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TRICARE and CHAMPVA

QuestionAnswer
What TRICARE health care choice is a fee-for-service cost sharing type of option TRICARE standard
What TRICARE health care choice is a preferred provider organization type of option in which the individual does not have to enroll or pay an annual fee. TRICARE extra
What TRICARE health care choice is a voluntary HMO or preferred provider organization type of option TRICARE prime
An individual who qualifies for TRICARE is known as an beneficiary
An active duty service member is called the sponsor
A person who is retired from a career in the armed forces and can remaine in TRICARE until age 65 is known as a service retiree or military retiree
What TRICARE health care program that offers additional TRICARE benefits as a supplementary payer to medicare for uniformed service retirees, there spouses, and survivors age 65 or older TRICARE for life (TFL)
What TRICARE health care program that offers additional TRICARE benefits as a supplementary payer to medicare for uniformed service retirees, there spouses, and survivors age 65 or older TRICARE for life (TFL)
A specific geographic region defined by ZIP codes and is based on an area of approximatley 40 miles in radius surrounding eack MTF in the US is known as catchment area
A three option managed health care program offered to spouses and dependents of service personel with uniform benefits and fees impllemented nationwide by the federal gov. is known as TRICARE
An electronic database used to verify beneficiary eligibility for those individuals in the TRICARE program is called defense enrollment eligibility reporting system (DEERS)
A service benefit program similar to TRICARE for veterans with total, permanent, service connected disabilities or surviving spouses and dependents of veterans who died of service-connected disabilities is called CHAMPVA
CHAMPVA is now known as the department of veteran affairs (VA)
ADSM active duty service members
MTF military treatment facility
The insurance company that handles the claims for care recevied within a particular state or country is known as regional contractor
The maximum dollar amount that a member has to pay under TRICARE or CHAMPVA in any fical year or enrollment period of covered medical bills is called catastrophic cap
A plan that continually assesses the effectiveness of inpatient and outpatient care is known as quality assurance program
When two insurance carriers work together and coordinate the payment of their benefits so that there is no duplication of benefits paid between the primary and secondary insurance carriers it is known as coordination of benefits
The document the fiscal agent sends to the provider or beneficiary, showing the serrvice or supplies received, allowable charges, amount billed, the amount paid by TRICARE, how much deductible has been paid, and the patients share cost is called summary payment voucher
NAS a certifiction from a military hospital stating that it cannot provide the care needed is known as nonavailability statement
Medically necessary treatment needed for an immediate illness or injury that would not result in further disability or death if not treated immediately is called urgent care
A sudden and unexpected medical condition or the worsening of a condition which poses a threat to life losing a limb or dight and requires immediate treatment to alleviate suffering is called an emergency
An option that lets TRICARE standard eligible persons receive inpatient or outpatient treatment from civilian providers of care in a military hospital, or from uniformed services providers of care in civilian facilities is called partnership program
A TRICARE standard is governed by, and administeres the TRICARE program is known as Department of defense DoD
Created by: maryce