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Health Insurance and Reimbursement > Ch 10: Review Test > Flashcards

Ch 10: Review Test Flashcards

Military Carriers

1
Q

TRICARE is organized into geographical regions in the United States and “areas” overseas. How many total regions and areas are there?

A

6

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2
Q

What is the name for the global, comprehensive, integrated system that includes combat medical services, health readiness futures, a healthcare delivery system, public health activities, medical education and training, and medical research and development?

A

Military Health System

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3
Q

Each TRICARE region is headed by a(n) ____ who works with the DoD to administer the TRICARE benefits in that region.

A

Regional contractor

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4
Q

A clinic or hospital operated by the DoD, located on a military base, that provides care to military personnel, retirees, and dependents

A

Military treatment facility (MTF)

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5
Q

What are the three main responsibilities of a TRICARE regional contractor?

A
  • Establishing provider networks
  • Operating TRICARE service centers
  • Providing healthcare services and support
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6
Q

On October 1, 2013, the Department of Defense (DoD) established (the) ____ to take over management of the Military Health System (MHS) activities, replacing the former Tricare Management Activity (TMA), which ceased operations on that same date.

A

Defense Health Agency (DHA)

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7
Q

The computerized data bank that lists all active and retired military service members

A

DEERS

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8
Q

Similar to Medicaid and Medicare, TRICARE-eligible individuals are commonly referred to as what?

A

Beneficiaries

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9
Q

What categories are covered under TRICARE?

A
  • Medal of Honor recipients
  • Active duty service members (ADSMs)
  • Spouses ans unmarried children of ADSMs
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10
Q

What are the three main program options available under TRICARE?

A
  • Extra
  • Prime
  • Standard
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11
Q

What provides benefits to beneficiaries living and traveling overseas when they are eligible for TRICARE?

A

TRICARE Overseas Program

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12
Q

TRICARE pays for only allowed services, supplies, and procedures, which are referred to as TRICARE ____?

A

TRICARE covered charges

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13
Q

If needed treatment is unavailable at an MTF and it becomes necessary for the individual to seek inpatient treatment in a civilian hospital, he or she sometimes must obtain what?

A

Nonavailability statement

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14
Q

If a TRICARE-eligible beneficiary has additional healthcare coverage through an employer or a private insurer, TRICARE considers this what?

A

Other health insurance (OHI)

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15
Q

What is TRICARE’s Medicare-wraparound coverage available to Medicare-eligible TRICARE beneficiaries?

A

TRICARE for Life

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16
Q

A hospital or institutional provider, physician, or other provider of services or supplies specifically authorized to provide benefits under TRICARE is commonly referred to as what?

A

TRICARE authorized provider

17
Q

By law, TRICARE nonPARs cannot charge more than ____% higher than the TRICARE maximum allowable charge

A

15%

18
Q

Providers submitting paper claims should use what form?

A

CMS-1500

19
Q

What are three methods for submitting claims to TRICARE electronically?

A
  • eZ TRICARE
  • EDI Gateway
  • Claims clearinghouse
20
Q

CHAMPVA is a federal health benefits program administered by who?

A

VA

21
Q

CHAMPVA eligibility can be lost if certain demographic changes occur such as what?

A
  • A widow remarrying

- Divorcing the sponsor

22
Q

CHAMPVA is managed by the VA’s Health Administration Center which is located where?

A

Denver, Colorado

23
Q

In general, CHAMPVA covers ____% of most healthcare services and supplies that are medically and psychologically necessary

A

75%

24
Q

To provide financial protection against a potential financial crisis of a long-term illness or serious injury, CHAMPVA has established what?

A

Annual catastrophic (cat) cap

25
Q

CHAMPVA pays for covered services and supplies when they are received from an authorized provider and are ____

A

Medically necessary

26
Q

What is the deadline for filing military claims?

A

1 year

27
Q

The annual cat cap for CHAMPVA is what?

A

$3000

28
Q

When completing a claim, the health insurance professional should remember that the active-duty service member is the ____?

A

Sponsor

Health Insurance and Reimbursement (38 decks)

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