TRICARE
What is TRICARE?
a health care program for active-duty service members (ADSMs) of the US military and their families.
Any individual who qualifies for TRICARE is known as a
beneficiary
TRICARE select is
TRICARE Select is offered to active duty members, retired service members and their families, family members of activated guard/reserve members, non-activated guard/reserve members and their families who qualify for care under the Transitional Assistance management program, retired guard/reserve members at age 60 and their families, survivors, medal of honor recipients and their families, and qualified former spouses
Fee-for-service, self-managed, preferred provider network plan
The VHA is for
spouses and dependent children of veterans with total, permanent disability
Claims must be billed on what form?
CMS-1500
Active duty members are issued a
common access card (CAC)
A service retiree remains in TRICARE until they turn
65
TRICARE Prime Remote is
HMO-style managed plan that’s available in remote areas in the US
Can only be used if both the sponsor's home and work addresses are more than 50 miles or 1 hour's drive time from a military hospital or clinic
Available to ADSMs and certain family members
CHAMPVA stands for
Civilian Health and Medical Program of the Veterans Administration
With TRICARE for life, claims must be submitted to __ first.
Medicare
An authorized provider is
a physician or provider of care, a hospital or supplier approved by TRICARE to provide medical care and supplies.
True or False:
If an individual served as an active-duty military person for 4 to 6 years and gives up their military career and leaves, no further family benefits are provided.
True
TRICARE Prime Overseas is
HMO-style managed care plan available overseas areas near military hospitals and clinics
Only available for active duty members and command sponsored family members
True or False
ID card required for all dependents over age 10
True
Is TRICARE usually primary or secondary payer?
Secondary
a network provider is
any TRICARE-authorized provider that has signed a contract with a regional TRICARE contractor.
What is a NAS?
A NAS is a certification from a military hospital stating that it cannot provide the care needed by the beneficiary
TRICARE Reserve select is
Premium-based health plan available worldwide for purchase by qualified members of the selected reserve and their families
Similar to TRICARE select
True or False:
No freedom of choice in selecting civilian providers
False
The VHA will issue an __ after payment has been made.
EOB
Non-network providers work on a
claim-by-claim basis
What is a catchment area?
Specific geographic region defined by zip codes and is based on an area of approximately 40 miles in radius surrounding each MTF in the US.
Individuals whose address zip code falls out of the local military hospital's service area do not need an NAS
TRICARE retired reserve is
Premium-based health plan that qualified retired reserve members and survivors may purchase
Coverage similar to TRICARE Select
Terminated at age 60
True or False:
Preauthorization is needed for some services
True
With a workers' compensation claim, who pays first? TRICARE or workers' compensation?
workers' compensation