013-018 Flashcards
When hospitals were first established, who typically worked as nurses in the hospitals?
Wives or widows of military personnel.
When was the Act that led to CHAMPUS signed into law?
1 Oct 66.
What was TRICARE designed to do?
Expand access to care, assure high-quality care, control healthcare costs, and improve medical readiness.
What did the “TRI” in “TRICARE” originally refer to?
The three main benefit plan options, TRICARE Prime, TRICARE Standard and TRICARE Extra.
What are the two distinct types of care?
Direct care and purchased care.
What is a network provider?
A provider under contract with TRICARE regional office to provide care to beneficiaries.
A provider that accepts TRICARE and agrees to the TRICARE allowable charge for their service is classified as what type of provider?
Participating provider.
What type of provider furnishes care to beneficiaries but does not sign agreements with regional contractors?
Non-Network provider.
What is a non-network, non-participating provider?
One who provides care, but does not have an agreement with TRICARE and they do not accept the allowable charge as payment
What providers are prohibited from balance billing?
Network and participating providers.
What payments contribute to the catastrophic cap?
Deductibles, cost-shares, prescription co-payments and Prime enrollment fees.
Under what system do TRICARE beneficiaries receive a majority of their care?
Direct care system.
Who has the highest priority for MTF care?
ADSMs and TRICARE Prime-enrolled active duty family members.
What is an HMO?
It’s a health plan in which a member pays for medical care, and it usually includes primary and preventive care
What are the four geographic health service regions?
TRO-North, TRO-South, TRO-West, and TOP.
Who makes referrals for tests/specialty care, and monitor adequacy and continuity of needed care?
The PCM.
