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advancement instructions > TRICARE prime > Flashcards

TRICARE prime Flashcards

0
Q

What regional contractor does TRICARE north use?

A

Health net federal services, LLC

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1
Q

What are the three TRICARE regions

A

North
South
West

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2
Q

What regional contractor does TRICARE south use?

A

Humana military

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3
Q

What regional contractor does TRICARE west use?

A

UnitedHealthcare

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4
Q

For ADSM enrollment in what form of TRICARE is mandatory?

A

TRICARE prime

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5
Q

What is the form used for TRICARE prime enrollment application and PCM change?

A

DD Form 2876

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6
Q

In order to qualify for TRICARE prime remote your DEERS and work zip code must be how many mile and how long of a drive from the closest mtf?

A

50 miles

Approximately 1 hour drive

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7
Q

What is the enrollment fee for ADSM and ADFMs?

A

None

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8
Q

What happens to the enrollment fees for surviving beneficiaries and medically retired members?

A

Frozen at the rate in effect at the time they become survivors or medically retired

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9
Q

The 12 month lock out from lack of payment does not apply to what pay grades?

A

E-1 to E-4

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10
Q

If the sponsor is deployed and family member moves they must change from TPRADFM to the appropriate TRICARE for the new location

A

Note

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11
Q

What is the definition of urgent care?

A

Medically necessary services for an illness or injury that would not result in further disability or death if not immediately treated, but does require professional attention with in 24 hours
(Sprain, soar throat, rising temp)

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12
Q

Can a specialist refer you to another specialist?

A

No they must contact your PCM

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13
Q

How many visits can non ADSM have for outpatient behavioral health care services per fiscal year?

A

8

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14
Q

What are telemental health program?

A

Uses secure audio-facial conferencing to connect eligible beneficiaries with off site TRICARE network providers

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15
Q

TRICARE covers how many substance use rehabs per lifetime? Per benefit period?

A

3 life

1 per period

16
Q

All treatment for substance use disorders requires prior authorization from the regional contractor

A

Note

17
Q

TRICARE offers hospice care for personnel with a life expectancy of how long or less?

A

6 months

18
Q

What are the four levels of hospice benefit care?

A

Routine home care
Continuous home care
Inpatient respite care
General hospice care

19
Q

Hospice care is only available in conus

A

Note

20
Q

TRICARE covers all necessary maternity care from your first OB visit till when?

A

6 weeks after the birth

21
Q

What type of fetal ultra sounds are not covered by TRICARE?

A

Not medically necessary

To determine the sex

22
Q

Is artificial insemination covered by TRICARE?

A

No

23
Q

TRICARE DOES NOT COVER ROUTINE ULTRASOUND SCREENINGS, maternal, even if a provider orders them as part of their plan

A

Important note

24
Q

If a family member needs to be in the EFMP what type of TRICARE will they need?

A

ECHO

25
Q

At an mtf pharmacy you may receive up to how many day supply of most medications at no cost?

A

90

26
Q

What is the least expensive option to get medications when not using a MTF pharmacy?

A

TRICARE pharmacy home delivery

27
Q

For non ADSM s using the pharmacy home delivery what medications are free at what quantity and which are not free?

A

90 day supply of generic meds

Brand name and non formulary require a copayment

28
Q

If upswing express scripts for home delivery of medication you will receive medications within how many days ?

A

14

29
Q

Through TRICARE retail network pharmacy you may fill prescription with one copayment for how many days of medication?

A

30 days

30
Q

What is the procedure for filling medications at non network pharmacies?

A

You pay full cost up front
File a claim
Receive partial reimbursement

31
Q

What is the TRICARE patients request for medical payment?

A

DD Form 2642

advancement instructions (55 decks)

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