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TRICARE-REM
ch. 16
| Term | Definition |
|---|---|
| beneficiary counseling and assistance coordinator (BCAC) | individual availaable at a military treatment facility (MTF) to answer questions, help sove healthcare-related problems, and assist beneficiaries in obtaining medical care through TRICAE, was previously called health benefits advisor (HBA). |
| beneficiary sErvices representative (BSR) | Employed at a TRICARE Service Center, provider informaton about using TRICARE and assists with other matters affecting access to health care (e.g., appointment scheduling). |
| catastrophic cap benefit | protects TRICARE beneficiaries from devastating financial loss due to serious illness orlong-term treatment by establishing limits over which payment is not required. |
| catchment area | the region defined by code boundaries within a 40-mile radius of a military treatment facility. |
| CHAMPUS Reform Initiative (CRI) | conducted in 1986; resulted in a new health program called TRIARE, which includes three option: TRICARE Prime, TRICARE Extra, MAC for reimbursement. |
| common access card (CAC) | identification card issued by the Department of Defense (DoD), which TRICARE enrollees show to receive healthcare services. |
| critical pathway | sequence of activities that can normally be expected to result in the most csot-effective clinial course of treatment. |
| debt colection assistance officer (DCAO) | indiviudals located at military treatment facilities to assist beneficiaries in resolvng healthcare collectoin-related issues. |
| Defense Enrollment Eligibility Reporting System (DEERS) | computer sywstem taht contains up-to-date Degense Department Workforce personnel information. |
| demonstration project | testa and establishes the feasibility of implementing a new porgram during a trial period, after which the program is evaluated, modified, and/or abandoned. |
| DSM (Diagnostic and Statistical Manual) | calssifies health disorders and isbased on ICD; published and is based on ICD; published by the American Psychiatric Association. |
| emergency care | care for the sudden and unexpected onset of a medical or mental health condition that is threatening to life, limbl, or sight. |
| fiscal year | for the federal government, October 1 of one year to September 30 of the next. |
| Health Affairs (HA) | refers to the Office of the Assistant Secretary of Defense for Health Affairs, which is responsible for both military readinaess and peacetime health caer. |
| healthcare finder (HCF) | registered nurse or physician assistant who assists primary care provdiers with preauthorizations and referrals to healthcare services in a military treatment facility or civilian provider network. |
| lead agent (LA) | servers as a federal healthcare team created to work with regional military treatment facility commanders, uniformed service headquarters' staffs, and Health Affairs(HA) to support the mission of the Military Health Servics System (MHSS). |
| Military Health Services System (MHSS) | entire health-care system of the U.S. uniformed servicesand includes military treatment facilities (MTFs) as well as various programs in teh civilian healthcae market, such as TRICARE. |
| military treatment facility (MTF) | healthcare facility operated by the military that provides inpatient and.or ambulatory (outpatient and emergency department) care to eligible TRICARE beneficiaries; capabilities of MTFs vary from limited acute care clinics to teaching and tertiary care me |
| nonavailability statement (NAS) | certificate issue dby a military treatment facility that cannot provide needed care to TRICARE Standard beneficiaries. |
| nurse advisor | available 24/7 fpr advoce amd assistance with treatment alternatives abdto discuss whether a TRICARE sponsor should see a provider based on a discussion of symptoms. |
| other health insurance (OHI) | insurance policy considered primary to TRICARE (e.g., civilian insurance plan, workers' compensation, liability insurance plan). |
| practice guidelines | decision-making tools used by providers to determine appropriate health care for specific clincial circumstances. |
| primary care manager (PCM) | provider (e.g., physician) who is assigned to a sponsor andpartof the TRICARE provider network. |
| Program Integrity (PI) Office | responsible for the worldwide surveillance of fraud and abuse activities involving purcheased care for beneficiaries in the Military Health Services System. |
| TRICARE | healthcare program for active duty memebers of the military and tehir qualified family memebers, CHAMPUS-eligible retirees and their qualified family members, and eligiblesujrvivors of members of the uniformed services. |
| TRICARE beneficiary | includes sponsors and dependents of sponsors. |
| TRICARE Extra | allows TRICARE Standard users to save 5 percent of their TRICARE Standard cost-shares by using healthcae providers in the TRICARE network. |
| TRICARE Management Activity (TMA) | formerly OCHAMPUS; the office that coordinatets and administers the TRICARE program and is accountable for quality health care provided to members of the uniformed services and their families. |
| TRICARE Prime | managed care option simialar to a civilian health maintenance organization (HMO). |
| TRICARE Program Management Organization | manages TRICARE programs and demonstration projects. |
| TRICARE Service Center (TSC) | business offices staffed by one or more beneficiary services representatives and healthcare finders who assist TRICARE sponsors with healthcare needs and answer questions about the program. |
| TRICARE sponsor | uniformed service personnel who are either active duty, retired, or deceased. |
| uniformed services | U.S. military branches that include the Army, Navy, Air Force, Marines, Coast Guard, Public Health Service, and the North Atlantic Treaty Organization (NATO). |
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cameliaclark