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TRICARE Systems Manual 7950.3-M

Each TMA Manual distributed on the web currently incorporates all published changes. Although changes are published, they are not implemented by the contractors until they receive direction to do so by the Contracting Officer. Each TRICARE Manual on the web incorporates all changes by the date of publication. Although changes are published, they may not be implemented by the contractor until directed to do so by the Contracting Officer.
The TRICARE Systems Manual (TSM) is incorporated by reference in the Managed Care Support Contracts (MCSCs) and is the primary vehicle for systems requirements and instructions. The TSM provides a mechanism for keeping the contracts current by clarifying or modifying existing contractual requirements, adding new specifications/requirements and deleting obsolete information. The TRICARE Systems Manual (TSM), 7950.3-M, defines contractor responsibilities for automated processing of health care information, reporting and transmission of relevant data between the contractor and the Defense Health Agency (DHA). The manual also provides requirements for TRICARE contractors to interface with the Defense Enrollment Eligibility Reporting System (DEERS) for obtaining beneficiary eligibility verifications from DEERS and performing TRICARE Prime enrollments onto DEERS. Requirements for the TRICARE Encounter Data (TED) and the TRICARE Duplicate Claims System (DCS) – TRICARE Encounter Data (TED) Version are located in this manual.
  • April 1, 2015 Edition
    Last Updated: June 22, 2018
    Most Recent Change Number: Change 16
    These manuals are applicable to the East and West Regional Managed Care Support Contracts awarded on or after 07/21/2016. Upon direction of the Contracting Officer, all or portions of these manuals may also apply to the TRICARE Quality Monitoring Contract (TQMC), TRICARE Claims Audit Review Services (TCARS), TRICARE Overseas Program (TOP), TRICARE Pharmacy (TPharm), TRICARE Dental Program (TDP), and TRICARE Dual Eligible Fiscal Intermediary Contract (TDEFIC).
    The April 1, 2015 edition of the TRICARE Systems Manual, 7950.3-M is available online.
    All future changes will be published to this edition.

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    Page Count: 772
    This change updates codes to the October quarterly Medicare OPPS. This change is published in conjunction with Apr 2015 TPM Change 12.
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