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Chapter 16

TRICARE Standard greatest freedom in selection and most expensive of TRICARE plans
There are.....TRICARE regions in the U.S. and .....for a total of four regions 1) three 2) one overseas
All active duty members are not eligible for TRICARE Extra because they are automatically enrolled on TRICARE Prime
The Health Affairs Office is responsible for both military readiness and peacetime health care
Catastrophic Cap Benefit protects beneficiaries who are the victims of medical malpractice from devastating financial loss
TMA office responsible for quality health care provided to members of the military and their families
Primary Care Manager (PCM) Physician who is part of the TRICARE provider network; assigned to sponsor
TRICARE sponsors uniformed service personnel; can be classified as active duty, retired or deceased
TRICARE has three health care options 1) TRICARE Standard 2) TRICARE Prime 3) TRICARE Extra
Business offices that assist TRICARE sponsors with healthcare needs are referred to as TRICARE Service Centers
CHAMPVA always pays after Medicare
Nurse advisors are available for advice and assistance with treatment alternatives
The Health Administration Center administers the CHAMPVA program by 1)processing applications, 2)determining eligibility, 3)authorizing benefits and 4)processing claims
Beneficiary Counseling and Assistance Coordinators (BCACs) used to be called Health Benefit Advisors (HBA)
TRICARE case management coordinates and monitors a beneficiary's healthcare options and services
Someone who assists primary care providers (PCPs) with preauthorization and referrals is called a health care finder
TRICARE's main office is located in Colorado
TRICARE used to be called CHAMPUS
Retired Reserve Component service members are eligible for retirement pay at age 60
The Army, Navy and Air Force are all covered by TRICARE
MTF Military Treatment Facility
There are......Tricare regions in the United States four(4)
Doctors assigned to sponsors and part of the TRICARE network are called Primary Care Managers
A preauthorization is an official approval obtained from a health care finder before certain specialty procedures and inpatient care can be given
A referral is a request for a member to receive treatment from another provider
The following are eligible for TRICARE Prime 1) Retirees and their family members who are under the age of 65 2) Active duty personnel 3) Family members of active duty personnel
The following are benefits offered under TRICARE Prime 1) Guaranteed access to timely medical care 2) Assignment of primary care manager 3) Priority care at military treatment facilites
When a person has CHAMPVA and Medicare CHAMPVA always pays after Medicare
The entire healthcare system of the U.S. uniformed services is referred to as the Military Health Services System
The Program Integrity Office is responsible for surveillance of fraud and abuse activities
Catchment Area Region defined by code boundaries within a 40-mile radius of an MTF (military treatment facility)
The nurse or doctor who helps Primary care providers with preauthorization is referred to as a health care finder
Decision-making tools that are used to decide appropriate health care for specific circumstances are called practice guidelines
TRICARE for Life provides Medicare wrap-around coverage
Beneficiary Services Representatives provide beneficiaries information about using TRICARE
When an MTF is unable to provide needed care they issue the patient an "non-availability statement"
TRICARE Prime is a managed care option for military that is similar to HMOs
Critical Pathway a sequence of activities that results in cost-effective course of treatment
The fiscal year runs from October 1 through September 30
Demonstration Project tests and establishes the feasibility of starting a new program
MTF Military Treatment Facility; healthcare facility operated by the military
Lead Agents federal health care team created to work with military treatment facility commanders
Catastrophic Cap Benefit out-of-pocket costs for covered services
It is the responsibility of Primary Care Manager to 1) Provide non-emergency care to eligible beneficiaries 2) Arrange referrals for specialty care if needed
The following are circumstances which would exclude TRICARE-authorized providers form program participation 1) Criminal conviction or civil judgment involving fraud 2) Fraud or abuse under TRICARE 3) Exclusion or suspension by another federal, state or local government agency 4) Participation in a conflict of interest situation
(continued)The following are circumstances which would exclude TRICARE-authorized providers form program participation (continued) 5) When it is in the best interest of the TRICARE program or its beneficiaries
TRICARE Prime guarantees enrollees access to care urgent care within one day and less urgent care within one week
Tricare Extra features include 1) Choice of any physician in the network 2) Less expensive than TRICARE Standard 3) May be more expensive than TRICARE Prime 4) Annual enrollment is not required 5) Low priority for care provided at military treatment facilities
Created by: drea08



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