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FLAVIN MOS150U4
TERMINOLOGY
| Term | Definition |
|---|---|
| If patients are covered by two insurance plans, the health insurance professional may have to submit a primary claim and a _____ claim. | secondary |
| The prescription plan under CHAMPVA is considered “_____________,” and beneficiaries typically do not have to sign up for a Medicare Part D plan. | credible coverage |
| If treatment is unavailable at an MTF and it becomes necessary for an individual to seek treatment in a civilian hospital, he or she sometimes must obtain a | nonavailability statement |
| The acronym for the computerized data bank that lists all active and retired military service members is | DEERS |
| Most state laws exclude coverage for injuries sustained while an employee is commuting to and from work. This is referred to as the _____ rule. | coming-and-going |
| The worldwide healthcare system for the military is currently called | TRICARE |
| TRICARE’s preferred provider option (PPO) is | TRICARE Extra |
| The facility that handles TRICARE claims is called a | claims processor |
| Which act provides workers’ compensation to employees of private maritime employers? | Longshore and Harbor Workers’ Compensation Act |
| An individual responsible for investigating and resolving workers’ complaints against the employer is called a/an | ombudsman |
| If there are no problems with the claim, the contractor should send a written notice, known as an __________, in about 1 month. | EOB |
| An alternative to the suspension file is to record claims information on a columnar form called a/an | insurance claims register |
| A maximum benefit amount paid for short-term disability policies is called a _____ cap. | benefit |
| An explanation of benefits is often referred to as a/an | remittance advice |
| Workers’ compensation insurance is considered to be “no-fault insurance,” which means | benefits are paid regardless of who is to blame for the injury |
| An employee who is not entitled to paid holiday or sick leave and has no expectation of ongoing employment | Casual employee |
| The service member, whether in active duty, retired or deceased | Sponsor |
| Annual upper limit a family will have to pay for TRICARE Standard-covered services in any fiscal year | Catastrophic cap |
| The goal is to return the injured worker to some sort of suitable, gainful employment that he or she can reasonable achieve | Vocational rehabilitation |
| Provides workers’ compensation for nonmilitary federal employees | Federal Employment Compensation Act |
| Serves as evidence of prior healthcare coverage under TRICARE | Certificate of credible coverage |
| A series of files set up chronologically and labeled according to the number of days since the claim was submitted | Suspension files |
| A treatment that focuses on helping individuals achieve independence in all areas of their lives. | Occupational therapy |
| Income from employment | Earned income |
| Organization that has agreed to provide services under the Ticket to Work program guidelines. | Employment network |
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