SSN Memo

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OFFICE OF THE ASSISTANT SECRETARY OF DEFENSE
HEALTH AFFAIRS
7700 ARLINGTON BOULEVARD, SUITE 510 1
FALLS CHURCH, VIRGlNlA 22042-5101

DEFENSE
HEALTH AGENCY

,-IAN - 9 2014

MEMORANDUM FOR THE RECORD
SUBJECT: Justification for the Use of the Social Security Number on the Form "TRICARE
DoD/CHAMPUS Medical Claim-Patient's Request for Medical Payment" (DD
Form 2642)
Department of Defense Instruction (DoDI) 1000.30, "Reduction of Social Security
Number (SSN) Use within DoD," dated August 1,2012, requires a memorandum to justify
collecting and using Social Security Numbers (SSNs) on Department forms. This justification
memorandum pertains to the revision and renewal ofDD Form 2642, "TRICARE
DoD/CHAMPUS Medical Claim-Patient's Request for Medical Payment" (DD Form 2642).
The current version ofDD Form 2642 is included as Attachment l.
The form "TRICARE DoD/CHAMPUS Medical Claim-Patient's Request for Medical
Payment" is used to collect personally identifiable information (PH) and protected health
information (PHI) and is covered by System of Records Notice EDTMA 04, MedicallDental
Claims History Files (November 18,2013, 78 FR 69706), as a Privacy Act of 1974 system of
records pursuant to DoD 5400.ll-R. "Department of Defense Privacy Program," May 14,
2007. EDTMA 04 is included as Attachment 2.
The form "TRICARE DoD/CHAMPUS Medical Claim-Patient's Request for Medical
Payment" is used by TRICARE beneficiaries to request payment for medical costs for which
they have paid. Historically, the SSN has been the primary identifier on the DD Form 2642
which the health care contractors use to verify beneficiary eligibility through the Defense
Eligibility Enrollment Reporting System (DEERS).
The Defense Health Agency (DHA), as successor to the TRICARE Management
Activity, has a SSN Reduction Plan for its Purchased Care Operations. The DHA plan is in­
line and consistent with the Defense Manpower Data Center's (DMDC) plan to remove SSNs
from DoD Identification (ID) Cards. Starting in late 2011, visibly printed SSNs were
removed from DoD ID Cards. Two new codes (alternative ID numbers) are printed on the ID
Card -- the DoD Benefits Number (DBN) and the Electronic Data Interchange-Personal
Identifier (EDIPI). While both of these codes currently exist, they are not known to all DoD
beneficiaries. Due to the ID card lifecycle, we estimated a three to four year process before
alternative ID numbers replace the visibly printed SSN on the card. At this point, we are two
years into the process, we anticipate all active duty service members or active duty family
members cards will be updated in the next two years. We acknowledge updates to retiree
cards will be on-going for years, as they have "indefinite" card expiration dates. We

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anticipate those updates will be done as retirees received word on the SSN removal and opt
to update their cards or when they update due to damage or lost cards.
TRICARE health care contractors (whose systems and interfaces are part ofDHA's
purchased care operations), have a process to query the Defense Enrollment Eligibility
Reporting System (DEERS) to determine an individual's eligibility using the DoD Benefits
Number. The TRICARE Systems Manual (TSM) require health care contractors to modify
their systems to include free-standing DBN and EDI-PI data fields in addition to data fields
for the SSN.
Based on the above, the SSN still needs to be collected on the form "TRICARE
DoD/CHAMPUS Medical Claim-Patient's Request for Medical Payment" until all DoD
beneficiaries are cognizant of alternate identifiers and where to find them in order to input
these numbers on the claim form instead of the SSN . This will logically occur when the SSN
is visibly replaced on the DoD ID Card with the alternate identifiers. As indicated above, this
process began in late 2011 and was estimated to be a three to four year process with two
years now remaining. As soon as possible, the agency will make a recommendation
regarding inclusion of the DoD Benefit Number as a new field on the claim form to be used
in lieu of the SSN. At that time, beneficiaries will be more knowledgeable about what this
number is and where to find it.
TRICARE's form "TRICARE DoD/CHAMPUS Medical Claim-Patient's Request for
Medical Payment" is secured to protect PH/PHI in accordance with DoD Regulations.
DoD I 1000.30, Enclosure 2, Paragraph 2.c.(11), includes "Legacy System Interface"
as an acceptable use of the SSN so long as there are plans in place for the migration away
from the SSN in the future. The above information reflects why the SSN still needs to be
currently collected on DD Form 2642 due to legacy system interface, but also details plans
that will allow migration away from collecting it on DD Form 2642 in the future.
If there are any questions, my point of contact is Shane Pham. She can be reached at
[email protected] or at (703) 681-8666.

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Mary Kaye Justis, SES
Director, TRICARE Health Plan

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