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Chapter 16 Insurance

QuestionAnswer
TRICARE is a health care program for uniformed service members and their families, National Guard/Reserve members and their families, survivors, former spouses, Medal of Honor recipients and their families,
Preauthorization is formal approval obtained from a health care finder before certain specialty procedures and inpatient care services are rendered
CHAMPVA- The Civilian Health and Medical Program of the Department of Veterans Affairs is a comprehensive health care program for which the Department of Veterans Affairs (VA) shares costs of covered health care services and supplies with eligible beneficiaries.
The CHAMPVA sponsor is a veteran who's permanently & totally disabled from a service-connected condition, died as a result of a service-connected condition, was rated permanently and totally disabled from a service-connected condition at the time of death, or died on active duty
TRICARE coverage includes options special programs, and supplemental programs, and TRICARE is the primary payer to Medicaid and TRICARE supplemental plans.
The health care program for active duty members of the military and their qualified dependents is called TRICARE
Commanders of selected military treatment facilities for TRICARE regions are called lead agents.
Which office coordinates and administers the TRICARE program and is accountable for the quality of health care provided to members of the uniformed services and their eligible dependents? TRICARE Management Activity (TMA)
Who assists TRICARE sponsors with information about the health program, along with other matters affecting access to health care (e.g., appointment scheduling)? customer service representative
A critical pathway is the sequence of activities that can normally be expected to result in the most cost-effective clinical course of treatment.
The managed care option that is similar to a civilian HMO is called TRICARE Prime
TRICARE Standard and Extra were combined to create TRICARE Select
TRICARE nonparticipating providers are subject to a limiting charge of _____ above the TRICARE fee schedule for participating providers. 15 percent
Which is a comprehensive health care program for which the Department of Veterans Affairs shares costs of covered health care services and supplies with eligible beneficiaries? CHAMPVA
The number of TRICARE regions has _____ since originally established. decreased
Health care finder a RN or PA who assists primary care providers with preauthorization and referrals
Beneficiary Services Representative Provide information about using TRICARE and assist with other administrative matters
What is the limit for filing TRICARE claism one year
Which TRICARE option requires annual enrollment? TRICARE Prime
The office that provides policies and procedures for prevention and detection of fraud and abuse is Program Integrity Office
Created by: vlw2861
 

 



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