0720-0006 SSN Justification Memo

DEFENSE HEALTH AGENCY
7700 ARLINGTON BOULEVARD, SUITE 5101
FALLS CHURCH, VIRGINIA 22042-5101

signed by
NOBLE.MARILY Digitally
NOBLE.MARILYNN.J.1108
NN.J.11081489 148930
Date: 2018.08.28 08:18:59
30
-04'00'

DHA Privacy
Office Review:
MEMORANDUM FOR DEFENSE PRIVACY, CIVIL LIBERTIES AND TRANSPARENCY
DIVISION
SUBJECT: Justification for the Use of the Social Security Number (SSN) for TRICARE
DoD/CHAMPUS Medical Claim-Patient’s Request for Medical Payment (DD Form 2642)
This memorandum is to satisfy the requirements of the Department of Defense
Instruction (DoDI) 1000.30, Reduction of Social Security Number (SSN) Use Within DoD, dated
August 1, 2012, that requires justification of the collection and use of SSNs on DoD forms. This
justification memorandum pertains to the revision and renewal of (DD Form 2642), TRICARE
DoD/CHAMPUS Medical Claim - Patient’s Request for Medical Payment(Attachment 1).
DD2642, TRICARE DoD/CHAMPUS Medical Claim - Patient's Request for Medical
Payment, is used to collect personally identifiable information (PII) and protected health
information (PHI) from beneficiaries. The form is covered by System of Records Notice
EDTMA 04, Medical/Dental Claims History Files (October 27, 2015, 80 FR 65720) (Attachment
2).
DD 2642 is used by TRICARE beneficiaries to request reimbursement for their out-ofpocket costs for medical services 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).
TRICARE managed care support contractors/purchased care contractors are required to
enter the information contained in the Form into DEERS using the Defense Online Enrollment
System application, which will reflect the beneficiary’s eligibility. Over all, the SSN has been
the primary identifier on the form, with the renewal and revision of DD Form 2642 we included
the DoD Benefits Numbers (DBN). The TRICARE Systems Manual requires health care
contractors to modify their systems to include DBN in addition to data fields for the SSN.
In order to verify eligibility against DEERS, the SSN still needs to be collected on DD
2642 until all DoD beneficiaries are cognizant of alternate identifiers and where to locate them
on their military identification card to use on the claim form as a replacement for the SSN.
In accordance with DoDI 1000.30, continued use of SSNs within DD 2642 must be
justified by one or more of the Acceptable Use Cases set forth in DoDI 1000.30, Enclosure 2.
The Acceptable Use Case applicable to DD 2642 is 2.c.(11), Legacy System Interface. The

above information regarding eligibility verification reflects why the SSN is still a requirement
for DD Form 2642 due to the DEERS legacy system interface.
If there are any questions, my point of contact is Ms. Vonda Lawson. Ms. Lawson can
be reached via e-mail at [email protected], or by phone at (703) 275-6221.
signed by
HUNTER.DANIT Digitally
HUNTER.DANITA.F.1087110946
A.F.1087110946 Date: 2018.08.28 07:24:24 -04'00'

Dr. Danita Hunter
Acting Deputy Chief, TRICARE Health Plan
Attachments:
As Stated