Transactions

The TRICARE Managed Care Support Contractors (MCSCs) have provided companion guides for some of the HIPAA transactions they perform. Please contact the MCSC point of contact for your region to obtain the latest information.

The GIQD is a web-based, direct data entry system which allows authorized users to make eligibility inquiries. The GIQD has been updated to include HIPAA-compliant data elements and can be used in lieu of a direct Electronic Data Interchange (EDI) with DEERS.

The DOES application is a web-based, direct data entry system which can be utilized by Managed Care Support Contractors (MCSCs) to enroll TRICARE beneficiaries into TRICARE programs in the Defense Enrollment Eligibility Reporting System (DEERS). DOES has been updated to include HIPAA-compliant data elements. The system includes upgraded security features and was deployed to all users as of May 2003. All TRICARE enrollments are performed using the HIPAA-compliant DOES application.

The Centers for Medicare and Medicaid Services (CMS) published a Claims Attachments Notice of Proposed Rulemaking (NPRM) (CMS-005-0-F) in the Federal Register in September 2005. However, that NPRM was withdrawn in 2010 because of technology and business need changes. The Patient Protection and Affordable Care Act of 2010 (also known as ACA) requires the Department of Health and Human Services (HHS) to publish a Final Rule to adopt a Claims Attachment Standard and Operating Rules by January 2014 with an effective date not later than January 2016. Please note, while originally called "Claims Attachments" the health care industry has shifted toward the phrase "Clinical Attachments" to reflect the broader usage of the standard for purposes including but not limited to claims, referrals, and requests for pre-authorization. On 5 July 2016, National Committee on Vital and Health Services (NCVHS), the statutory advisory committee responsible for providing recommendations on health information policy and standards to HHS, recommended HHS publish a Final Rule to adopt a Clinical Attachment standard. As of January 2017, a Final Rule to adopt a Clinical Attachments Standard and Operating Rules had not been published.

In a Final Rule published by the Department of Health and Human Services (HHS) in January 2009, covered entities were mandated to be in full compliance with Version 5010 and NCPDP Version D.0 by January 1, 2012. The Military Health System (MHS) successfully implemented the EDI standards and is in compliance with the Final Rule.