Tricare

Front 1

Tricare was created in ___ & implemented in ____

Back 1

created=1966
implemented=1967

Front 2

What personnel is covered under Tricare?

Back 2

Army, Navy, Airforce, Marines, Coast Guard, Public health service & NATO

Front 3

How many regions & where are they

Back 3

4; North, South,West & overseas

Front 4

MTF's

Back 4

Military Treatment Facilities

Front 5

Must be active duty for __ days to be covered

Back 5

30 days

Front 6

DEERS stands for & does what?

Back 6

Defense Enrollment Eligibility Reporting System;;; Tricare computer system used for personal info

Front 7

BSR stands for & what does it do

Back 7

Beneficiaries Services Representatives ;;; Service centers, gives assistance/ info about using Tricare & matters affecting access to health care

Front 8

HCF stands for & what does it do?

Back 8

Health Care Finder;;; RN or PA who assist PCP (primary care provider) with reauthorizations & referrals

Front 9

Nurse Advisor

Back 9

24/7 advice & assistance w/ treatment alternatives, whether you should see a provider, based on a discussion of symptoms

Front 10

BCAC stands for & previously called?

Back 10

Beneficiary Counseling & Assistance Coordinators;;; Previously=(HBA) Health Benefits Advisors

Front 11

DCAO stands for & does what?

Back 11

Debt Collection Assistance Officers;;; Resolves health care collection related issues

Front 12

TSC stands for & does what?

Back 12

Tricare Service Centers;;; assist Tricare sponsors w/health care needs & answer questions about programs

Front 13

PI stands for & does what?

Back 13

Program Integrity Office;;; Surveillance of fraud & abuse in military heath care

Front 14

CHAMPVA eligibility

Back 14

must be sick.injured during active duty & covers pt & fam

Front 15

TRICARE covers who?

Back 15

-Kids &Spouses,
-Retired Servicemen,
-Widow/ers,
-Medal of Honor Recipients, -Step kids(til 21 or 23 in school) -Ex spouses until remarried

Front 16

TRICARE Prime & who is eligible

Back 16

Managed care option -Lowest Cost
-1 yr enroll't, -
Eligibility:::: Active duty personell & family, Retirees & family (under 65)

Front 17

TRICARE Standard

Back 17

-MTF's or Primary Care Provider -Most expensive -Enroll't not req. -Can be used w/EXTRA -Copay/Deducts during active duty & retir'mt -Fee-For-Service -Lowest priority at MTF -Highest out-of-pocket

Front 18

TRICARE Extra

Back 18

-PPO -Dr's w/in network -Low priority @MTF -Pay reduced Copay/Deductibles ;;;;;;;;
ELIGIBLE= fam members of active duty & retirees an family members under 65 are eligible

Front 19

what does TMA stand for & what does it do?

Back 19

Tricare Management Activity;; office that coordinates & administers TRICARE program & accountable for quality health care for members of the service and their families

Front 20

what is formerly known as OCHAMPUS?

Back 20

TMA;;Tricare management activity

Front 21

What are TRICARE sponsors?

Back 21

uniformed service personnel who are either active duty, retired or deceased

Front 22

What is needed for verification using DEER?

Back 22

SSN, DOB & last name

Front 23

who submits Tricare claims?

Back 23

claims are processed by Tricare contractors for diff regions of country & overseas

Front 24

DEER provides?

Back 24

up-to-date Defense Department workforce personnel info

Front 25

Tricare beneficiaries include

Back 25

sponsors & dependents of sponsors

Front 26

The catastrophic cap

Back 26

maximum out-of-pocket expense;; sponsers & fam=$1000/yr & retired =$3000/yr

Front 27

Medicare is Primary when ..

Back 27

.. you're paying for it. EX] 65+ and not on disability

Front 28

Demonstration Project

Back 28

Tests and establishes the a new program during a trial period

Front 29

TRICARE Supplemental

Back 29

Helps pay a portion of medical bills; offsets out-of-pocket costs

Front 30

Filling Deadline

Back 30

1 yr after service was rendered

Front 31

Re-file claim if not paid with in __

Back 31

45 days

Front 32

Which is an HMO?

Back 32

TRICARE Prime

Front 33

Which is PPO?

Back 33

TRICARE Extra

Front 34

General benefit changes for Tricare are enacted by?

Back 34

US Congress

Front 35

Who has oversight for fraud and abuse w/Tricare?

Back 35

Program Integrity Office

Front 36

Survivor benefits-How long must the soldier serve for benefits to be payable?

Back 36

more than 30days or in the line of duty

Front 37

When is Tricare primary?

Back 37

to Medicaid and Tricare supplemental plans

Front 38

When is Tricare secondary?

Back 38

to: -civilian insurance plans -workers compensation -liability insurance plans -employer-sponsored HMO plans

Front 39

Tricare Prime POS benefit

Back 39

if the beneficiary seeks medical care without prior approval payment of an annual deductible plus 50% or more of visit or treatment fees is required

Front 40

Who is covered under CHAMPVA?

Back 40

1.spouse or child of veteran who is totally disabled; 2.surviving spouse or child of a veteran who died from a VA-rated service connected disability; 3.surviving child or spouse of veteran who at the time of death was totally disabled;4.surviving child or spouse of military member who dies in the line of duty

Front 41

who oversees Tricare?

Back 41

Department of Defense

Front 42

how many branches of military?

Back 42

7

Front 43

CHAMPVA stands for

Back 43

Civilian Health And Medical Program of the department of Veteran Affairs

Front 44

Gov't fiscal year?

Back 44

10/01-09/31

Front 45

Supplemental Plan

Back 45

takes care of some out-of-pocket costs

Front 46

DUAL ELIGIBILITY

Back 46

PRIMARY= if only insurance
CHILDREN= Bday rule
eligible for mc on basis of age = MEDICARE Secondary
IF DISABILITY: TRICARE PRIMARY

Front 47

facility code:
11=
20=
21=
22=
23=

Back 47

11=Dr Office
20=Urgent Care
21=INpatient
22=OUTpatient
23=Emergency Room

Front 48

used to confirm eligibility

Back 48

DEERS

Front 49

ADSM stands for & what does it do?

Back 49

active duty service member;;;active member of the United States government military services

Front 50

allowable charge

Back 50

an amount on which TRICARE figures the patient's cost-share for covered care. This is based on 75% to 80% of the allowable charge

Front 51

authorized provider

Back 51

a physician, hospital, clinic, or supplier who has applied and been approved to provide medical care and supplies

Front 52

catchment area

Back 52

In the TRICARE program, an area, defined by ZIP codes, that is approximately 40 miles in radius surrounding each United States military treatment facility

Front 53

cooperative care

Back 53

when a patient is seen by a civilian physician or hospital for services cost-shared by TRICARE

Front 54

coordination of benefits

Back 54

Two insurance carriers working together and coordination the paymentof their benefits so that ther are no duplicatoin of benefits paid between the primary and secondary insurance carriers. In TRICARE, the coordination of the payment of TRICARE benefits with the payment of benefits made bya the double coverage plan, so that there is no duplication of benefits paid between the double coverage plan and TRICARE, likewise applied to disability programs

Front 55

cost -share

Back 55

The portion of the allowable charges (20% or 25%) after the deductible has been met that the TRICARE patient is responsible fo

Front 56

5 supplemental programs

Back 56

1. Tricare for Life
2 Tricare Plus
3. Tricare Dental program
4.Tricare pharmacy program
5.extended health care option

Front 57

HA stands for & does what?

Back 57

Health Affairs;;; is office of Assistant Secretary of Defense for Health Affairs

Front 58

service-connected injury

Back 58

njury incurred by a service member while on active duty

Front 59

CHAMPVA is for?

Back 59

1.Dependents of veterans who have disabilities
2.Survivors of veterans who died in the line of duty or at time of death were disabled

Front 60

partnership program

Back 60

A program that lets patient treatment from civilian providers of care in a military hospital or from uniformed services providers of care in civilian facilities

Front 61

quality assurance program

Back 61

a plan that continually assesses the effectiveness of inpatient and outpatient care in the TRICARE and CHAMPVA programs

Front 62

service benefit program

Back 62

a program that provides benefits without a contract guaranteeing the indemnification of an insured party against a specific loss; no premiums

Front 63

summary payment voucher

Back 63

Document the fiscal agent sends to the provider or beneficiary, showing the service received, allowable charges, amount billed, the amount TRICARE paid, how much deductible has been paid, adn the patient's cost-share

Front 64

What is Tricare organized under?

Back 64

Tricare utilization management

Front 65

Tricare Prime-

Back 65

Managed care option
1. Enrollment guarantees priority access to care at MTF
2. Lowest cost of the 3 Tricare options
3. Requires enrollment of 1 year

Front 66

Tricare Catastrophic cap Benefit

Back 66

Protects Tricare beneficiaries from devastating financial loss due to serious illness or long term treatment

Front 67

Who is Tricare Extra ideal for?

Back 67

Ppl who do not have convenient access to MTF’s & want reduced health care cost compared to Standard

Front 68

Who is eligible for Extra?

Back 68

1. Family members of active duty sponsors
2. Retirees (except Medicare elgible)
3. family members under 65

Front 69

Originally known as CHAMPUS

Back 69

TRICARE Standard

Front 70

what is the "good faith" policy?

Back 70

copy of enrollee's card is invalid. if there are copies on file & TRICARE gives notification that patient was ineligible the local BSR will investigate claim

Front 71

what is PCM primary care manager

Back 71

part of Tricare Prime
1. dr who guide members thru system;; coordinates specialty treatment needs
2. provides nonemergency care & arranges referrals for specialty care