List_of_Data_Available_to_Offerors.pdf

List of Data Available to Offerors

• Important Information – Read First

• Detail Level Data Files: Ordering Instructions and Fees

Eligible Beneficiary Data

• Guide to Historical Data Package – Beneficiary Data

• Summary Report, Underwritten DEERS Eligibles

• Eligibles Per Month, (Date Range)

• DEERS Enrollment Transaction Information

• Enrollment, Disenrollment, and Enrollment Fee Transaction Information

• Beneficiary Web Enrollment Data

Direct Care Data

• Guide to Historical Data Package – Direct Care Data

• Direct Care Ambulatory Detail File (record level)*

• Direct Care Ambulatory Summary File (summarized on key variables)*

• Summary Report, Inpatient Claims Cost and Workload for Underwritten Beneficiaries

• Summary Report, MTF Outpatient Encounters for Underwritten Beneficiaries

Purchased Care Data

• Important Information on Claims Completion Factors

• TMA Website Data Directory (www.tricare.mil/datadictionary)

• Guide to Historical Data Package – Purchased Care Data

• Purchased Care Institutional Header Claims File (individual claim level)*

• Purchased Care Institutional Line Item Revenue Claims file (individual claim level)*

• Purchased Care Non-Institutional Claims file (individual claim level)*

• Summary Report, Inpatient Claims Cost and Workload for Underwritten Beneficiaries

• Summary Report, Outpatient Claims Cost and Workload for Underwritten Beneficiaries

• TEDS Processed and Edit Errors, (Date Range)

Government Development of Health Care Cost Estimates

• Explanation of Government Development of Health Care Cost Estimates

• T-2017 Underwritten Health Care Cost Estimating Worksheets

Pharmacy Data

• Guide to Historical Data Package – Pharmacy

• Pharmacy Data Transaction Service (PDTS) Detail file*

Claims Data

• Electronic and Paper Claims Data: Quantities of Electronic and Paper Claims filed by Region, (Date Range)

• Raw TEDS Data – Data used to determine Quantities of Electronic and Paper Claims

• Other Health Insurance Claims Data

Historical Disease Management Data

• Important Information Regarding Disease Management Data

• Patient Identification and Risk Stratification

• Outcome Metrics

• Disease Management Enrollment Candidates by Region

Additional Information Based on Feedback from Industry

• Additional Information Based on Feedback from Industry

Current Contract Memoranda of Understanding

• Note Concerning Current Contract Memoranda of Understanding

• North Region MOUs

• MTF MOUs (Number of Files)

• North Region MOU (Number of Files)

• North Regional Operating Procedures (Number of Files)

• South Region MOUs

• MTF MOUs (Number of Files)

• South Regional MOU (Number of Files)

• Coast Guard Maintenance & Logistics Command, Atlantic MOU (Number of Files)

• West Regions MOUs

• MTF MOUs (Number of Files)

• West Regional MOU (Number of Files)

• TRICARE Alaska Office, TRO West MOU (Number of Files)

• Coast Guard Clinics, Pacific Area MOU (Number of Files)

Current Contract Prime Service Area Zip Codes

• Introduction, Prime Service Area Zip Codes Lists by Type and Region

• Geographic Area of Coverage (First Posting of Document listed above)

• Prime Service Area Zip by Type and Region for T-NEX

• Prime Service Area Zip for TRO West

DEERS Draft Operating Guides

• Caution Regarding DEERS Draft Documents

• DEERS/MHS Draft Documents: External Specs, CAC documents, and Data Dictionary (Number of Files)

• HIC-OHI Technical Specification – (Version Number)

• Policy Notification Tech. Spec. – (Version Number)

• CAC NG Implementation Guide – (Version Number)

• CAC Reader Specification Release 3.0 (Version Number)

• CCDD Technical Specification – (Version Number)

• Civilian PCM Load Technical Specification – (Version Number)

• Claims Technical Specification – (Version Number)

• CPR Workstation Specification – (Version Number)

• DoD CAC Middleware Requirements Release 3.0 (Version Number)

• T-NEX Data Dictionary (Version Number)

• Gold File Technical Specification (Version Number)

• DMDC Authentication Services for Beneficiary Web Access External Technical Specification (Version Number)

• BEFP Interface Technical Specification – (Version Number)

MTF/eMSM Profiles