| # | Name | Location | Type | Details | Index | Description |
|---|---|---|---|---|---|---|
| .01 | tc facility | 0;1 | POINTER | 4 | B | Enter a TRICARE-specific Pay-to Provider. Usually, a Pay-to Provider is a medical center (e.g. VAMC, M&ROC, etc.). If you enter only one TRICARE-specific Pay-to Provider, it will be the default Pay-to Provider for all TRICARE claims and you would not need to associate divisions with the default. Multiple TRICARE- specific Pay-to Providers must be associated with the divisions to which they apply. |
| .02 | tc name(+) | 0;2 | FREE TEXT | You may modify the TRICARE-specific Pay-to Provider name for use on electronic or printed claims. | ||
| .03 | tc federal tax number | 0;3 | FREE TEXT | Enter the Federal Tax ID for the TRICARE-specific Pay-to Provider. Make sure you enter the Tax ID Number for the TRICARE Pay-to Provider, which may be different from your site's Tax ID. Enter 10 characters in the format NN-NNNNNNN. | ||
| .04 | tc telephone number | 0;4 | FREE TEXT | Enter the phone number to be used on electronic or printed claims. This is the number you would want a payer to use to contact the site about a TRICARE claim. | ||
| .05 | tc parent pay-to provider | 0;5 | NUMERIC | This field determines if this entry in the sub-file is a TRICARE Pay-to Provider institution or if it is a Division being linked to the parent TRICARE Pay-to Provider institution, that is, another sub-file entry. If this field is defined, then it holds the IEN in this sub-file of the parent TRICARE Pay-to Provider institution for this specific division. If this field is nil, then this sub-file entry is the parent TRICARE Pay-to Provider institution. This field should not be set via FileMan. The application in the IB Site Paremeter edit option will set this field appropriately based on user input. | ||
| 1.01 | tc street address 1 | 1;1 | FREE TEXT | You may modify the TRICARE-specific Pay-To Provider Address for use on electronic or printed claims. You may enter a P.O. Box. | ||
| 1.02 | tc street address 2 | 1;2 | FREE TEXT | Enter additional address information, if needed. | ||
| 1.03 | tc city | 1;3 | FREE TEXT | You may modify the TRICARE Pay-to Provider address for use on electronic or printed claims. | ||
| 1.04 | tc state | 1;4 | POINTER | 5 | You may modify the TRICARE Pay-to Provider address for use on electronic or printed claims. | |
| 1.05 | tc zip | 1;5 | FREE TEXT | You may modify the TRICARE Pay-to Provider address for use on electronic or printed claims. |
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