OHI_Information_Request.docx

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TRICARE Dental Program (TDP)
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HT940215R0001
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Text version

Please indicate whether or not you collect Other Health Insurance (OHI) information. If you collect OHI data, how do you collect it and how often do you collect it? Do you collect any of the data stated below? Please provide any additional data that you collect that is not stated below.

•Policy Identifier (policy number) •OHI Effective Date •HIPAA Insurance Type Code •HIPAA Person Association Code •Claim Filing Code •OHI Coverage Type Code •OHI Coverage Payer Type Code •OHI Coverage Effective Date •OHI Policy Coverage Precedence Code •Health Insurance Name •Health Insurance Coverage Type Code •Health Insurance Payer Type Code

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