                             1 = Poor
                                                                                                             2 = Fair
Q13B                    Q13B X-Ray Services Rating.            NUM (8)         Q13B        1, 2, 3, 4 or 5   3 = Good
                                                                                                             4 = Very good
                                                                                                             5 = Excellent




 October 2011 Version                                                    CSS                                                                       Page 87 of 1408
                                                                          CSS

                                                                          Position or SAS
       Data Element                      Definition            Format                           Values                                       Notes
                                                                             Variable
                                                                                                                1 = Poor
                                                                                                                2 = Fair
Q13C                    Q13C Laboratory Services Rating.       NUM (8)          Q13C         1, 2, 3, 4 or 5    3 = Good
                                                                                                                4 = Very good
                                                                                                                5 = Excellent


                                                                                                                1 = Poor
                                                                                                                2 = Fair
Q13D                    Q13D Medical Record Services Rating.   NUM (8)          Q13D         1, 2, 3, 4 or 5    3 = Good
                                                                                                                4 = Very good
                                                                                                                5 = Excellent

                                                                                                                1 = Yes
                                                                                                                2 = No
Q14                     Q14 TRICARE Prime Enrollment.          NUM (8)          Q14           1, 2, 3 or 4
                                                                                                                3 = Not eligible to enroll
                                                                                                                4 = Don't know

                                                                                                                1 = Yes
Q15                     Q15 Is Dr. ___ your PCM.               NUM (8)          Q15             1, 2 or 3       2 = No
                                                                                                                3 = Don't know

                                                                                                                1 = Enroll
                                                                                                                2 = Re-enroll
Q16                     Q16 Reenrollment in TRICARE Prime.     NUM (8)          Q16          1, 2, 3, 4 or 5    3 = De-enroll
                                                                                                                4 = Not enroll
                                                                                                                5 = Not avail.

                                                                                                                1 = Excellent
                                                                                                                2 = Very good
Q17                     Q17 Your health Rating.                NUM (8)          Q17          1, 2, 3, 4 or 5    3 = Good
                                                                                                                4 = Fair
                                                                                                                5 = Poor

                                                                                                                A = Officer (01 - 10, MO)
                                                                                                                B = Warrant Officer (W1 - W4)
                                                                                                                C = Cadet/Midshipman (CD)
                                                                                            A, B, C, D, E, F,   D = Senior Enlisted (E5 - E9)
Rank                    Rank.                                  CHAR (1)     RANKGRP
                                                                                                  G, X          E = Junior Enlisted (E1 - E4)
                                                                                                                F = Other Military (ME enlisted)
                                                                                                                G = Civilian (C3)
                                                                                                                X = Unknown




 October 2011 Version                                                     CSS                                                                        Page 88 of 1408
                                                                                      CSS

                                                                                      Position or SAS
         Data Element                        Definition                    Format                           Values                                     Notes
                                                                                         Variable
                                                                                                                          A = Army
                                                                                                                          B = NOAA
                                                                                                                          C = Coast Guard
                                                                                                                          F = Air Force
                                                                                                        A, B, C, F, K, M,
Sponsor Branch of Service   Sponsor Branch of Service.                    CHAR (1)          PATCAT                        K = Other
                                                                                                            N, P, R
                                                                                                                          M = Marines
                                                                                                                          N = Navy
                                                                                                                          P = Public Health Service
                                                                                                                          R = NATO/Non-NATO

                                                                                                                            A = Army
                                                                                                                            C = Coast Guard
                                                                                                                            F = Air Force
                                                                                                                            M = Marine Corps
Sponsor Service Common      Sponsor Service Common.                       CHAR (1)       COMSVC         A, C, F, M, N, Z
                                                                                                                            N = Navy
                                                                                                                            Z = Other
                                                                                                                            Prior to Nov 98 for US surveys and Oct 98 for Overseas
                                                                                                                            Surveys, All Values are Z.

Treatment MTF               Treatment MTF.                                CHAR (4)          DMISID         e.g. 0001        See DMIS Information.

Treatment MTF Name          Treatment MTF Name.                           CHAR (36)     MTFNAME                             See DMIS Information.

                                                                                                                            01 = Northeast
                                                                                                                            02 = Mid-Atlantic
                                                                                                                            03 = Southeast
                                                                                                                            04 = Gulf South
                                                                                                                            05 = Heartland
                                                                                                                            06 = Southwest
                                                                                                                            07 = TRICARE Central
                                                                                                        01 - 07, 09 - 12,   09 = Southern California
Treatment MTF Region        Treatment MTF Region.                         CHAR (2)          REGION
                                                                                                        14, 15, EU, AK      10 = Golden Gate
                                                                                                                            11 = Northwest
                                                                                                                            12 = TRICARE Pacific
                                                                                                                            EU = Europe
                                                                                                                            14 = Western Pacific/Asia
                                                                                                                            15 = Central/South America & Other
                                                                                                                                OCONUS
                                                                                                                            AK = Alaska

                                                                                                                            A = Army
Treatment MTF Service       Treatment MTF Service.                        CHAR (1)       SERVICE            A, F, N         F = Air Force
                                                                                                                            N = Navy

Treatment MTF Type          Treatment MTF Type.                           CHAR (1)      MTFTYPE              2 or 3         No Derivation.

                            Weight associated with each individual
Weight                      response. Based on MTF size and beneficiary    NUM (8)       WEIGHT                             No Derivation.
                            demographic factors, and response rates.




  October 2011 Version                                                                CSS                                                                           Page 89 of 1408
                                                                                         DESPROV (Clinical)

                                                                                  Clinical Designated Provider File

Common File Name: clin.sas7bdat
Dataset Location: /mdr/pub/desprov/fyXX/ where 'XX' is the two digit fiscal year - ranging from '02 forward
                                                                                                                                     Source System: Designated Provider
Update Frequency: Updated Monthly
                                                                                                                                     Contractor Database
Description: Clinical Designated Provider Master File
                                                                                                        Position or
          Data Element                                Definition                           Format                       Values                               Notes
                                                                                                       SAS Variable

                                                                                                                                     0190 = Johns Hopkins Medical Services Corporation
                                                                                                                                     0191 = Brighton Marine Health Care
                                                                                                                                     0192 = CHRISTUS Health-St Johns
                               DMIS ID Representing one of eight Designated                                                          0193 = St. Vincent Catholic Medical Centers of NY
DMIS ID                                                                                    Char(4)        DMISID      190 - 198
                               Provider Enrolling sites.                                                                             0194 = Pacific Medical Clinics
                                                                                                                                     0196 = CHRISTUS Health-St. Joseph‟s
                                                                                                                                     0197 = CHRISTUS Health-St. Mary's (inactive)
                                                                                                                                     0198 = Martin‟s Point Health Care

                               Identifier that uniquely identifies a family for the
DEERS Family Identifier                                                                    Char(9)        FAMID                      Assigned by DEERS.
                               purposes of DoD benefits.

                               Identifier that uniquely identifies a family member for                                               00 = Sponsor
DEERS Beneficiary Identifier                                                               Char(2)        BENID         00 - 99
                               the purposes of DoD benefits.                                                                         01 - 99 = Dependents


Patient Identifier             Identifier associated with a specific patient.              Char(10)       PATID                      Same as the EDIPN in the PITE.


Sponsor Social Security NumberSocial Security Number of the beneficiary's sponsor.         Char(9)      SPONSSN


                                                                                                                                     01 - 19 = Dependent Child
                                                                                                                                     20 = Sponsor
                                                                                                                                     30 - 39 = Spouse of sponsor
                                                                                                                                     40 - 44 = Mother of sponsor
                                                                                                                                     45 - 49 = Father of sponsor
                            DEERS specific code indicating the relationship of                                        01 - 19, 20,
Legacy DEERS Dependent Suffix                                                              Char(2)            DDS                    50 - 54 = Mother-In-Law of sponsor
                            the beneficiary to the sponsor.                                                           30 - 75, 98
                                                                                                                                     55 - 59 = Father-In-Law of sponsor
                                                                                                                                     60 - 69 = Other eligible dependents
                                                                                                                                     70 - 74 = Unknown by DEERS
                                                                                                                                     75 = Pseudo DDS unknown by contractor
                                                                                                                                     98 = Service secretary designee

Patient's Last Name            Last name of the patient.                                   Char(26)      LNAME
Patient's First Name           First name of the patient.                                  Char(20)      FNAME
Patient's Middle Name          Middle name of the patient.                                 Char(20)      MNAME
Patient's Cadency Name         Cadency name of the patient.                                Char(4)      CADENCY
Patient's Date of Birth
                               Date of birth of the patient.                               Date(8)            DOB                    SAS Date
(SAS Date)




   October 2011 Version                                                                  DESPROV (Clinical)                                                            Page 90 of 1408
                                                                                           DESPROV (Clinical)

                                                                                                          Position or
         Data Element                                   Definition                           Format                         Values                                  Notes
                                                                                                         SAS Variable
                                                                                                                                         F = Female
Patient's Gender                  Code used to indicate the gender of the patient.           Char(1)       PATSEX           F, M, Z      M = Male
                                                                                                                                         Z = Unknown
                                                                                                                                         Valid claim, invoice encounter, or reference number that
                             Unique claim or episode of care number.                                                                     uniquely identifies the encounter. Every transaction type "I"
Unique Patient Reference Number
                             Valid claim, invoice encounter, or reference number             Char(12)       RECID                        record will have a separate unique number. On
                             that uniquely identifies the encounter.                                                                     transactions "C", "D", and "F", the record will have the
                                                                                                                                         originally submitted unique patient reference number.
                                                                                                                                         I = Initial submission
                                                                                                                                         F = Further episode submission
                                  Code to indicate the transaction type of the record on                                                 C = Correction submission
Transaction Type                                                                             Char(1)      TRANTYPE         I, F, C, D
                                  Clinical and Pharmacy submissions.                                                                     D = Delete submission
                                                                                                                                         The "F" Transaction is an overflow record of additional
                                                                                                                                         information from the preceding record.

Fiscal Year                       Fiscal year the drug was dispensed.                        Num(8)             FY          2002+        Derived from the latest encounter date.


                                                                                                                                         1 = October        7 = April
                                                                                                                                         2 = November        8 = May
                                                                                                                                         3 = December        9 = June
                                                                                                                                         4 = January       10 = July
Fiscal Month                      Fiscal month the drug was dispensed.                       Num(8)             FM           1 - 12
                                                                                                                                         5 = February       11 = August
                                                                                                                                         6 = March         12 = September

                                                                                                                                         Derived from the latest encounter date.


Patient's Zip Code                US resident zip code of the patient.                       Char(5)        PATZIP


                                  Code that represents how DEERS views the sponsor
Member Category Code                                                                         Char(1)       MEMCAT                        See Designated Provider Codes List
                                  based on his or her entitlements.


                                                                                                                                          A = Army
                                                                                                                                          C = Coast Guard
                                                                                                                                          D = Office of the Secretary of Defense
                                                                                                                                          F = Air Force
                                                                                                                                          H = The Commissioned Corps of the Public Health Service
                                                                                                                                          M = Marine Corps
                                Code that represents the branch of service                                              A, D, C, F, H, M, N = Navy
Service Branch Classification Code                                                           Char(1)       SERVICE
                                classification with which the sponsor is affiliated.                                     N, O, X, 1 - 4   O = The Commissioned Corps of the National Oceanic and
                                                                                                                                          Atmospheric Administration (NOAA)
                                                                                                                                          X = Not Applicable
                                                                                                                                          1 = Foreign Army
                                                                                                                                          2 = Foreign Navy
                                                                                                                                          3 = Foreign Marine Corps
                                                                                                                                          4 = Foreign Air Force




   October 2011 Version                                                                    DESPROV (Clinical)                                                                 Page 91 of 1408
                                                                                           DESPROV (Clinical)

                                                                                                          Position or
         Data Element                                  Definition                            Format                     Values                                Notes
                                                                                                         SAS Variable
                                                                                                                                  H = Hospital Services
Encounter Setting                Setting of patient encounter/episode of care.               Char(1)            ENC     H, I, O   I = Inpatient Professional Services
                                                                                                                                  O = Outpatient Professional Services

                                ICD-9-CM code, in the inpatient setting, identifying
                                the condition established, after study, to be chiefly
Patient Principal/Primary Diagnosis
                                responsible for the patient to have obtained medical         Char(7)            PDX
                                care; or in the outpatient setting, the reason for the
                                encounter.

                                 ICD-9-CM code identifying a j diagnosis that affects
Patient Diagnosis J              the care, management, or treatment provided during          Char(7)            DXJ               J = diagnosis code 2 - 12
                                 an inpatient or outpatient encounter.

                                 Provider's Tax ID number for the individual/group
                                 responsible for the service provided. Use clinic's Tax
Tax ID of Provider Entity        ID when care is provided in a clinic setting,               Char(9)        TAXID
                                 physician's Tax ID if care is provided in a non-clinic
                                 setting, or pharmacy's Tax ID for pharmacies.
Unique Provider ID Number        Facility created unique provider ID number.                 Char(18)      PROVID
                                 Provider Major Specialty code or type of institution
Major Spec/Institution Type                                                                  Char(2)            SPC               See Designated Provider Codes.
                                 where care was provided.
                                                                                                                                  United States: 006010000 - 999509999
Provider Zip Code                Zip code of provider/pharmacy providing service.            Char(9)       PROVZIP
                                                                                                                                  Outside United States or Unknown: 123456789
                                                                                                                                  For Inpatient and Outpatient Professional Services
                                 Provider who ordered ancillary services, or who                                                  Records, this field is equal to the Unique Provider ID for the
Ordering Physician                                                                           Char(18)     ORDERPHY
                                 referred patient for specialty or inpatient care.                                                physician who ordered the services; field should be blank
                                                                                                                                  for Hospital Services.
                                 The facility‟s total charges generated by or billed to
                                 the beneficiary for services rendered for one full
Cost Data                        episode of care when reporting clinical encounters.         Num(11)        COST
                                 An episode of care is one issuance of one clinical
                                 encounter/prescription.
                                 Money collected from the beneficiary or family unit for
Co-payment Amount Collected                                                                  Num(6)         COPAY
                                 an episode of care.
Emergency Flag                   Flag indicating emergency ambulatory care.                  Char(1)       ERFLAG        Y, N
Date of Related Admission        Date of admission for inpatient hospital care related
                                                                                             Date(8)      ADMDATE
(SAS Date)                       to professional services.
Date of Related Disposition      Date of disposition for inpatient hospital care related
                                                                                             Date(8)      DISPDATE
(SAS Date)                       to professional services.


Number of Services               Number of professional services provided.                   Char(1)      NUMSVCS


Service J Start Date             Start date the provider provided service for this
                                                                                             Date(8)      SVCBEGJ                 J = Service 1 - 6
(SAS Date)                       encounter.




   October 2011 Version                                                                    DESPROV (Clinical)                                                           Page 92 of 1408
                                                                                         DESPROV (Clinical)

                                                                                                        Position or
        Data Element                                 Definition                            Format                     Values                             Notes
                                                                                                       SAS Variable
Service J End Date            Last date the provider provided service for this
                                                                                           Date(8)      SVCENDJ                J = Service 1 - 6
(SAS Date)                    encounter.

                              Code that represents the type of setting in which                                                See Designated Provider Codes
Service J Place Of Service                                                                 Char(2)       SVCPLCJ
                              provider performed the service/procedure.                                                        J = Service 1 - 6

                                                                                                                               Valid Revenue Center Codes:

                                                                                                                               RC570 = Home Health Aide general classification-
                                                                                                                                 personal care of the patient
                                                                                                                               RC572 = Home Health Aide Hourly Charge-personal
                                                                                                                                 care of the patient
                                                                                                                               RC579 = Home Health Aide Other Charge-personal
                                                                                                                                 care of the patient
                                                                                                                               RC580 = Home Health General visit Charge-visits other
                                                                                                                                 than therapy
                                                                                                                               RC581 = Home Health Visit Charge-visits other than
                              CPT, HCPCS or approved Revenue Center codes                                                        therapy
Service J Procedure Code                                                                  Char(13)      SVCPROCJ
                              describing the service and/or procedure performed.                                               RC582 = Home Health Visit hourly Charge-visits other
                                                                                                                                 than therapy
                                                                                                                               RC589 = Home Health Visit other unit charge-visits other
                                                                                                                                 than therapy
                                                                                                                               RC590 = Home Health Unit Service general
                                                                                                                               RC591 = Home Health Unit Service other
                                                                                                                               RC560 = Home Health Oxygen general
                                                                                                                               RC562 = Home Health Oxygen
                                                                                                                               RC571 = Home Health Aide Visit Charge-personal care
                                                                                                                                 of the patient

                                                                                                                               J = Service 1 - 6

                              ICD-9-CM code for the diagnosis or related sign,
Service J Related Diagnosis
                              symptom, or finding responsible for the service              Char(7)       SVCDXJ                J = Service 1 - 6
Code
                              provided.
                              Number of days or units, most commonly used for
Service J Quantity            multiple visits, units of supplies, anesthesia units, or     Char(3)      SVCQTYJ                J = Service 1 - 6
                              oxygen volume
Hospital Service Admission
                              Date of hospital admission.                                  Date(8)      HOSPADM
Date (SAS Date)
                                                                                                                               1 = Emergency
Hospital Service Admission    The code to indicate admission type for hospital                                                 2 = Urgent
                                                                                           Char(1)      HOSPTYPE
Type                          services stay.                                                                                   3 = Elective
                                                                                                                               4 = Newborn




   October 2011 Version                                                                  DESPROV (Clinical)                                                        Page 93 of 1408
                                                                                       DESPROV (Clinical)

                                                                                                      Position or
        Data Element                                 Definition                          Format                         Values                                    Notes
                                                                                                     SAS Variable
                                                                                                                                       1 = Physician Referral
                                                                                                                                       2 = Clinic Referral
                                                                                                                                       3 = HMO Referral
                                                                                                                                       4 = Transfer from a Hospital
Hospital Service Admission     The code to indicate source of admission for this
                                                                                         Char(1)      HOSPSRC            1-9           5 = Transfer from a Skilled Nursing Facility
Source                         hospital stay.
                                                                                                                                       6 = Transfer from Another Health Care Facility
                                                                                                                                       7 = Emergency
                                                                                                                                       8 = Court / Law Enforcement
                                                                                                                                       9 = Information Not Available

                                                                                                                                       01 = Discharge to home or self-care
                                                                                                                                       02 = Discharged/Transferred to another short-term
                                                                                                                                             general hospital
                                                                                                                                       03 = Discharged/Transferred skilled nursing facility
                                                                                                                                             (SNF)
                                                                                                                                       04 = Discharged/Transferred to an intermediate care
                                                                                                                                             facility (ICF)
                                                                                                                                       05 = Discharged/Transferred to another type of institution
                                                                                                                                       06 = Discharged/Transferred to home under care of
                                                                                                                                             organized home health service organization
                                                                                                                                       07 = Left against medical advice
                                                                                                                                       09 = Reserved for national assignment
                                                                                                                    01 - 07, 09, 10,   10 - 19 = Discharged to be defined at state level, if
Hospital Service Disposition   The code to indicate status of patient upon discharge
                                                                                         Char(2)      HOSPSTAT      20, 21 - 29, 30,         necessary
Status                         from the hospital.
                                                                                                                    31 - 39, 40 - 99   20 = Deceased
                                                                                                                                       21 - 29 = Deceased to be defined at state level, if
                                                                                                                                            necessary
                                                                                                                                       30 = Still a patient
                                                                                                                                       31 - 39 = Still a patient to be defined at state level, if
                                                                                                                                            necessary
                                                                                                                                       *40 = Expired at home
                                                                                                                                       *41 = Expired in a medical facility; e.g., hospital, SNF,
                                                                                                                                               ICF, free standing hospice
                                                                                                                                       *42 = Expired-Place Unknown
                                                                                                                                       43 - 99 = Reserved for National Assignment

                                                                                                                                       *For use only on Medicare claims for hospital care
Hospital Service Disposition
                               Date of discharge from hospital.                          Date(8)      HOSPDISP
Date (SAS Date)
Diagnosis Related Group
                                                                                         Char(3)            DRG
(DRG)
Hospital Service Patient       ICD-9-CM code identifying the principal procedure
                                                                                         Char(7)     HOSPPRCP
Principal Procedure            performed during hospital stay.
Hospital Service Patient       ICD-9-CM code identifying the Jth procedure
                                                                                         Char(7)      HOSPPRCJ                         J = Procedure 2 - 6
Procedure J                    performed during hospital stay.
                               Equals the latest encounter date on the record.
Latest Encounter Date (SAS     Encounter dates considered include the disposition
                                                                                         Date(8)      LASTENC
Date)                          date, hospital service disposition date, and service
                               end dates 1-6.


   October 2011 Version                                                                DESPROV (Clinical)                                                                   Page 94 of 1408
                                                                                         DESPROV (Pharmacy)

                                                                                  Pharmacy Designated Provider File
Common File Name: prov.sas7bdat
Dataset Location: /mdr/pub/desprov/prov/
                                                                                                                                    Source System: Designated Provider Contractor
Update Frequency: Updated Monthly
                                                                                                                                    Database
Description: Designated Provider Master Provider File
                                                                                                      Position or SAS
          Data Element                                 Definition                          Format                        Values                                Notes
                                                                                                         Variable
                                                                                                                                    0190 = Johns Hopkins Medical Services Corporation
                                                                                                                                    0191 = Brighton Marine Health Care
                                                                                                                                    0192 = CHRISTUS Health-St Johns
                               DMIS ID Representing one of eight Designated                                                         0193 = St. Vincent Catholic Medical Centers of NY
DMIS ID                                                                                     Char(4)       DMISID        190 - 198
                               Provider Enrolling sites.                                                                            0194 = Pacific Medical Clinics
                                                                                                                                    0196 = CHRISTUS Health-St. Joseph‟s
                                                                                                                                    0197 = CHRISTUS Health-St. Mary's (inactive)
                                                                                                                                    0198 = Martin‟s Point Health Care

                               Identifier that uniquely identifies a family for the
DEERS Family Identifier                                                                     Char(9)       FAMID                     Assigned by DEERS
                               purposes of DoD benefits.

                               Identifier that uniquely identifies a family member for                                              00 = Sponsor
DEERS Beneficiary Identifier                                                                Char(2)       BENID          00 - 99
                               the purposes of DoD benefits.                                                                        01 - 99 = Dependents

Patient Identifier             Identifier associated with a specific patient.              Char(10)       PATID                     Same as the EDIPN in the PITE
Sponsor Social Security
                               Social Security Number of the beneficiary's sponsor.         Char(9)     SPONSSN
Number (SSN)

                                                                                                                                    01 - 19 = Dependent Child
                                                                                                                                    20 = Sponsor
                                                                                                                                    30 - 39 = Spouse of sponsor
                                                                                                                                    40 - 44 = Mother of sponsor
                                                                                                                                    45 - 49 = Father of sponsor
Legacy DEERS Dependent         DEERS specific code indicating the relationship of the
                                                                                            Char(2)        DDS           01 - 98    50 - 54 = Mother-In-Law of sponsor
Suffix                         beneficiary to the sponsor.
                                                                                                                                    55 - 59 = Father-In-Law of sponsor
                                                                                                                                    60 - 69 = Other eligible dependents
                                                                                                                                    70 - 74 = Unknown by DEERS
                                                                                                                                    75 = Pseudo DDS unknown by contractor
                                                                                                                                    98 = Service secretary designee

Patient's Last Name            Last name of the patient.                                   Char(26)       LNAME

Patient‟s First Name           TRICARE Regional Office Market Area IDs.                    Char(20)       FNAME

Patient‟s Middle Name          Default BPA Catchment Area ID for Navy/Marines.             Char(20)      MNAME

Patient‟s Cadency Name         Default BPA PRISM Area ID for Navy/Marines.                  Char(4)     CADENCY

Patient‟s Date Of Birth        Date of birth of the patient.                                Date(8)        DOB                      SAS Date




     October 2011 Version                                                                DESPROV (Pharmacy)                                                               Page 95 of 1408
                                                                                            DESPROV (Pharmacy)

                                                                                                         Position or SAS
        Data Element                                     Definition                           Format                         Values                                    Notes
                                                                                                            Variable
                                                                                                                                          F = Female
Patient‟s Gender                  Code used to indicate the gender of the patient.             Char(1)        SEX            F, M, Z      M = Male
                                                                                                                                          Z = Unknown
                                  Drug quantity the patient physically received, not the
Quantity Dispensed                                                                             Char(6)        QTY
                                  amount prescribed by the physician.
Date Dispensed                    Date the prescription was dispensed.                         Date(8)     DISPDATE                       SAS Date
                                                                                                                                          Valid Nation Drug Code
                                  Specific nation drug code number assigned for the
National Drug Code Number         drug, or the default values for the durable medical         Char(11)        NDC
                                                                                                                                          Valid NDC for DME = 55555555551
                                  equipment and compound drugs.
                                                                                                                                          Valid NDC for Compounds = 8888888881
                                  The facility‟s total charges generated by or billed to
                                  the beneficiary for services rendered for one full
Cost Data                         episode of care when reporting clinical encounters.         Num(11)        COST
                                  An episode of care is one issuance of one clinical
                                  encounter/prescription.
                                                                                                                                          00 = Not applicable or not available
                                                                                                                                          01 = Average Wholesale Price (AWP)
                                                                                                                                          02 = Local wholesale
                                                                                                                                          03 = Direct
                                                                                                                                          04 = Estimated Acquisition Cost (EAC)
                                                                                                                                          05 = Acquisition
                                                                                                                                          06 = Federal Maximum Allowable Cost (MAC)
                                  Code indicating the method used to calculate drug                                        00 - 09, 20,
Basis For Cost Determination                                                                   Char(3)     COSTDET                        06x = Brand medically necessary
                                  costs.                                                                                    30, 88, 90
                                                                                                                                          07 = Usual & customary (submitted total price)
                                                                                                                                          08 = Unit dose used on tape and diskette only
                                                                                                                                          09 = Other
                                                                                                                                          20 = State unit cost
                                                                                                                                          30 = Baseline price
                                                                                                                                          88 = Submitted ingredient cost
                                                                                                                                          90 = Undiscounted ingredient cost

                                                                                                                                          Valid claim, invoice encounter, or reference number that uniquely
                                                                                                                                          identifies the encounter. Every transaction type "I" record will
Unique Patient Reference
                                  Unique claim or episode of care number                      Char(12)       RECID                        have a separate unique number. On transactions "C", "D", and
Number
                                                                                                                                          "F", the record will have the originally submitted unique patient
                                                                                                                                          reference number.
                                  Money collected from the beneficiary or family unit for
Co-Payment Amount Collected                                                                    Num(6)        COPAY
                                  an episode of care.
                                  NABP (National Association of Board of Pharmacy)
Pharmacy NABP Number                                                                          Char(18)       RXNUM
                                  number assigned to the pharmacy.
Number Of Days Provided           Number of days the filled prescription will cover.           Num(3)      DAYSSUP
                                  Unique provider identifier number of the physician
Provider Prescribing Medication                                                               Char(18)      PROVID
                                  prescribing the medication.




    October 2011 Version                                                                    DESPROV (Pharmacy)                                                                     Page 96 of 1408
                                                                                          DESPROV (Pharmacy)

                                                                                                       Position or SAS
        Data Element                                   Definition                           Format                       Values                                    Notes
                                                                                                          Variable

                                                                                                                                      0 = Not Product Selection Indicated
                                                                                                                                      1 = Substitution NOT Allowed. Brand Drug Mandated by
                                                                                                                                          person who Prescribed it.
                                                                                                                                      2 = Substitution Allowed. Patient Requested Brand Drug.
                                                                                                                                      3 = Substitution Allowed. Pharmacist Selected Brand Drug.
                                                                                                                                      4 = Substitution Allowed. Generic Not in Stock.
                                 Code indicating if the drug was dispensed as written
Dispensed As Written Indicator                                                               Char(1)      GENERIC          0-9        5 = Substitution Allowed. Brand Drug Dispensed as Generic.
                                 on the prescription.
                                                                                                                                      6 = Override
                                                                                                                                      7 = Substitution NOT Allowed. Brand Drug Mandated by Law.
                                                                                                                                      8 = Substitution Allowed. Generic Not Available in
                                                                                                                                          Marketplace.
                                                                                                                                      9 = Other
                                                                                                                                      Blank is not a valid value.


                                                                                                                                      I = Initial submission
                                                                                                                                      F = Further episode submission
                                 Code to indicate the transaction type of the record on                                               C = Correction submission
Transaction Type                                                                             Char(1)     TRANTYPE        I, F, C, D
                                 Clinical and Pharmacy submissions.                                                                   D = Delete submission
                                                                                                                                      The "F" Transaction is an overflow record of additional
                                                                                                                                      information from the preceding record.

Fiscal Year                      Fiscal year the drug was dispensed.                         Num(8)            FY         2003+       Derived from the Dispensing Date.

                                                                                                                                      1 = October       7 = April
                                                                                                                                      2 = November      8 = May
                                                                                                                                      3 = December       9 = June
Fiscal Month                     Fiscal month the drug was dispensed.                        Num(8)            FM                     4 = January       10 = July
                                                                                                                                      5 = February      11 = August
                                                                                                                                      6 = March         12 = September
                                                                                                                                      Derived from dispensing date.




    October 2011 Version                                                                  DESPROV (Pharmacy)                                                                   Page 97 of 1408
                                                                                                DESPROV (Provider)

                                                                                             Designated Provider File

Common File Name: prov.sas7bdat
Dataset Location: /mdr/pub/desprov/prov/
                                                                                                                                             Source System: Designated Provider Contractor
Update Frequency: Updated Monthly
                                                                                                                                             Database
Description: Designated Provider Master Provider File
                                                                                                                  Position or
           Data Element                                        Definition                            Format                      Values                                  Notes
                                                                                                                 SAS Variable
                                                                                                                                             0190 = Johns Hopkins Medical Services Corporation
                                                                                                                                             0191 = Brighton Marine Health Care
                                                                                                                                             0192 = CHRISTUS Health-St Johns
                                        DMIS ID Representing one of eight Designated                                                         0193 = St. Vincent Catholic Medical Centers of NY
DMIS ID                                                                                              Char(4)          DMISID    190 - 198
                                        Provider Enrolling sites.                                                                            0194 = Pacific Medical Clinics
                                                                                                                                             0196 = CHRISTUS Health-St. Joseph‟s
                                                                                                                                             0197 = CHRISTUS Health-St. Mary's (inactive)
                                                                                                                                             0198 = Martin‟s Point Health Care
                                        Facility created unique provider ID number or each
Unique Provider ID Number/
                                        pharmacy's National Association of Pharmaceutical            Char(18)         PROVID
Pharmacy NABP Number
                                        Doctors (NAPD) number.
                                                                                                                                             C = Civilian network
                                        Code to indicate whether the provider is a network or                                                D = Direct Care network
Provider Type Code                                                                                   Char(1)         TYPECODE   C, D, N, U
                                        non-network provider.                                                                                N = None
                                                                                                                                             U = Uniformed Services Family Health Plan (USFHP)
Provider License Identifier             Provider's license number.                                   Char(24)     LICENSE
Provider Full Name                      Full name of provider/pharmacy.                              Char(40)    PROVNAME
Provider Group Name                     Group name of the provider.                                  Char(40)    GRPNAME

                                                                                                                                             Use clinic's Tax ID when care is provided in a clinic
                                        Provider's Tax ID number for the individual/group
Tax ID of Provider Entity                                                                            Char(9)          TAXID                  setting, physician's Tax ID if care is provided in a non-clinic
                                        responsible for the service provided.
                                                                                                                                             setting, or pharmacy's Tax ID for pharmacies.

                                                                                                                                             C = Contracted
Provider Affiliation Code               TRICARE Regional Office Market Area IDs.                     Char(1)         AFFILCD     C, S, O     S = Staff
                                                                                                                                             O = Other
                                                                                                                                             I = Institutional
Institution/Non-Institution             Default BPA Catchment Area ID for Navy/Marines.              Char(1)         INSTTYPE      I, N
                                                                                                                                             N = Non-institutional
Provider Telephone Number               Default BPA PRISM Area ID for Navy/Marines.                  Num(14)          PHONE
Provider Street Address                 Street address where provider/pharmacy is located.           Char(40)        ADDRESS
Provider City                           City where provider/pharmacy is located.                     Char(20)          CITY
Provider State                          State where provider/pharmacy is located.                    Char(2)           SATE
Provider Zip Code                       Zip code of provider/pharmacy providing service.             Char(9)           ZIP
                                        If non-institution: Provider's major specialty; If
1st Major Specialty/ Institution Type                                                                Char(2)           SPC1                  See Designated Provider Codes .
                                        institutional: Type of institution providing care.
2nd Major Specialty                     If non-institution: Provider's major specialty.              Char(2)           SPC2                  See Designated Provider Codes .
3rd Major Specialty                     If non-institution: Provider's major specialty.              Char(2)           SPC3                  See Designated Provider Codes .
4th Major Specialty                     If non-institution: Provider's major specialty.              Char(2)           SPC4                  See Designated Provider Codes .
5th Major Specialty                     If non-institution: Provider's major specialty.              Char(2)           SPC5                  See Designated Provider Codes .


   October 2011 Version                                                                        DESPROV (Provider)                                                                   Page 98 of 1408
                                                                                         DESPROV (Provider)

                                                                                                           Position or
           Data Element                                  Definition                           Format                     Values                         Notes
                                                                                                          SAS Variable
                                   Date the provider began providing services for the
Provider Location Begin Date                                                                   Date(8)        BEGDATE
                                   DP.
                                   Date the provider terminated providing services for
Provider Location End Date                                                                     Date(8)        ENDDATE
                                   the DP.

                                                                                                                                   F = Female
Provider Gender Code               Code to indicate the gender of provider.                    Char(1)          SEX      F, M, Z   M = Male
                                                                                                                                   Z = Unknown

                                   Code that represents whether a Primary Care
Remote Enrollee Assignment                                                                                                         Y = Yes
                                   Manager can be assigned to a beneficiary enrolled in        Char(1)        RMTENR      Y, N
Indicator Code                                                                                                                     N = No
                                   a TRICARE remote coverage plan.
Provider Assignment Remarks Text Remarks about the assignment of a provider.                  Char(80)         TEXT
                                                                                                                                   Y = Yes
Provider Accreditation Indicator   Code that indicates if the provider is accredited.          Char(1)        ACCRED      Y, N
                                                                                                                                   N = No
                                                                                                                                   G = Guard
                                   If non-institution, code that represents provider‟s
Guard/Reserve Status                                                                           Char(1)        GRDSTAT    G, R, N   R = Reserve
                                   Guard/Reserve status.
                                                                                                                                   N = Not Applicable




   October 2011 Version                                                                  DESPROV (Provider)                                                     Page 99 of 1408
                                                                                          DMIS ID Index

                                                                                      MDR DMIS ID Table
Common File Name: fyYY.sas7bdat
Dataset Location: /mdr/ref/
                                                                                                                                        Source System: MTF Master DMIS ID Table,
                                                                                                                                        MEPRS Parent Table, Cost Parent Table,
                                                                                                                                        CHCS Parent Table, MEPRS/CHCS Alias
Update Frequency: Monthly                                                                                                               Table, ADS Parent Table, DMIS ID Name
                                                                                                                                        Table, TFL LOE/Unit Price/Parent Tables, BPA
                                                                                                                                        DMIS ID Table, PPS Table and PPS Parent
                                                                                                                                        Table.
Description: DMIS ID reference file.

                                                                                                      Position or
        Data Element                                   Definition                         Format                        Values                                   Notes
                                                                                                     SAS Variable
                                                                                                                     e.g. 0001, 0067,
ADS DMIS ID Parent                Parent DMIS ID as reported in ADM.                         $4           ADS_PAR
                                                                                                                            etc.
                                                                                                                                        Identifies instances where an MTF may have changed
                                                                                                                     e.g. 0001, 0067,
Alias DMIS ID                     Alias DMIS ID used for reporting data.                     $4            ALIAS                        DMIS ID's, or used more than one DMIS ID to report
                                                                                                                            etc.
                                                                                                                                        data in different systems.
TFL MILPAY Cost per Aggregate     Indicates TFL Military Pay Earnings per Aggregate
                                                                                              8           APGMILPY                      Not populated prior to FY00. Only populated for DMIS
APG Weight                        APG weight for this DMIS ID and Fiscal Year.
                                                                                                                                        ID's associated with direct care facilities.
Cost per Aggregate APG weight,    Normative value of cost per aggregate APG weight
                                                                                              8           APGMTF                        Note that these values are not calculated at child level.
MTF Norm                          within the direct care system.
                                  Normative value of cost per RWP within the direct
Cost per RWP, MTF norm                                                                        8           RWPMTF                        Note that these values are not calculated at child level.
                                  care system.

TFL other cost per aggregate APG Indicates TFL Earnings (less milpay) per Aggregate
                                                                                              8           APGOTH                        Not populated prior to FY00. Only populated for DMIS
weight                           APG weight for this DMIS ID and Fiscal Year.
                                                                                                                                        ID's associated with direct care facilities.
                                  Normative value of cost per aggregate APG weight
Cost per Aggregate APG weight,
                                  within the peer group associated with the parent DMIS       8           APGPEER                       Note that these values are not calculated at child level.
MTF Peer Norm
                                  ID.
                                  Normative value of cost per relative weighted product
Cost per RWP, MTF peer norm       within the peer group associated with the parent DMIS       8           RWPPEER                       Note that these values are not calculated at child level.
                                  ID.
Authorized TRICARE Enrollment     Indicates whether or not enrollments are allowed for
                                                                                             $1           AUTHENRL       N or Y         FY01 and forward.
Site                              this DMIS ID.
                                  Parent DMIS ID used in settling historical TRICARE                                 e.g. 0001, 0067,
BPA Parent DMIS ID                                                                           $4           BPA_PAR
                                  contracts.                                                                                etc.
                                  Region of DMIS ID used in settling TRICARE
BPA Region                                                                                   $2           BPA_REG        01 - 13
                                  contracts.
M2 DMIS ID Name                   Name used in the M2 for the DMIS ID.                      $40           BRIDGENM
                                                                                                                     e.g. 0001, 0067,
CHCS Parent DMIS ID               Indicates CHCS Host of DMIS ID.                            $4           CHCS_PAR                      Only updated sporadically.
                                                                                                                            etc.
                                  Parent DMIS ID used in assigning costs to MTF                                      e.g. 0001, 0067,
Costing Parent DMIS ID                                                                       $4           COST_PAR
                                  workload files.                                                                           etc.




    October 2011 Version                                                                  DMIS ID Index                                                                  Page 100 of 1408
                                                                                          DMIS ID Index


                                                                                                      Position or
          Data Element                                    Definition                      Format                         Values                                  Notes
                                                                                                     SAS Variable
                                                                                                                                         This value applies only to MDC's 19/20. Only populated
PPS Mental Health Market Value     Represents the global private sector cost per mental
                                                                                              8           DAYMKTVL                       for FY03 forward and only for DMIS ID's associated with
per Bed Day                        health day, adjusted for locality.
                                                                                                                                         direct care facilities.
DCW ID                             Unique identifier for MTF's.                              $5            DCWID
                                                                                                                      e.g. 0001, 0067,
DMIS ID                            DMIS ID (key field).                                      $4            DMISID
                                                                                                                             etc.
DMIS ID Name                       Name associated with the DMIS ID.                        $30           DMISNME
DMIS ID City                       Location of DMIS ID, if a fixed facility.                $32           FACCITY

DMIS ID Country                    Country of DMIS ID.                                       $2           FACCNTRY                         FY01 and forward. See State and Country Codes.

UBU Facility Name                  Name of MTF.                                             $42           FACNME
UBU Facility State or Country Code State of MTF.                                             $2           FACSTATE                         FY01 and forward. See State and Country Codes.
                                                                                                                                     ADMIN = Administrative
                                                                                                                                     AFLOAT = Navy Afloat
                                                                                                                                     CLINIC = Clinic
                                                                                                                                     DECOMM = Decommissioned
                                                                                                                     ADMIN, AFLOAT,
                                                                                                                                     DENTAL = dental
                                                                                                                     CLINIC, DECOMM,
                                                                                                                                     FLAG = flag
                                                                                                                      DENTAL, FLAG,
                                                                                                                                     HOSP = Hospital
DMIS ID Type                       Type of DMIS ID.                                          $6           FACTYPE      HOSP, INACT,
                                                                                                                                     INACT = Inactive
                                                                                                                      NONCATSHIP,
                                                                                                                                     NONCAT = Non-Catchment
                                                                                                                       STSF, TGRO,
                                                                                                                                     SHIP = Ship
                                                                                                                     TSCPMC, VETCL
                                                                                                                                     STSF = Specialized Treatment Facility
                                                                                                                                     TGRO = TRICARE Global Prime Remote
                                                                                                                                     TSCPMC
                                                                                                                                     VETCL = Veterinary Clinic
MTF Zip Code                       Facility zip code.                                        $5            FACZIP
                                                                                                                                         N = North
                                                                                                                                         W = West
                                                                                                                       A, N, W, S, O,    S = South
HSSC Region                        Tnex Region.                                              $1           HSSCREG
                                                                                                                           Blank         O = OCONUS
                                                                                                                                         A=Alaska
                                                                                                                                         blank = Unknown
Installation Name                  Name of installation associated with a DMIS ID.          $35           INSTALNM
                                   Invoice Parent DMIS ID to which MTF Enrollee
Invoice Parent DMIS ID             Workload is credited for service level                    $4           INV_PAR          0001
                                   budgeting/payment of private sector claims.
TFL Level of Effort Aggregate APG Total Aggregate APG weights for seniors, used by the
                                                                                              8            LOEAPG                        Only populated for FY00 forward.
Weights                            TFL program to measure workload.
                                   Total MTF value of military pay for care provided to
TFL Level of Effort - Military Pay                                                            8           LOEMILPY                       Only populated for FY00 forward.
                                   seniors, as measured by the TFL program.
                                   Total MTF value of care, less military pay and
TFL Level of Effort - Other        pharmacy, for care provided to seniors, as measured        8            LOEOTH                        Only populated for FY00 forward.
                                   by the TFL program.
                                   Total MTF value of pharmacy care provided to
TFL Level of Effort - Rx                                                                      8           LOEPHARM                       Only populated for FY00 forward.
                                   seniors, as measured by the TFL program.




    October 2011 Version                                                                  DMIS ID Index                                                                 Page 101 of 1408
                                                                                            DMIS ID Index


                                                                                                        Position or
         Data Element                                  Definition                           Format                        Values                                     Notes
                                                                                                       SAS Variable
TFL Level of Effort - Relative    Total MTF RWP's for seniors, used by the TFL
                                                                                                8           LOERWP                        Only populated for FY00 forward.
Weighted Products                 program to measure workload.
                                  Total MTF - filled prescription count for seniors, used
TFL Level of Effort - Rx Counts                                                                 8            LOERX                        Only populated for FY00 forward.
                                  by the TFL program to measure workload.
DMIS ID Command                   Command associated with the DMIS ID.                         $8           MAJCMND
                                                                                                                       e.g. 0001, 0067,
MEPRS Parent                      Parent DMIS ID associated with MEPRS reporting.              $4           MEPR_PAR
                                                                                                                              etc.
DMIS ID Region                    Health Service Region associated with the DMIS ID.           $2           MOD_REG      00 - 15, AK
PPS Prospective Ambulatory
                                  PPS Expected Ambulatory Earnings for the FY.                  8           PAMBEARN
Earnings
PPS Prospective Ancillary
                                  PPS Expected Ancillary Earnings for the FY.                   8           PANCEARN                      Currently not populated.
Earnings
                                                                                                                                          Only populated for FY03 forward and only for DMIS ID's
PPS Capitation Rate               Capitation rate for enrollee care, associated with PPS.       8           PCAPRATE
                                                                                                                                          associated with direct care facilities.
MTF Peer Group                    Peer group associated with the MTF.                          $1           PEERGRP     1 - 3, A - C, M   See Notes on DMISID Norms tab.
PPS Prospective Inpatient                                                                                                                 Only populated for FY03 forward and only for DMIS ID's
                                  PPS Expected Inpatient Earnings for the FY.                   8           PINPEARN
Earnings                                                                                                                                  associated with direct care facilities.
                                                                                                                                          Only populated for FY03 forward and only for DMIS ID's
                                  PPS Expected Other Earnings for the FY.                       8           POTHEARN
PPS Prospective Other Earnings                                                                                                            associated with direct care facilities.
                                                                                                                       e.g. 0001, 0067,   Only populated for FY03 forward and only for DMIS ID's
PPS Parent DMIS ID                Parent DMIS ID for purposes of PPS Budgeting.                $4           PPS_PAR
                                                                                                                              etc.        associated with direct care facilities.
                                  Indicates whether or not this DMIS ID contributes to
PPS Enrollment Site               the portion of the service's budgets determined by           $1            PPSENR      Y or Blank       Only populated for FY03 forward.
                                  PPS.
                                                                                                                                          Only populated for FY03 forward and only for DMIS ID's
PPS Prospective Earnings          PPS Expected Total Earnings for the FY.                       8           PRSPEARN
                                                                                                                                          associated with direct care facilities.
PPS Prospective Pharmacy                                                                                                                  Only populated for FY03 forward and only for DMIS ID's
                                  PPS Expected Pharmacy Earnings for the FY.                    8           PRXEARN
Earnings                                                                                                                                  associated with direct care facilities.
                                                                                                                                          A = Army, C = Coast Guard, F = Air Force, J = US
                                                                                                                                          Defense Attache Office (USDAO), M = Marine Corps, N
UBU DMIS ID Branch of Service     Branch of Service of DMIS ID.                                $1           RAW_SVC         e.g. A        = Navy, O = Other, S = Non-Catchment, T = US Family
                                                                                                                                          Health Plan Facility (USTF), V = VA, X = Not Valid,
                                                                                                                                          Unknown, blank = unknown
Raw HSSC Region                   Unmodified HSSC Region.                                      $2           RAWHSSC    00 - 15, 17 - 19
Cost per RVU civilian norm        Cost per RVU civilian norm.                                  8             RVUCIV                       Currently not populated.
Cost per RVU civilian managed
                                  Cost per RVU civilian managed care norm.                      8            RVUMC                        Currently not populated.
care norm
                                  Represents the private sector cost per work RVU,                                                        Only populated for FY03 forward and only for DMIS ID's
PPS RVU Market Value                                                                            8           RVUMKTVL
                                  adjusted for locality.                                                                                  associated with direct care facilities.
                                  Normative value of cost per work RVU within the direct
Cost per RVU, MTF Norm                                                                          8            RVUMTF                       Note that these values are not calculated at child level.
                                  care system.
                                  Normative value of cost per work RVU within the peer
Cost per RVU, MTF Peer Norm                                                                     8           RVUPEER                       Note that these values are not calculated at child level.
                                  group associated with the parent DMIS ID.
                                                                                                                                          Estimated using a variety of sources, including the
Cost per RWP, Civilian Norm       Cost per RWP, Civilian Norm.                                  8            RWPCIV
                                                                                                                                          Solucient Sourcebook.
Cost per RWP Civilian Managed                                                                                                             Estimated using a variety of sources, including the
                                  Cost per RWP Civilian Managed Care Norm.                      8            RWPMC
Care Norm                                                                                                                                 Solucient Sourcebook.


    October 2011 Version                                                                    DMIS ID Index                                                                  Page 102 of 1408
                                                                                         DMIS ID Index


                                                                                                     Position or
          Data Element                               Definition                          Format                         Values                                Notes
                                                                                                    SAS Variable
                                Indicates TFL Military Pay Earnings per RWP for this                                                   Not populated prior to FY00. Only populated for DMIS
TFL Military Pay Cost per RWP                                                                8           RWPMILPY
                                DMIS ID and Fiscal Year.                                                                               ID's associated with direct care facilities.
                                Represents the private sector cost per acute care                                                      Only populated for FY03 forward and only for DMIS ID's
PPS RWP market value                                                                         8           RWPMKTVL
                                RWP (excluding mental health), adjusted for locality.                                                  associated with direct care facilities.
                                Indicates TFL Earnings (less milpay) per RWP for this                                                 Not populated prior to FY00. Only populated for DMIS
TFL Other Cost per RWP                                                                       8           RWPOTH
                                DMIS ID and Fiscal Year.                                                                              ID's associated with direct care facilities.
                                Indicates TFL Military Pay Earnings per prescription                                                  Not populated prior to FY00. Only populated for DMIS
TFL MilPay Cost per Script                                                                   8           RXMILPY
                                drug for this DMIS ID and Fiscal Year.                                                                ID's associated with direct care facilities.
PPS Prescription Drug Market    Represents the private sector cost per prescription,                                                  Only populated for FY03 forward and only for DMIS ID's
                                                                                             8           RXMKTVL
Value                           adjusted for locality.                                                                                associated with direct care facilities.
                                Indicates TFL Other Earnings per prescription drug for                                                Not populated prior to FY00. Only populated for DMIS
TFL Other Cost per Script                                                                    8            RXOTH
                                this DMIS ID and Fiscal Year.                                                                         ID's associated with direct care facilities.
UBU Service Area Code           Service Area.                                               $4           SVCAREA    6002 - 6015, 6512 Not coded for the majority of records.
                                                                                                                     e.g. 0001, 0067,
UBU DMIS ID Parent              DMIS ID Table Parent.                                       $4           UBU_PAR
                                                                                                                            etc.
                                Region associated with DMIS ID, as reported in DMIS
UBU DMIS ID Region                                                                          $2           UBU_REG         00 - 15
                                ID Table.
                                                                                                                                       A = Army DHP
                                                                                                                                       B = Army Civilian Resource Sharing
                                                                                                                                       C = Coast Guard
                                                                                                                                       D = Army Line Unit
                                                                                                                                       F = Air Force DHP
                                                                                                                                       G = AF Civilian Resource Sharing
                                                                                                                                       I = Inactive
                                                                                                                                       J = US Defense Attache Office (USDAO)
                                                                                                                                       L = AF Line Unit
                                Branch of Service of DMIS ID, separately identifies                                                    M = Managed Care Support Contractor
UBU DMIS ID Branch of Service                                                               $1           UBU_SVC         e.g. A
                                entities not associated with the DHP.                                                                  N = Navy DHP
                                                                                                                                       O = Other
                                                                                                                                       Q = Navy Line Unit
                                                                                                                                       R = Navy Civilian Resource Sharing
                                                                                                                                       S = Non-catchment
                                                                                                                                       T = US Family Health Plan (USFHP)
                                                                                                                                       V = Veterans Admin
                                                                                                                                       X = Administrative
                                                                                                                                       Blank = Unknown

                                Indicates whether or not the DMIS ID is associated                                                     Y = Yes (US)
US Flag                                                                                     $1            USFLAG         Y or N
                                with a US Location.                                                                                    N = No




    October 2011 Version                                                                 DMIS ID Index                                                                Page 103 of 1408
                                                                                       DMISID Norms

                                                                       NORMS - DMISID (Norms for the DMISID File)
Common File Name: fyXX.sas7bdat, where XX = 03+
Dataset Location: /mdr/raw/dmisid/norms/fyXX/d040727
Update Frequency: Current and out FYs, around summer                                                                                  Source System:
Description: DMISID Normative Data
                                                                                                      Position or SAS
        Data Element                                    Definition                         Format                         Values                              Notes
                                                                                                         Variable
                                Total B Account MEPRS Costs divided by B Account
Cost per APG Wt MTF Norm                                                                   N(8.2)        APGMTF
                                SADR APG Weights in DHP-funded MTF's.
                                Total B Account MEPRS Costs divided by B Account
Cost per APG Wt MTF Peer Norm                                                              N(8.2)       APGPEER
                                SADR APG Weights in DHP-funded Peer Group MTF's.

                                                                                                                                      1 = Large Hospitals
                                                                                                                                      2 = Medium Hospitals
                                                                                                                                      3 = Small Hospitals
                                                                                                                                      A = Large Clinics
                                                                                                                                      B = Medium Clinics
                                                                                                                                      C = Small Clinics
                                                                                                                                      M = MCS Contractor

                                Peer Group for Inpatient (1 - 4), Ambulatory (A - D)                                                   FY03 to FY07:
Peer Group                                                                                  C(1)           PGP          1 - 3, A -C, M 1 = Large Hospitals
                                DMISID's.
                                                                                                                                       2 = Medium Hospitals
                                                                                                                                       3 = Small Hospitals
                                                                                                                                       4 = Tiny Hospitals
                                                                                                                                       A = Large Clinics
                                                                                                                                       B = Medium Clinics
                                                                                                                                       C = Small Clinics
                                                                                                                                       D = Tiny Clinics
                                                                                                                                       M = MCS Contractor


Cost per RVU Wt Civ Norm        Cost per RVU derived from MGMA Cost Survey Data.           N(8.2)        RVUCIV                       Populated FY06 and forward.
Cost per RVU Wt Civ MC Norm     Cost per RVU derived from MGMA Cost Survey Data.           N(8.2)        RVUMC
                              Total B Account MEPRS Costs divided by B Account
Cost per RVU Wt MTF Norm                                                                   N(8.2)        RVUMTF
                              SADR Simple RVU Weights in DHP-funded MTF's.
                              Total B Account MEPRS Costs divided by B Account
Cost per RVU Wt MTF Peer Norm SADR Simple RVU Weights in DHP-funded Peer Group             N(8.2)       RVUPEER
                              MTF's.
                              Cost per RWP derived from Solucient Sourcebook and
Cost per RWP Civ Norm                                                                      N(8.2)        RWPCIV                       Populated FY06 and forward.
                              other sources.
                              Cost per RWP derived from Solucient Sourcebook and
Cost per RWP Civ MC Norm                                                                   N(8.2)        RWPMC
                              other sources.
                              Total A Account MEPRS Costs divided by Total RWP
Cost per RWP MTF Norm                                                                      N(8.2)        RWPMTF
                              Weights in DHP-funded MTF's.
                              Total A Account MEPRS Costs divided by Total RWP
Cost per RWP MTF Peer Norm                                                                 N(8.2)       RWPPEER
                              Weights in DHP-funded Peer Group MTF's.




    October 2011 Version                                                               DMISID Norms                                                                   Page 104 of 1408
                                                                                     Encounter Death

                                                                               ENCOUNTER DEATH FILE
Common File Name: encdead.sas7bdat
Dataset Location: /mdr/pub/death/enc/
                                                                                                                                  Source System: HCSR/TED Institutional, SADR,
Update Frequency: Updated monthly
                                                                                                                                  SIDR
Description: All deaths found in encounter records
                                                                                            Position or SAS
  Data Element                             Definition                          Format                               Values                                    Notes
                                                                                               Variable
Sponsor SSN      Social security number of active duty member.                  Char(9)        sponssn
Date of Birth    Date of birth of individual.                                  SAS Date           dob
EDIPN            Unique Identifier of individual.                              Char(10)          edipn                            Blank in 56% of records.
                                                                                                                                     01 - 19 = Dependent Child
                                                                                                                                     20 = Sponsor
                                                                                                                                     30 - 39 = Spouse of sponsor
                                                                                                                   01 - 19, 20,      40 - 44 = Mother of sponsor
                                                                                                              30 - 39, 40 - 44, 45 - 45 - 49 = Father of sponsor
                 DEERS Dependent Suffix: Code maintained by DEERS
DDS                                                                            Char(2)            dds         49, 50 - 54, 55 - 59, 50 - 54 = Mother-In-Law of sponsor
                 that uniquely identifies the beneficiary within the family.
                                                                                                              60 - 69, 70 - 74, 75, 55 - 59 = Father-In-Law of sponsor
                                                                                                                        98           60 - 69 = Other eligible dependents
                                                                                                                                     70 - 74 = Unknown by DEERS
                                                                                                                                     75 = Pseudo DDS unknown by contractor
                                                                                                                                     98 = Service secretary designee
                                                                                                                                  M = Male
Gender           Patient/beneficiary Gender.                                   Char(1)          gender               M, F
                                                                                                                                  F = Female
Death Date       Date of recorded death.                                       SAS Date         dthdate
                                                                                                                                  H = HCSR/TED-Institutional
Source           Source of death information.                                  Char(1)          source              H, S, A       S = SIDR
                                                                                                                                  A = SADR
Death Code       Flag that indicates whether the record contains a death.      Char(1)          dthcode                Y          Set to 'Y' for all files.

                                                                                                                                  0 - 1 = Dependent Child
                                                                                                                                  2 = Sponsor
                                                                                                                                  3 = Spouse of sponsor
                 First digit of DDS, which defines whether patient is                                                             4 = Parent of sponsor
Relationship                                                                   Char(1)            rel               0 - 7, 9
                 sponsor, spouse, dependent, or other.                                                                            5 = Parent-In-Law of sponsor
                                                                                                                                  6 = Other eligible dependents
                                                                                                                                  7 = Unknown
                                                                                                                                  9 = Service secretary designee




   October 2011 Version                                                             Encounter Death                                                                   Page 105 of 1408
                                                                                                ENR

                                                                                    ENR (TRICARE Enrollment File)

Common File Name: fyXX.sas7bdat, where 'XX' is the 2-digit calendar year
Object Class Location: /mdr/pub/enr/
Update Frequency: Updated monthly or every time the PITE is processed                                                                     Data Source System: DEERS
Description: TRICARE Enrollment File
                                                                                                      Position or SAS
      Data Element                                   Definition                            Format                           Values                                 Notes
                                                                                                         Variable
                           The ending date [projected or actual] for the insured with a
ACV End Date                                                                               Char (8)      ACVEND           yyyymmdd        D_MI_PCM_SLCT_END_DT
                           particular Primary Care Manager.

                           The date when a beneficiary begins with a Primary Care
ACV Start Date                                                                             Char (8)      ACVBEG           yyyymmdd        D_MI_PCM_SLCT_BGN_DT
                           Manager.


Age                        Beneficiary age.                                                Numeric         AGE                            D_AGE_QY


                                                                                                                                          D_AGE_GRP_CD
                                                                                                                                          A = 0 to 4
                                                                                                                                          B = 5 to 14
                                                                                                                                          C = 15 to 17
                                                                                                                                          D = 18 to 24
                                                                                                                         A, B, C, D, E,   E = 25 to 34
Age Group Code             Standard Age Group Codes.                                       Char (1)     DAGEGRP
                                                                                                                          F, G, H, Z      F = 35 to 44
                                                                                                                                          G = 45 to 64
                                                                                                                                          H = 65 and over
                                                                                                                                          Z = Unknown

                                                                                                                                          Note: Populated February 2004 and later.


                                                                                                                                          A=Active Duty Prime
                                                                                                                                          B=TRICARE Global Remote Overseas Prime Active Duty
                                                                                                                                          D=TRICARE Senior Prime
                                                                                                                                          E=Non-Active Duty Prime
                                                                                                                                          F=TRICARE Global Remote Overseas Prime Active Duty
                                                                                                                                          Family Member
                                                                                                                                          G=TRICARE Plus (CHAMPUS/TFL Eligible)
                          Alternate Care Value: Code that indicates the enrollment                                      A, B, D, E, F, G,
                                                                                                                                          H=TRICARE Overseas Prime Active Duty
Alternate Care Value (ACV)status of the beneficiary, as reported in DEERS at the time      Char (1)        ACV          H, J, L, M, Q, R,
                                                                                                                                          J=TRICARE Overseas Prime Active Duty Family Member
                          of the extract.                                                                                   U, V, Null
                                                                                                                                          L=TRICARE Plus (not CHAMPUS/TFL Eligible)
                                                                                                                                          M=AD not reported enrolled (added FY05)
                                                                                                                                          Q=AD enrolled to Op Forces
                                                                                                                                          R=TRS
                                                                                                                                          U=USTF/USFHP
                                                                                                                                          V=TRICARE Retired Reserve
                                                                                                                                          Null = Not Enrolled




      October 2011 Version                                                                      ENR                                                                      Page 106 of 1408
                                                                                             ENR

                                                                                                   Position or SAS
      Data Element                                   Definition                         Format                           Values                                Notes
                                                                                                      Variable
                                                                                                                                    R_BEN_CAT_CD
                                                                                                                                    ACT = Active Duty
                                                                                                                                    RET = Retirees
                                                                                                                                    GRD = Medically Eligible Guard/Reserve
                                                                                                                                    DA = Dependents of Active Duty
                                                                                                                     ACT, RET, GRD,
                                                                                                                                    DR = Dependents of Retiree
Beneficiary Category      Category of beneficiary.                                      Char (3)     DBENCAT          DA, DR, DS,
                                                                                                                                    DS = Dependent Survivor
                                                                                                                      DGR, OTH, Z
                                                                                                                                    DGR = Dependent of Medically Eligible Guard/Reserve
                                                                                                                                    OTH = Other
                                                                                                                                    Z = Unknown

                                                                                                                                     Note: Populated February 20
                          Beneficiary SSN (or other identifier, as described in
Beneficiary SSN                                                                         Char (9)      BENSSN           123456789     PN_ID: Note: Populated February 2004 and later.
                          "Beneficiary ID Type Code).

                                                                                                                                     01 = January    07 = July
                                                                                                                                     02 = February   08 = August
                                                                                                                                     03 = March      09 = September
Calendar Month            Calendar month data were reported.                            Char (2)         CM              01 - 12
                                                                                                                                     04 = April      10 = October
                                                                                                                                     05 = May        11 = November
                                                                                                                                     06 = June       12 = December


Calendar Year             Calendar year data were reported.                             Char (4)         CY                          Derived from MDR PITE file name.


                                                                                                                                     Catchment Area ID derived in MHS Data Repository (MDR)
                                                                                                                                     processing by linking to the Catchment Area Directory
                          The catchment area surrounding an MTF or noncatchment
                                                                                                                                     (CAD). Results do NOT incorporate any updates/retrofits of
Catchment Area ID         area based on beneficiary zip code, sponsor service, FY and   Char (4)      DCATCH            e.g., 0039
                                                                                                                                     data.
                          FM.
                                                                                                                                     Note: Populated February 2004 and later.


CHCS Family Member Prefix                                                               Char (2)        FMP


                                                                                                                                     D_COM_BEN_CAT_CD
                                                                                                                                     1 = Dependent of Active Duty/Guard
Common Beneficiary Category
                        Broadest category of beneficiaries.                             Char (1)      COMBEN              1-4        2 = Retired
                                                                                                                                     3 = Dep of Retired or Survivor, Other, Unknown
                                                                                                                                     4 = Active Duty and Guard

Date of Birth             The date a person was born.                                   Char (8)        DOB             yyyymmdd     PN_BRTH_DT




       October 2011 Version                                                                  ENR                                                                    Page 107 of 1408
                                                                                               ENR

                                                                                                     Position or SAS
      Data Element                                  Definition                            Format                           Values                                  Notes
                                                                                                        Variable
                                                                                                                                         LEG_DDS_CD:
                                                                                                                                         01 - 19 = Dependent Child
                                                                                                                                         20 = Sponsor
                                                                                                                         01 - 19, 20,    30 - 39 = Spouse of sponsor
                       The code that represents the dependent of a sponsor. Prior                                      30 - 39, 40 - 44, 40 - 44 = Mother of sponsor
DEERS Dependent Suffix to the E2R2 project, this attribute was known as the DEERS         Char (2)        DDS          45 - 49, 50 - 54, 45 - 49 = Father of sponsor
                       dependent suffix.                                                                               55 - 59, 60 - 69, 50 - 54 = Mother-In-Law of sponsor
                                                                                                                            98, 99       55 - 59 = Father-In-Law of sponsor
                                                                                                                                         60 - 69 = Other eligible dependents
                                                                                                                                         98 = Service Secretary Designee
                                                                                                                                         99 = Not Classified Elsewhere
                           Legal name of beneficiary. The last name is at least two
Enrollee Name                                                                            Char (29)       NAME          E.g.: DOE, JOHN PN_LST_NM (1st 19), PN_1ST_NAME (10)
                           characters followed by a comma.
Enrollment DMISID          The DMIS ID of the facility where the member is enrolled.      Char (4)       DMISID           e.g., 0001    D_MI_PCM_EDVSN_DMIS_ID
                                                                                                                                        D_ENR_RGN_CD
                                                                                                                                        01 = Northeast
                                                                                                                                        02 = Mid-Atlantic
                                                                                                                                        03 = Southeast
                                                                                                                                        04 = Gulf South
                                                                                                                                        05 = Heartland
                                                                                                                                        06 = Southwest
                                                                                                                                        07, 08 = TRICARE Central
                           Code that identifies the DoD Region associated with the                                     01 - 15, AK, 16,
Enrollment Region                                                                         Char (2)      REGION                          09 = Southern California
                           enrollment site.                                                                              00, UK, XX
                                                                                                                                        10 = Golden Gate
                                                                                                                                        11 = Northwest
                                                                                                                                        12 = Hawaii
                                                                                                                                        13 = TRICARE Europe
                                                                                                                                        14 = TRICARE Pacific
                                                                                                                                        15 = TRICARE Latin America
                                                                                                                                        AK = Alaska
                                                                                                                                        UK, XX, 00, 16 = Unknown
                                                                                                                                        MDR_EL_AGECAT_CD
                                                                                                                                        1=0-1
                                                                                                                                        2 = 2 - 11
                                                                                                                                        3 = 12 - 17
                                                                                                                                        4 = 18 - 44 for single females or 18 - 37 single males
                          Equivalent Lives Age Group is used to classify beneficiaries                                                  5 = 18 - 44 married females or 18 - 37 married males
Equivalent Lives Age Group                                                                Char (1)       ELAGE              1-9
                          into -resource groups.                                                                                        6 = 45 - 54 females or 38 - 54 male
                                                                                                                                        7 = 55 - 64
                                                                                                                                        8 = 65 - 74
                                                                                                                                        9 = 75 and up

                                                                                                                                        Note: Populated February 2004 and later.




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                                                                                                   Position or SAS
      Data Element                                  Definition                          Format                            Values                                 Notes
                                                                                                      Variable
                                                                                                                                  MDR_EL_BENGRP_CD
                                                                                                                                  ADA = Active Duty, Army
                                                                                                                                  ADAF = Active Duty, Air Force
                                                                                                                      ADA, ADAF,
                                                                                                                                  ADFMLY = Active Duty, Family Members
                          The code that represents the Summary Beneficiary Group as                                  ADFMLY, ADN,
Equivalent Lives Ben Group                                                              Char (6)      BENCAT                      AND = Active Duty, Navy and Others
                          reported with DEERS Enrollment.                                                             RTA, RTAF,
                                                                                                                                  RTA = Retired, Army
                                                                                                                     RTFMLY, RTN
                                                                                                                                  RTAF = Retired, Air Force
                                                                                                                                  RTFMLY = Retirees' Family Members
                                                                                                                                  RTN = Retired, Navy and Others

                         The identifier created as a result of a duplication of a
                                                                                                                                       SPN_DUP_ID
                         Sponsor Person Identifier and Sponsor Person Identifier
Family Sequence ID                                                                      Char (1)        FSN                1-9
                         Type Code pairing. The Sponsor Duplicate Identifier will
                                                                                                                                       Note: Populated February 2004 and later
                         help create a unique record.
                                                                                                                                       01 = October         07 = April
                                                                                                                                       02 = November      08 = May
                         Fiscal Month: The numeric code to identify the DoD fiscal                                                     03 = December       09 = June
Fiscal Month                                                                            Char (2)         FM               01 - 12
                         month in which the data were extracted.                                                                       04 = January        10 = July
                                                                                                                                       05 = February       11 = August
                                                                                                                                       06 = March          12 = September
                         Fiscal Year:
                         The twelve month accounting period used by the federal
Fiscal Year              government that begins on 1 October and ends on 30             Char (4)         FY                            Derived from MDR PITE file name:
                         September; identifies the fiscal year in which the data were
                         extracted.

                                                                                                                                       PN_SEX_CD:
                                                                                                                                       M = Male
Gender                   Beneficiary gender.                                            Char (1)      GENDER              M, F, Z
                                                                                                                                       F = Female
                                                                                                                                       Z = Unknown

                                                                                                                                       MDR_MARITAL_AGG_CD
Marital Status           Code indicating the marital status of the sponsor.             Char (1)      MARITAL              M, S        M = married
                                                                                                                                       S = single

                                                                                                                                       MDR_MARKET: See Regional Staff for more information.
                         TRO-defined market area based on Beneficiary ZIP code.
Market Area                                                                             Char (3)      MARKET             001 - 999
                         Use in conjunction with Beneficiary Region.
                                                                                                                                       Note: populated February 2004 an later.
                                                                                                                                          D_ELG_CD
                                                                                                                                          1 = Direct Care Only
                                                                                                                                          2 = Direct Care and CHAMPUS
                                                                                                                                          4 = Transitional Direct Care Only
                                                                                                                                          5 = Transitional Direct Care and CHAMPUS
                                                                                                                     1, 2, 4, 5, 6, 7, C,
Medical Privilege Code   Code indicating type of eligibility for medical benefits.      Char (1)     DMEDELG                              6 = Transitional Direct Care and Medicare,
                                                                                                                            M, U
                                                                                                                                              not CHAMPUS Eligible
                                                                                                                                          7 = Direct Care and Medicare, not CHAMPUS Eligible
                                                                                                                                          C = CHAMPUS Only
                                                                                                                                          M = TRICARE for Life only
                                                                                                                                          U = USFHP/USTF Enrollee


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                                                                                                      Position or SAS
      Data Element                                       Definition                        Format                           Values                                   Notes
                                                                                                         Variable
                                                                                                                                          A = Medicare A
                                                                                                                                          B = Medicare B
                                                                                                                                          C = Medicare A and B
Medicare Eligibility Code   Medicare Eligibility Code.                                     Char (1)    DMEDCARE            A, B, C, N
                                                                                                                                          N = Not eligible for Medicare

                                                                                                                                          Note: Populated February 2004 and later.

                                                                                                                                          A = Active duty member
                                                                                                                                          B = Presidential Appointee
                                                                                                                                          C = DoD civil service employee, except Presidential
                                                                                                                                               appointee
                                                                                                                                          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)
                                                                                                                                          H = Medal of Honor recipient
                                                                                                                                          I = Non-DoD civil service employee, except Presidential
                                                                                                                                              appointee
                                                                                                                        A, B, C, D, E, F, J = Academy student
                            The code that represents how DEERS views the sponsor                                        G, H, I, J, K, L, K = Non-Appropriated Fund DoD employees
Member Category Code                                                                       Char (1)     SPONSTAT
                            based on his or her entitlements.                                                            M, N, O, P, Q,
                                                                                                                                          L = Lighthouse service
                                                                                                                        R, S, T, U, V, W
                                                                                                                                          M = Non-government agency personnel
                                                                                                                                          N = National Guard member
                                                                                                                                          O = Non-DoD contract employee
                                                                                                                                          Q = Reserve retiree not yet eligible for retired pay
                                                                                                                                               (gray area retiree )
                                                                                                                                          R = Retired military member eligible for retired pay
                                                                                                                                          T = Foreign military
                                                                                                                                          U = Authorized foreign national civilian
                                                                                                                                          V = Reserve member
                                                                                                                                          W = DoD Beneficiary, a person who receives benefits
                                                                                                                                                from the DoD based on prior association, condition
                                                                                                                                                or authorization, an example is a former spouse
                                                                                                                                          Z = Unknown
                            Zip code of residence for non-active duty/guard, zip code of
MHS-Derived Zip Code                                                                       Char (5)      DZIPCD           e.g., 03245     Note: Populated February 2004 and later.
                            assigned unit for AD/grd.
                                                                                                                                          PG_CD:
                                                                                                                                          00 = Unknown
                                                                                                                                          00 - ZZ (not WW) = Used when pay plan is civil service
                            The code that represents the level of pay. (The combination                                                   01 = Used when pay plan is cadet
Pay Grade                   of pay plan code and pay grade code represents the             Char (2)      PAYGRD             00 - 11       01 - 05 = Used when pay plan is warrant officer
                            sponsor‟s pay category.)                                                                                      01 - 09 = Used when pay plan is enlisted
                                                                                                                                          01 - 11 = Used when pay plan is officer

                                                                                                                                          Note: Populated February 2004 and l.




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                                                                                                   Position or SAS
     Data Element                                Definition                            Format                            Values                                   Notes
                                                                                                      Variable

                                                                                                                                    PAYPLAN_CD:
                                                                                                                                    GS = General Schedule
                                                                                                                                    MC = Cadet
                       The code that represents the type of pay category. (The
                                                                                                                      GS, GSE, MC, ME = Entitled
Pay Plan               combination of pay plan code and pay grade code                 Char (5)       PAYPLAN
                                                                                                                     ME, MO, MW, ZZ MO = Officer
                       represents the sponsor‟s pay category.)
                                                                                                                                    MW = Warrant Officer

                                                                                                                                       Note: Populated February 2004 and later.

                       The identifier that uniquely represents a Primary Care
                       Manager. This may be, for example, either the SSN or the                                                        D_MI_PCM_ID
PCM ID                                                                                 Char (18)       PCMID
                       Tax Identifier of the PCM, depending on the value of the                                                        Note: Populated February 2004 and later.
                       Primary Care Manager Identifier Type Code.
                                                                                                                                      D_MI_PCM_ID_TYP_CD:
                                                                                                                                      C = MCSC Internal Provider Number
                                                                                                                                      D = DEA Number
                                                                                                                                      H = HIPAA Provider ID
                       The code that specifies what type of identifier is being used
PCM ID Type                                                                            Char (1)       PCMIDTP        C, D, H, L, S, T L = Legacy Value
                       to uniquely identify a Primary Care Manager.
                                                                                                                                      S = SSN
                                                                                                                                      T = Tax ID Number

                                                                                                                                       Note: Populated February 2004 and later.

                                                                                                                                       PN_ID_TYP_CD:
                                                                                                                                       D = 9 digit code for individuals without an SSN
                                                                                                                                       F = 9 digit code for foreign military and nationals
                                                                                                                                       N = 9 digit code that looks like an SSN but is not in
                                                                                                                       D, F, N, P,         the valid range
Person ID Type Code    Code that represents a specific kind of person identifier.      Char (1)       PNIDTP
                                                                                                                        S, T, X        P = 9 digit code created for US military personnel from
                                                                                                                                           Service Numbers before switch to SSNs
                                                                                                                                       S = Social Security Number
                                                                                                                                       T = Test (858 series)
                                                                                                                                       X = Unknown


                                                                                                                                       D_MHS_POP_SECTOR_CD:
                                                                                                                                       1 = Active Duty
                                                                                                                                       2 = Active Duty Dependents less than 65
                       Represents the broad population class to which the person                                                       3 = Non Active Duty Dependent less than 65
Population Sector                                                                      Char (1)      DPOPSECT          1, 2, 3, 4, Z
                       belongs.                                                                                                        4 = Non Active Duty Greater than 65
                                                                                                                                       Z = Unknown

                                                                                                                                       Note: Populated February 2004 and later.




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                                                                                                 Position or SAS
      Data Element                                 Definition                         Format                           Values                                 Notes
                                                                                                    Variable

                                                                                                                                    PPS_LIVES_QY:
                          Total MHS PPS equivalent lives for a given month for the
                                                                                                                                    The raw enrollment count (reported by DEERS as of the first
                          query. MHS PPS Lives are intended to normalize each
PPS Equivalent Lives                                                                  Numeric      PPSLIVES                         of each month, multiplied by the appropriate PPS equivalent
                          enrollee's expected relative resource utilization across
                                                                                                                                    lives factor in each PPS equivalent lives category. Is
                          beneficiary category, age group, and sponsor service.
                                                                                                                                    populated for FY03 and forward; earlier years will be 0.

                                                                                                                                    1 = Prime (ACV = A, D, E)
PRIME                                                                                 Char (1)       PRIME              0, 1
                                                                                                                                    0 = not Prime
                                                                                                                                    D_PRISM_ID
                          The code indicating PRISM (Provider Requirement
                                                                                                                                    PRISM Area ID derived in MHS Data Repository (MDR)
                          Integrated Specialty Model) Area of residence. The PRISM
                                                                                                                                    processing by linking to the Catchment Area Directory
PRISM Area ID             area represents roughly a 20-mile area surrounding stand-   Char (4)      DPRISM           e.g., 0036
                                                                                                                                    (CAD).
                          alone MTFs. Records area assigned to PRISM areas based
                          on beneficiary zip code, sponsors.
                                                                                                                                    Note: Populated February 2004 and later.
                          The identifier that represents a person who is a sponsor.
Sponsor Person ID         This attribute will usually contain the sponsor‟s Social    Char (9)     SPONSSN                          SPN_PN_ID
                          Security Number.

                                                                                                                                    D_SPON_BR_SVC_CD
                                                                                                                                    As of February 2004:

                                                                                                                                     A = Army
                                                                                                                                     C = Coast Guard
                                                                                                                                     F = Air Force
                                                                                                                                     M = Marine Corps
                                                                                                                                     N = Navy
                                                                                                                                     V = Navy Afloat
                                                                                                                                     X = Other
                                                                                                                   A, C, F, I, M, N,
Sponsor Service Aggregated ode indicating service of sponsor.
                         C                                                            Char (1)      SERVICE                          Z = Unknown
                                                                                                                       V, X, Z
                                                                                                                                    Prior to February 2004:

                                                                                                                                    A = Army
                                                                                                                                    E = Public Health Service
                                                                                                                                    F = Air Force
                                                                                                                                    I = Nat'l Oceanic and Atmospheric Adm.
                                                                                                                                    M = Marine Corps
                                                                                                                                    N = Navy
                                                                                                                                    P=C

                                                                                                                                    MDR_M2_SUM_PRIV_CD
                                                                                                                                    U = USFHPD = Direct Care Only
                                                                                                                                    C = CHAMPUS Eligible
Summary Privilege Code    Summary Medical Privilege Code.                             Char (1)      SUMPRIV         U, D, C, M, O   M = Medicare Eligible, not CHAMPUS eligible
                                                                                                                                    O = Other

                                                                                                                                    Note: Populated February 2004 and later.




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                                                                                                    Position or SAS
     Data Element                                  Definition                           Format                           Values                                    Notes
                                                                                                       Variable
                                                                                                                                       DOD_EDI_PN_ID:
                         The identifier that is used to represent the person within a                                                  DEERS Electronic Data Interchange Person ID.
Unique Person ID                                                                        Char (10)      PATUNIQ
                         Department of Defense Electronic Data Interchange.
                                                                                                                                       Note: Populated February 2004 and later.

                                                                                                                                       D_HSSC_ENR_RGN_CD
                                                                                                                                       A = Alaska
                                                                                                                                       N = North
                         Code that identifies the HSSC, or TNEX, Region associated                                    A, N, O, S, W,
HSSC Enrollment Region                                                                  Char (1)      DHSSCENR                         O = OCONUS
                         with the enrollment site. Derived in MDR processing.                                             blank
                                                                                                                                       S = South
                                                                                                                                       W = West
                                                                                                                                       blank = all other or not defined (or not enrolled)




      October 2011 Version                                                                    ENR                                                                        Page 113 of 1408
                                                                                          Enrollment Norms

                                             NORMS - ENROLLMENT (Norms for the TRICARE Enrollment File)
Common File Name: fyXX.sas7bdat, where XX = 03+
Dataset Location: /mdr/ref/enr.norms.fyXX/
Update Frequency: Current and out FYs, around summer                                                    Source System:
Description: Enrollment Normative Data
                                                                                                             Position or SAS
         Data Element                                Definition                              Format                               Values                             Notes
                                                                                                                Variable
                              Binary variable describing individuals on active duty (or
Active Duty Status                                                                             N(3)                AD              1, 0
                              not).
                              Binary variable describing marital vs. unmarried status
Active Duty Marital Status                                                                     N(3)              ADMAR             1, 0
                              of active duty persons in age groups D, E, and F.
                              As specified in TRICARE Relationship File, except that
Age Group                                                                                      C(1)              AGEGP             A-H
                              all persons age 65 or older are coded as 'H'.
                              Average bed days per Prime enrollee per month within                                                           Used to create Bed Days MHS Norm and Bed Days MHS
Bed Days MHS Norm                                                                             N(8.6)           DAYSPER
                              the MHS.                                                                                                       Norm PMPM.
                              Average admissions per Prime enrollee per month                                                                Used to create Admissions MHS Norm and Admissions
Admissions MHS Norm                                                                           N(8.6)            DISPPER
                              within the MHS.                                                                                                MHS Norm PMPM.

                              Average full cost per Prime enrollee per month in the                                                          Used to create Full Cost MHS Norm and Full Cost MHS
Full Cost MHS Norm                                                                            N(8.2)           FCOSPER
                              MHS.                                                                                                           Norm PMPM.
                                                                                                                                             0 = male
Female                        Binary variable describing females (or not).                     N(3)               FEM              1, 0
                                                                                                                                             1 = female
                              Average bed days per Prime enrollee per month within                                                           Used to create Bed Days MHS Peer Norm and Bed Days
Bed Days MHS Peer Norm                                                                        N(8.6)           PDAYSPER
                              the MHS Peer Group.                                                                                            MHS Peer Norm PMPM.

                              Average admissions per Prime enrollee per month                                                                Used to create Admissions MHS Peer Norm and
Admissions MHS Peer Norm                                                                      N(8.6)           PDISPPER
                              within the MHS Peer Group.                                                                                     Admissions MHS Peer Norm PMPM.
                              Average full cost per Prime enrollee per month within                                                          Used to create Full Cost MHS Peer Norm and Full Cost
Full Cost MHS Peer Norm                                                                       N(8.2)           PFCOSPER
                              the MHS Peer Group.                                                                                            MHS Peer Norm PMPM.
                              DMISID Peer Group for Inpatient (1 - 4), Ambulatory (A -
Peer Group                    D), and Managed Care Support Contractor (M)                      C(1)               PGP          1 - 3, A - C, M See Notes on DMISID Norms tab.
                              DMISIDs.

                              Average RVUs per Prime enrollee per month within the                                                           Used to create RVUs MHS Peer Norm and RVUs MHS
RVUs MHS Peer Norm                                                                            N(9.4)           PRVUSPER
                              MHS Peer Group.                                                                                                Peer Norm PMPM.

                              Average variable cost per Prime enrollee per month                                                             Used to create Variable Cost MHS Peer Norm and
Variable Cost MHS Peer Norm                                                                   N(8.2)           PVCOSPER
                              within the MHS Peer Group.                                                                                     Variable Cost MHS Peer Norm PMPM.
                              Average RVUs per Prime enrollee per month in the                                                               Used to create RVUs MHS Norm and RVUs MHS Norm
RVUs MHS Norm                                                                                 N(9.4)           RVUSPER
                              MHS.                                                                                                           PMPM.
                              Average variable cost per Prime enrollee per month in                                                          Used to create Variable Cost MHS Norm and Variable
Variable Cost MHS Norm                                                                        N(8.2)           VCOSPER
                              the MHS.                                                                                                       Cost MHS Norm PMPM.
                              Average admissions per enrollee per month in private
Admissions Civ MC Norm                                                                        N(8.6)                                         TBD.
                              sector managed care organizations.
                              Average admissions per enrollee per month in the
Admissions Civ Norm                                                                           N(8.6)                                         TBD.
                              private sector.
                              Average bed days per enrollee per month in private
Bed Days Civ MC Norm                                                                          N(8.6)                                         TBD.
                              sector managed care organizations.



    October 2011 Version                                                                  Enrollment Norms                                                                      Page 114 of 1408
                                                                                     Enrollment Norms

                                                                                                        Position or SAS
        Data Element                              Definition                            Format                            Values          Notes
                                                                                                           Variable
                           Average bed days per enrollee per month in the private
Bed Days Civ Norm                                                                        N(8.6)                                    TBD.
                           sector.
                           Average full cost per enrollee per month in private
Full Cost Civ MC Norm                                                                    N(8.2)                                    TBD.
                           sector managed care organizations.

                           Average full cost per enrollee per month in the private
Full Cost Civ Norm                                                                       N(8.2)                                    TBD.
                           sector.

                           Average RVUs per enrollee per month in private sector
RVUs Civ MC Norm                                                                         N(9.4)                                    TBD.
                           managed care organizations.
                           Average RVUs per enrollee per month in the private
RVUs Civ Norm                                                                            N(9.4)                                    TBD.
                           sector.




    October 2011 Version                                                             Enrollment Norms                                             Page 115 of 1408
                                                                                          HCPR

                                                                            HCPR (Health Care Provider Record)

Common File Name: hcpr.sas7bdat
Object Class Location: /mdr/pub/hcpr/
Update Frequency: Monthly. Last updated August, 2006                                                                                 Source System: HCSR
Description: A listing of all entities (e.g., hospitals, supply companies, nursing homes, physician groups, and health care professionals) that submit HCSR claims to the MHS
for services and supplies rendered.
                                                                                                 Position or SAS
         Data Element                                 Definition                    Format                             Values                                  Notes
                                                                                                    Variable
American Hospital Association ID
                                 American Hospital Association ID Number.           Char(9)         AHAIDNO        e.g., 999999999
Number

AHA Multi-Hospital System Code AHA Multi-Hospital System Code.                      Char(4)        AHAMLTCD          e.g., 2310

Batch Process Date              Batch Process Date.                                 Char(8)        BATCHDT          YYYYMMDD
                                                                                                                                     A = Active
CHAMPUS Provider Code           CHAMPUS Provider Code.                              Char(1)        CHPRVCD               A, I
                                                                                                                                     I = Inactive

CHAMPUS Provider History        CHAMPUS Provider History.                           Char(1)       CHPRVHCD                P          P = Provider

                                                                                                                                     03 = Humana Region 3
                                                                                                                                     06 = HealthNet Region 6
                                                                                                                                     07 = Triwest, Regions 7 and 8
                                                                                                                                     11 = HealthNet Region 11
                                                                                                                                     13 = Unisys (terminated 6/30/99)
                                                                                                                                     25 = Humana Regions 2 and 5
                                                                                                                                     26 = Sierra Region 1
                                                                                                                                     38 = Blue Cross/Blue Shield of SC (terminated 6/30/99)
                                                                                                                                     45 = WPS
                                                                                                                                     53 = Foundation CRI
Contractor Number               Contract Number.                                    Char(2)        CONTRNO           e.g., 03, 65
                                                                                                                                     57 = New Orleans Coordinated Care (terminated 5/29/97)
                                                                                                                                     69 = Aetna (terminated 9/30/97)
                                                                                                                                     60 = Foundation Regions 9, 10 and 12
                                                                                                                                     61 = TRex
                                                                                                                                     62 = Tnex West
                                                                                                                                     63 = Tnex South
                                                                                                                                     64 = Tnex North
                                                                                                                                     65 = TDEFIC
                                                                                                                                     72 = Managed Care Support - FHC Options (terminated
                                                                                                                                          3/1/99)
DRG Exempt/Non-Exempt
                                DRG Exempt/Non-Exempt Effective Date.               Char(8)        DRGEFDT          YYYYMMDD         Majority of records coded "00000000".
Effective Date
                                                                                                                                     C = DRG Non-Exempt/Contracted Reimbursement
                                                                                                                                     Arrangement
DRG Exempt/Non-Exempt
                                DRG Exempt/Non-Exempt Indicator.                    Char(1)        DRGEXNEX        C, E, N or Null   E = DRG Exempt
Indicator
                                                                                                                                     N = DRG Non-Exempt
                                                                                                                                     Blank = Not Applicable
Health Service Region Code      Health Service Region Code.                         Char(2)        HSREGION        01 - 12, AK, PR



      October 2011 Version                                                                HCPR                                                                         Page 116 of 1408
                                                                                             HCPR

                                                                                                    Position or SAS
          Data Element                                       Definition                Format                           Values                                   Notes
                                                                                                       Variable
Indirect Medical Education Ratio
                                    Indirect Medical Education Ratio Effective Date.   Char(8)        IDMERTDT        YYYYMMDD       Majority of records coded "00000000".
Effective Date

Indirect Medical Education Ratio    Indirect Medical Education Ratio.                  Num(8)         IDMERTIO

Institution/Non-Institution                                                                                                          I = Institutional
                                    Institution/Non-Institutional Indicator.           Char(1)        INNINFLG            I, N
Indicator                                                                                                                            N = Non Institutional

                                                                                                                                     L = Long Term (average length of stay for all patients is
                                                                                                                                         30 days or more or over 50 percent of all patients are
                                                                                                                                         admitted to units where average length of stay is 30
Type Of Institution Code            Type of Institution Code.                          Char(1)        INSTTYPE        L, S or Null
                                                                                                                                         days or more.)
                                                                                                                                     S = Short Term (average length of stay for all patients is
                                                                                                                                          less than 30 days.)

Medicare Number                     Medicare Number.                                   Char(8)        MEDICRNO

Multiple Provider Flag              Multiple Provider Flag.                            Char(1)        MLTPRVCD         Y or Null     Y = Yes

                                                                                                                                     See DMISID Information .
MTF Code                            MTF Code.                                          Char(3)          MTFCD          e.g., 001
                                                                                                                                     Note: Leading zero for normal 4 digit DMISID is not present.

Provider Acceptance Date            Provider Acceptance Date.                          Char(8)        PRVACCDT        YYYYMMDD

Provider Street Address             Provider Street Address.                           Char(30)       PRVADDR
                                                                                                                                     0 = Not Applicable
                                                                                                                                     1 = Contracted
Provider Contractor Affiliation                                                                                                      2 = Not Contracted
                                    Provider Contractor Affiliation Code.              Char(1)        PRVAFFCD           0-5
Code                                                                                                                                 3 = Contracted/Not Contracted
                                                                                                                                     4 = Active Duty TPR
                                                                                                                                     5 = Non-Certified Providers
Provider Billing Street Address     Provider Billing Street Address.                   Char(30)       PRVBADDR

Provider Billing City               Provider Billing City.                             Char(18)       PRVBCITY

Provider Billing State Or Country
                                    Provider Billing State or Country Code.            Char(2)        PRVBSTCO        e.g., 17, PR   See State and Country Codes, PC.
Code

Provider Billing Zip Code           Provider Billing Zip Code.                         Char(5)         PRVBZIP

Provider City                       Provider City.                                     Char(18)        PRVCITY

Provider Major Specialty Or Type                                                                                                     See Provider Specialty Codes. Blank for Non-Institutional
                                 Provider Major Specialty or Type of Institution.      Char(2)        PRVMAJSP        e.g., 01, HA
Of Institution                                                                                                                       Providers.

Provider Name                       Provider Name.                                     Char(40)         PRVNM

Provider State Or Country Code      State or Country of provider's mailing address.    Char(2)        PRVSTCO         e.g., 17, PR   See State and Country Codes, PC.



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                                                                                                      Position or SAS
           Data Element                                Definition                        Format                             Values                                   Notes
                                                                                                         Variable
                                 Identification number that uniquely identifies
                                 individual providers using the same taxpayer
Provider Sub identifier                                                                  Char(4)        PRVSUBID           e.g. 0002
                                 identification number (TIN). Codes are assigned
                                 per OCHAMPUS instructions.
Provider Termination Date        Provider Termination Date.                              Char(8)        PRVTRMDT         YYYYMMDD

Provider Taxpayer Number
                                 Provider Taxpayer Number Identifier.                    Char(1)        PRVTXNID            A, E, S
Identifier
                                                                                                                                          For individual providers it must be the EIN or SSN, if
                               The IRS Taxpayer Identification Number (TIN)
                                                                                                                                          available. If not available, the contractor will report the
                               assigned to the institution/provider supplying the                                       e.g., 10130427,
                                                                                                                                          contractor-assigned number. On HCSRs, all nines are used
Provider Taxpayer Number (TIN) care. For institutions, it must be the employer ID        Char(9)        PRVTXNO            ZA000025
                                                                                                                                          for transportation services under the program for the
                               number (EIN).
                                                                                                                                          handicapped and for the drug program when the services are
                                                                                                                                          from a non-participating pharmacy.
                                 The first five digits of the zip code of the location
Provider Zip Code                                                                        Char(5)         PRVZIP
                                 where the care was provided.
Record Effective Date            Record Effective Date.                                  Char(8)        RECEFDT          YYYYMMDD
                                                                                                                                          R = Rural
Rural/Urban Indicator            Rural/Urban Indicator.                                  Char(1)        RURALURB            L, R, U       U = Urban
                                                                                                                                          L = Large Urban Area.

                                                                                                                                          T = TED record
                                 A flag to determine whether the record originated as                                                     null = HCSR
TED Flag                                                                                 Char(1)         TEDFLG            T or null
                                 a HCSR or a TED.
                                                                                                                                          TED adjustments to original HCSRs will have a value of "T".
                                                                                                                                          A = Added Record
Transaction Code                 Transaction Code.                                       Char(1)        TRANSCD             A, I, M       I = Inactive Record
                                                                                                                                          M = Modified Record
Area Wage Index Effective Date   Area Wage Index Effective Date.                         Char(8)       WAGEEFDT          YYYYMMDD

Area Wage Index                  Area Wage Index.                                        Num(8)         WAGEINDX




       October 2011 Version                                                                    HCPR                                                                          Page 118 of 1408
                                                                                            HCSR-I

                                                                                   HCSR Institutional
Common File Name: hcsri.fy**.txt
Object Class Location: /mdr/pub/hcsri/
                                                                                                             Data Source System: Aurora Claims Acceptance
Update Frequency: Monthly; updates include new/changed records since prior reporting. Last HCSR-I processed in Fiscal Year 2005
                                                                                                             System (HCSR)
Description: Each record represents a TRICARE Institutional Claim, with all adjustments applied. Cancellations and denials are included in this file. To remove
these from your queries, limit records using type of submission code.
                                                                                               Position or SAS
      Data Element                                 Definition                      Format                         Values                             Notes
                                                                                                  Variable
Error Count                                                                         SN3              1

Record Type Code           Set=1 for all records in the institutional data file.    $1               4              1      1 = institutional HCSR or TED

                                                                                                                           03 = Humana Region 3
                                                                                                                           06 = Health Net Region 6
                                                                                                                           07 = Triwest, Regions 7 and 8
                                                                                                                           11 = Health Net Region 11
                                                                                                                           13 = Unisys (terminated 6/30/99)
                                                                                                                           25 = Humana Regions 2 and 5
                                                                                                                           26 = Sierra Region 1
                                                                                                                           38 = Blue Cross/Blue Shield of SC (terminated 6/30/99)
                                                                                                                           45 = WPS
                           Code indicating the contractor who submitted the                                                53 = Foundation CRI
Contractor Number                                                                   $2               5            03, 06
                           claim.                                                                                          57 = New Orleans Coordinated Care (terminated 5/29/97)
                                                                                                                           69 = Aetna (terminated 9/30/97)
                                                                                                                           60 = Foundation Regions 9, 10 and 12
                                                                                                                           61 = TRex
                                                                                                                           62 = Tnex West
                                                                                                                           63 = Tnex South
                                                                                                                           64 = Tnex North
                                                                                                                           65 = TDEFIC
                                                                                                                           72 = Managed Care Support - FHC Options (terminated
                                                                                                                                3/1/99)
                                                                                                                           96C0002 = Humana 3/4
                                                                                                                           95C0005 = Health Net 6
                                                                                                                           96C0004 = Triwest 7/8
                                                                                                                           94C0003 = Health Net 11
                           Contract number identifying contract under which                                                97C0005 = Humana 2/5
HCSR Contract Number                                                                $7               7
                           claim is processed.                                                                             97C0003 = Sierra 1
                                                                                                                           95C0007 = Foundation 9/10/12
                                                                                                                           03C0009 = Tnex West
                                                                                                                           03C0011 = Tnex North
                                                                                                                           03C0015 = TDEFIC
                                                                                                                           Batch = 0
Record Type Code (Batch) Code indicating the type of record.                        $1               14
                                                                                                                           Voucher = 5

                                                                                                                           Only valid when record type code indicates a batch (batch =
Batch Create Date          Date in which the batch was created.                      7               15          YYYYDDD   0). Value does not change in the event a HCSR needs to be
                                                                                                                           resubmitted.



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                                                                                             HCSR-I

                                                                                                Position or SAS
      Data Element                                Definition                        Format                         Values                                 Notes
                                                                                                   Variable
Voucher Branch of Service Branch of service to which voucher belongs.                $2               15                     See Voucher Branch of Service.

                                                                                                                             Numeric, representing the last digit of the FY. Only valid
                            Designates fiscal year to which voucher funds are
Voucher Number FY                                                                    $1               17            0-9      when record type code indicates a voucher (voucher = 0).
                            obligated.
                                                                                                                             Value does not change in the event a claim is resubmitted.

                                                                                                                             Only valid when record type code indicates a voucher
Voucher Number Seq.         Uniquely identifies each voucher for a given FI for a
                                                                                     $3               18            123      (voucher = 0). Value does not change in the event a claim
Number                      given fiscal year.
                                                                                                                             needs to be resubmitted.

Voucher Resubmit Seq.       The number of times a voucher has been resubmitted
                                                                                     $2               21             00      Initial submission is set to 00.
Number                      to correct edit errors.

                                                                                                                             Only valid when record type code indicates a batch (batch =
Batch Sequence Number       Sequence number assigned to a batch.                     $2               22                     0). Value does not change in the event a claim needs to be
                                                                                                                             resubmitted.

                        The number of re-submissions for the batch for other                                                 Only valid when record type code indicates a batch (batch =
Batch Resubmit Sequence
                        than batch-level error rejections. Incremented by one        $2               24                     0). Value does not change in the event a claim needs to be
Number
                        for each resubmission.                                                                               resubmitted.
                            Begin date of batch of HCSRs, as submitted by the
HCSR Batch Begin Date                                                                $8               26          YYYYMMDD
                            contractors.
                            End date of batch of HCSRs, as submitted by
HCSR Batch End Date                                                                  $8               34          YYYYMMDD
                            contractors.
                                                                                                                             Only valid when record type code indicates a voucher
Voucher Notice Date         The date that voucher funding was approved by TMA.       $8               42          YYYYMMDD   (voucher = 0). Value does not change in the event a HCSR
                                                                                                                             needs to be resubmitted.

                                                                                                                             Only valid when record type code indicates a voucher
                            Date the contractor first submitted the voucher to
Voucher Create Date                                                                  $8               50          YYYYMMDD   (voucher = 0). Value does not change in the event a HCSR
                            TMA.
                                                                                                                             needs to be resubmitted.

                                                                                                                             Only valid when record type code indicates a voucher
Subtype Sort Number         Voucher Key.                                              2               58                     (voucher = 0). Value does not change in the event a HCSR
                                                                                                                             needs to be resubmitted.

                                                                                                                             Only valid when record type code indicates a voucher
Record Received
                            Uniquely identifies each record within a voucher.         7               60                     (voucher = 0). Value does not change in the event a HCSR
Sequence Number
                                                                                                                             needs to be resubmitted.


Record Processed            Sequence Number associated with each record in a                                                 Only valid when record type code indicates a voucher
                                                                                      7               67
Sequence Number             voucher.                                                                                         (voucher = 0).

                            Code that indicates the filing state or country where
Filing State/Country Code                                                            $2               97                     See Country Codes.
                            the care was provided.




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                                                                                        HCSR-I

                                                                                           Position or SAS
      Data Element                              Definition                     Format                              Values                                   Notes
                                                                                              Variable

                          Identifies to which TRICARE program the services                                                       i = institutional
Program Indicator Code                                                          $1               111                 i, h
                          being reported on the claim are related.                                                               h = program for the handicapped

                          Processed to completion date for the claim record
HCSR Processed to
                          (HCSR or TED). This date does not change for re-       8               112            YYYYMMDD
Completion Date
                          submissions unless previously coded in error.
                          Date the contractor determined an adjustment was
HCSR Adjustment           required. This date does not change for re-
                                                                                 8               120            YYYYMMDD
Identified Date           submissions unless previously coded in error. This
                          date is zero filled on non-adjustment HCSRs.

                          Sponsor social security account number or veterans                                                     All blanks = NATO & security agent claims (extremely rare)
Sponsor SSN                                                                     $9               128             111111111
                          administration file number.                                                                            First 3 digits zeroes = deceased sponsor only

                                                                                                                                    00 = unknown enlisted
                                                                                                                                    01 - 09 = enlisted (e1 - e9)
                                                                                                                                    10 = unknown warrant officer
                                                                                                                                    11 - 14 = warrant officer (w1 - w4)
                                                                                                                                    19 = academy of navy OCS students
                                                                                                             00 - 14, 19 - 31, 40 - 20 = unknown officer
Sponsor Pay Grade         Sponsor's pay grade code.                             $2               137
                                                                                                                58, 90, 95, 99      21 - 31 = officer (01 - 011)
                                                                                                                                    40 = unknown civil service
                                                                                                                                    41 - 58 = GS1 - GS18
                                                                                                                                    90 = unknown
                                                                                                                                    95 = not applicable (including CHAMPVA)
                                                                                                                                    99 = other
                                                                                                                                    A = Army
                                                                                                                                    E = Public Health Service
                                                                                                                                    F = Air Force
                                                                                                              A, E, F, I, M, N, P, I = NOAA
Sponsor Branch of Service Branch of service of sponsor.                         $1               139
                                                                                                                       C            M = Marines
                                                                                                                                    N = Navy
                                                                                                                                    P = Coast Guard
                                                                                                                                    C = CHAMPVA




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                                                                                           HCSR-I

                                                                                              Position or SAS
      Data Element                             Definition                         Format                          Values                                Notes
                                                                                                 Variable
                                                                                                                             A = Active Duty
                                                                                                                             B = Presidential Appointee
                                                                                                                             C = Civil Servant
                                                                                                                             D = DAV
                                                                                                                             E = DoD Contract Employee
                                                                                                                             F = Former Member
                                                                                                                             G = Guard
                                                                                                                             H = Medal of Honor
                                                                                                                             I = Non-DoD Civil Servant
                                                                                                                             J = Academy Student
                                                                                                                             K = NAF DoD Employee
Sponsor Status           Status of sponsor at the time of health care delivery.    $1               140            A, B      L = Lighthouse Keeper
                                                                                                                             M = Non Government Agency Personnel
                                                                                                                             N = Guard
                                                                                                                             O = Non-DoD contract employee
                                                                                                                             P = TAMP
                                                                                                                             Q = Reserve Retiree (not ready for retired pay)
                                                                                                                             S = Reserve
                                                                                                                             T = Foreign Military
                                                                                                                             U = Authorized foreign national
                                                                                                                             V = Reserve
                                                                                                                             W = DoD benefit from prior relationship
                                                                                                                             Z = Unknown
                                                                                                                             Blank = Sponsor
                                                                                                                             C = Child
                                                                                                                             F = Un-remarried widow
                                                                                                                             G = Unmarried widow
                                                                                                                             H = Unmarried former spouse 20/20/20
                                                                                                                             L = Parent in Law
                                                                                                                             M = Step parent in law
                                                                                                                             P = Parent
Patient Relationship     Code indicating relationship of patient to sponsor.       $1               141                      R = Un-remarried former spouse 20/20/15
                                                                                                                             S = Spouse
                                                                                                                             T = Un-remarried former spouse 20/20/20
                                                                                                                             U = Step parent
                                                                                                                             V = Step child
                                                                                                                             W = Ward
                                                                                                                             X = Other
                                                                                                                             Y = Un-remarried former spouse 20/20/15
                                                                                                                             Z = Unknown
Patient Name             Name of patient.                                          $27              142                      Name of patient.
Patient SSN              Patient social security number.                           $9               169          111111111   Social security number of patient.
Patient DOB              Patient date of birth.                                    $8               178         YYYYMMDD     Date of birth of patient.




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                                                                                            HCSR-I

                                                                                               Position or SAS
      Data Element                               Definition                        Format                        Values                                 Notes
                                                                                                  Variable
                                                                                                                           01 - 19 = Dependent Child
                                                                                                                           20 = Sponsor
                                                                                                                           30 - 39 = Spouse of sponsor
                                                                                                                           40 - 44 = Mother of sponsor
                                                                                                                           45 - 49 = Father of sponsor
DEERS Dependent Suffix     Code maintained by DEERS that uniquely identifies
                                                                                    $2               186           20      50 - 54 = Mother-In-Law of sponsor
Code                       the patient within the family.
                                                                                                                           55 - 59 = Father-In-Law of sponsor
                                                                                                                           60 - 69 = Other eligible dependents
                                                                                                                           70 - 74 = Unknown by DEERS
                                                                                                                           75 = Pseudo DDS unknown by contractor
                                                                                                                           98 = Service secretary designee

                                                                                                                           M = Male
Patient Sex                Gender of patient.                                       $1               188          F, M
                                                                                                                           F = Female
                                                                                                                           Zip code of patient residence for U.S. residents. APO/FPO if
Patient Zip/Country Code   Zip/country code of patient.                             $9               189         22026
                                                                                                                           available, otherwise country code.

                           Code indicating enrollment status of patient. Some                                              AD enrollees are not identifiable. This fields will contain
Enrollment Code            values of this code are not related to enrollment        $2               198          Z, U     values for "supplemental care" for all active duty. See
                           however.                                                                                        Enrollment Status.

                           A one character numeric digit at the beginning of the
NAS ID Number Prefix       NAS ID number. For valid and active NAS ID               $1               200
                           numbers, this is a zero.
NAS MTF Code               Code indicating MTF that issued the NAS.                 $3               201          123

NAS Issue Date             Julian Date, indicating date of issuance of NAS.         $4               204
NAS Facility Sequence      Sequence number of NAS.                                  $3               208
                                                                                                                           A = mental health pre-authorization not obtained
Reason for Payment                                                                                                         B = adjunctive dental care pre-authorization not obtained
                           Reason payment reduced.                                  $1               211         A, B, C
Reduction                                                                                                                  C = procedure/services in TRICARE regions not
                                                                                                                               authorized
Major Diagnostic Category Code representing MDC. Only populated when NAS
                                                                                    $2               212         01, 02    See MDC Codes.
Code                      issued.

Derived Major Diagnostic   Code indicating major diagnostic category. Populated
                                                                                    $2               214         01, 02    See MDC Codes.
Code                       for all claims.

                                                                                                                           1 = Facilities unavailable
                                                                                                                           2 = Professional capability unavailable
                                                                                                                           3 = Medically inappropriate
                                                                                                                           4 = Facilities temporarily N/A
                           Code representing the reason that the NAS was
NAS Issue Reason Code                                                               $1               216           1       5 = Professional capability temporarily N/A
                           issued.
                                                                                                                           6 = Facilities permanently unavailable
                                                                                                                           7 = Enrollee network care authorization, restricted NAS
                                                                                                                           8 = Enrollee non-network care authorization, restricted NAS
                                                                                                                           9 = Non-enrolled, authorized network care only




  October 2011 Version                                                                      HCSR-I                                                                 Page 123 of 1408
                                                                                             HCSR-I

                                                                                                Position or SAS
      Data Element                             Definition                           Format                              Values                                    Notes
                                                                                                   Variable
                                                                                                                                       A = DD form 2520 (long)
                                                                                                                                       B = DD form 2520 (short)
                                                                                                                                       C = HCFA form 1500
                                                                                                                                       D = UBF-1
                         The code associated with the primary claim form                                          A, B, C, D, F, G, H,
Claim Form Type                                                                      $1               217                              F = UB-92
                         submitted.                                                                                       I, J
                                                                                                                                       G = electronic institutional claim submission
                                                                                                                                       H = electronic non-institutional claim submission
                                                                                                                                       I = electronic drug submission
                                                                                                                                       J = other
                                                                                                                                      ** Note: For HCSR-based records, this will contain the
                                                                                                                                      enrollment DMIS ID for non-active duty beneficiaries enrolled
                                                                                                                                      in Prime. For active duty, it contains the referring DMIS ID, if
                                                                                                                                      there is one. For OCONUS TOP Prime enrollees (including