1. How to Assign and Use Patient Categories (PATCATs)
Track x – xxx day –
How to Assign and Use Patient Categories (PATCATs)
20 March EDT
22 March EDT
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2. Objectives
Understanding Patient Categories (PATCATs)
Importance of a Correct PATCAT
Dissecting PATCATs
PATCAT Positioning
PATCAT Assignment
PATCAT Assignment Issues
PATCATs and Dual Eligible Patients
VA PATCATs
PATCAT and Updated Eligibility
TRICARE Updates Regarding PATCATs
AHLTA and PATCATs
AF ePatient Data Integrity Management & Support Team

3. Understanding Patient Categories
What is a Patient Category (PATCAT)?
Assigning the PATCAT in CHCS will determine whether a patient is billable and what type of billing is appropriate for each episode of care
PATCATs can affect additional functional areas outside of billing in CHCS:
Categorizing the enrolled population
Workload accountability
Outpatient records, retirement procedures, and multiple other areas

4. Importance of a Correct PATCAT
What are the consequences of an incorrect PATCAT?
Incorrect billing (wrong rates, forms, sources, and patients)
Possible loss of revenue
Incorrect MTF workload
Inaccurate categorization of enrolled population
Poor data quality
Multiple systems receiving incorrect data
We’ve heard it time and time again,
BAD DATA IN = BAD DATA OUT

5. Basic code covers a “category” of interest F11 = USAF ACTIVE DUTY
Dissecting PATCATs
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Currently there are 368 PATCAT codes identifying the patient population
Basic code covers a “category” of interest
F11 = USAF ACTIVE DUTY
K53 = OTHER FED AGENCY/DEPT EMPLOYEE
Sub-categories segment the group
F11 A = USAF ACTIVE DUTY OFFICER
F11 B = USAF ACTIVE DUTY ENLISTED
K53 S = DOD SCHOOL TEACHER OUTSIDE THE US
K53 T = OTHER DOD EMPLOYEE OUTSIDE THE US

6. PATCAT Codes – First Position
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Sponsor’s Service
A = Army
B = National Oceanic and Atmospheric Administration
C = Coast Guard
F = Air Force
K = Other and Special categories
M = Marines
N = Navy
P = Public Health Service
R = Reciprocal Agreements (US with other nations)

7. PATCAT Codes – Second Position
Beneficiary Category
1x = Extended Active Duty sponsors
2x = ROTC; Inactive Duty Guard/Reserves, TAMP/TRS, former members, applicants
3x = Retirees
4x = Family members, former spouses and family members
5x – 9x = Used to segment “K” codes

8. PATCAT Assignment PATCAT CHCS Registration Function (For Current
DEERS
Information
Service
Component
Status
Special
Program
MTF Research
Findings
ID Card
Birth Info
Orders
Contract Info
Etc, etc, etc.
PATCAT
(For Current
Episode of Care)
CHCS
Registration
Function
Slide reprinted with permission from a previous UBO presentation

9. PATCAT Assignment
PATCAT assignments may be impacted depending on the type of registration used to register a patient:
Auto registration – CHCS automatically assigns a patient’s PATCAT if it can successfully translate the DEERS data
Mini or Full registration – MTF personnel registering a patient will manually assign the PATCAT in CHCS

10. Types of registration, cont.
PATCAT Assignment
Types of registration, cont.
Mail-In registration – Do not use for initial registration since CHCS does not require a PATCAT
Lab personnel should use mini or full registration to register a patient and then use mail-in registration to set the lab referral location
Lab interoperability registration – Receiving MTFs utilize mail-in registration as part of their specimen processing
Lab personnel accept the PATCAT from the MTF (CHCS host) sending the specimen

11. PATCAT Assignment Issues
If CHCS cannot translate DEERS data during an auto registration, a PATCAT cannot be assigned, leaving the field null or resulting in a PCM Information Transfer (PIT) error 10
The first user to access the patient data with a null PATCAT will be prompted to assign a PATCAT
CHCS will allow “non logical” sponsor/dependent Service and eligibility mismatches (example F41/N43)
Screen for and edit during registration and patient file maintenance
An incomplete registration could result in a null PATCAT

12. PATCATs and Dual-Eligible Patients
By design, CHCS utilizes defined business rules between rank, Service, and Family Member Prefix (FMP) to determine valid PATCATs
PATCATs entered into CHCS should always reflect a person’s DEERS eligibility
Some dual-eligible patients may pose problems; the PATCAT cannot be changed for associated episodes of care (example: patient is dual eligible F41/K57)

13. Dual-Eligible Patients, cont.
Highly recommend MTFs avoid creating duplicate patients to resolve problems associated with dual eligibility
AF MTFs refer to NOTAM dated Oct 2010
Register patients one time under the highest level of eligibility
Army/Navy procedures and instructions match Air Force
Move patient between sponsors if possible
Manually address billing data if it is not possible to change sponsorship to apply correct PATCAT in episode of care

14. VA PATCATs
K61 1 – Veterans Admin Beneficiary
K61 2 – DOD/VA Sharing Agreement
Enrolled beneficiaries utilizing VA services in a MTF require a PATCAT change prior to VA episode of care
PATCAT should be changed from *31 (Retired) to K61
Once VA services are rendered the PATCAT should be edited to previous eligible PATCAT
Leaving the PATCAT at a K61 will affect:
Billing
Workload
Enrolled Capacities

15. PATCAT and Updated Eligibility
A patient’s PATCAT does not automatically update in CHCS when his/her DEERS eligibility has changed
DEERS ELIGIBILITY DATA Name: PATIENT,EXAMPLE M FMP/SSN: 20/1XX-XX-XXXX Patient Category: USAF ACTIVE DUTY SEX/DOB/AGE: M/27Oct1961/45Y ───────────────────────────────────────────────────────────────────────── Eligibility Date: 22 Jan 2007
Name First: EXAMPLE Sponsor SSN: 1XX-XX-XXXX
Middle: M Branch of Service: AIR FORCE
Last: PATIENT Pay Grade: 07
Cadency: Sponsor Cat Code: Retired
DOB: 27 Oct Sponsor Rank: SERGEANT
Sex: MALE Sponsor UIC:
Relationship: Self UIC Zip Code:
HCDP Code: Type: MEDICAL Enr DMIS ID: 1XXX
TRICARE PRIME FAMILY COVERAGE FOR RETIRED AND MEDAL OF HONOR SPONSORS AND FAMILY MEMBERS
HCDP Start Date: 22 Jan Region Code: 1X
HCDP End Date: 22 Jan Network Provider: Direct Care Net
WII HCDP Code:
HCDP Start Date: HCDP End Date:
ECHO Code: Sponsor DNA On File: Yes
ECHO Start Date: ECHO End Date: ─────────────────────────────────────────────────────────────────────────
PCM HCDP Demographics prInt hElp eXit

16. TRICARE Updates Regarding PATCATs
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TRICARE Reserve Select
New PATCATs associated with Health Care Delivery Program (HCDP) codes (418,419,420, and 421)
*36 – Retired Reservist
*37 – Retired Reservist Family Member
Once beneficiary turns 65 yrs of age, the PATCAT changes to normal retiree codes
TRICARE Young Adult Program
New HCDP codes associated with standard dependent PATCATs
HCDP codes from 422 to 432

17. AHLTA and PATCATs
Do not use AHLTA to verify or reference a patient’s PATCAT
AHLTA could display an incorrect PATCAT assigned to a patient from another CHCS host (“last in wins”)
If the PATCAT is incorrect in AHLTA, correct it in the CHCS host
The local CHCS host PATCAT is the relevant PATCAT, since billing is initiated via the CHCS data

18. ePatient Data Integrity Management & Support Team
Performs the following functions for Air Force MTFs:
Resolves patient demographic errors
PIT errors (compliments MTF efforts)
Merges CHCS duplicate patient records (compliments MTF efforts)
The effort includes resolving several PATCAT problems:
Null, incorrect, mismatched PATCATs
Army and Navy do not have similar centralized office
Army MTFs should go to their PAD & local CHCS offices
Navy MTFs should contact their PAD Officer(s). They follow BUMEDINST B for eligibility/registration procedures.

19. ePatient Data Integrity Management & Support Team
MTF personnel still need to be diligent in correcting PATCATs
Combining our efforts with the MTF’s due diligence will enhance data quality and ensure proper billing
MTF Colleagues – PAD staff are your friends
Understanding who has what entitlement
Investigating and resolving possible PATCAT errors

20. Where to Get Help
Questions regarding registration, PIT errors, merging duplicate records, and patient identity questions can be addressed to:
Air Force Data Quality Patient File/NED Error/TOPA SMEs:
Army and Navy have no centralized office that handles this function
Army MTFs should contact their PAD & local CHCS offices
Navy MTFs should contact their PAD Officer. MTF PAD Officers may contact Mr. Skip Katon for add’l advice

21. TMA UBO Website Resources
The following resources and training materials are available at
Current PATCAT table
PATCAT on-line training module
PATCAT finder tool (Use this ‘logic flow’ tool to help identify a specific PATCAT code for a patient)
UBU Web Site:

22. Questions?

23. Instructions for CEU Credit
This live Webinar broadcast has been approved by the American Academy of Professional Coders (AAPC) for 1.0 CEU credit. Granting of this approval in no way constitutes endorsement by the AAPC of the program, content or the program sponsor. There is no charge for this credit, but to receive it participants must login with their: 1) full name; 2) Service affiliation; and 3) address prior to the broadcast. If more than one participant is viewing the Webinar on one computer or mobile device, then the names and addresses of each participant who wishes to receive CEU credit must be entered into the Q&A pod below the presentation screen. If a participant cannot login and requires a dial in number to hear the Webinar, then for CEU credit he/she must the within 15 minutes of the end of the live broadcast with “request CEU credit” in the subject line. Participants must also listen to the entire Webinar broadcast. At the completion of the broadcast, the Certificate of Approval with Index Number will be sent via only to participants who logged in prior to the broadcast and provided their full name and address as required.
Participants may also view and listen to the archived version of this Webinar—which will be posted to the UBO Learning Center shortly after the live broadcast--for one (1.0) AAPC approved CEU credit. To receive this credit, after viewing the archived Webinar, they must complete a ten (10) question minimum post-test that will be available on the UBO Learning Center and submit their answers via to If at least 70% of the post-test is answered correctly, participants will receive via a Certificate of Approval and Index Number.

24. Instructions for CEU Credit, cont.
Participants may not alter the original Certificate of Approval. CEU certificates should be maintained on file for at least six months beyond your renewal date in the event you are selected for CEU verification by AAPC. For additional information or questions, please contact the AAPC concerning CEUs and its policy.

25. Other Organizations Accepting AAPC CEUs
Participants certified with the American Health Information Management Association (AHIMA) may self-report AAPC CEUs for credit at
The American College of Healthcare Executives (ACHE) grants one (1.0) Category II ACHE educational credit hour per one (1.0) hour executive/management-level training course or seminar sponsored by other organizations toward advancement or recertification. Participants may self-report CEUs on their personal page at
The American Association of Healthcare Administrative Managers (AAHAM) grants one (1.0) CEU unit “for each hour in attendance at an educational program or class related to the health care field” for AAHAM-credentialed participants who self-report using AAHAM’s on-line CEU tool. Participants may self-report CEUs during their recertification process at