Tricare - A Health Care Program Created By The Usa Congress

The United States congress created the Civilian Health and Medical Program of Uniformed Services (CHAMPUS), but it wasn’t until January of 1994 that it came to be know as TRICARE

TRICARE is a health care program that was created because individuals in the military were finding it increasingly difficult to pay for the medical care required by their families. Beginning in 1988, CHAMPUS beneficiaries had a choice of retaining their benefits under CHAMPUS or enrolling in a regional managed care plan called CHAMPUS Prime, a plan to control escalating medical costs and standardize benefits. Fordney, Marilyn. Insurance Handbook for the Medical Office - E-Book (p. 444). Elsevier Health Sciences. Kindle Edition.

Who administers TRICARE?

TRICARE standard is administered by the Department of Defense (DOD). TRICARE Management Activity (TMA) is the current name of the administrative office that was formerly known as the Office of Civilian Health and Medical Programs of the Uniformed Services (OCHAMPUS). All TRICARE-eligible persons must be enrolled in the Defense Enrollment Eligibility Reporting System (DEERS) computerized database. TRICARE claims processors check DEERS before processing claims to verify beneficiary eligibility. Fordney, Marilyn. Insurance Handbook for the Medical Office - E-Book. Elsevier Health Sciences. Kindle Edition.

The difference between TRICARE and CHAMPVA

The difference between TRICARE and CHAMPVA is that CHAMPVA is for spouse and dependent children of veterans with total or permanent disability. TRICARE enrollees may be dependents of personnel who are actively serving in the armed services and military retirees and their dependents. Veterans Health Administration (also known as CHAMPVA) is managed by Veteran Administration. Beneficiaries from this program are not eligible for TRICARE. Fordney, Marilyn. Insurance Handbook for the Medical Office - E-Book (p. 444). Elsevier Health Sciences. Kindle Edition.

What are TRICARE Service Centers?

What kinds of services do they provide? (p. 446) Cooperative care consists of services or supplies that may be cost-shared by TRICARE Standard under certain conditions. partnership program is another option that allows TRICARE Standard–eligible persons to receive inpatient or outpatient treatment from civilian providers of care in a military hospital or from uniformed services providers of care in civilian facilities. There are times when there is no service hospital in the catchment area and a TRICARE Standard beneficiary may seek care through a private physician’s office or hospital. Fordney, Marilyn. Insurance Handbook for the Medical Office - E-Book (p. 446). Elsevier Health Sciences. Kindle Edition.

What is the difference between TRICARE Prime and TRICARE Extra?

TRICARE Extra is a preferred provider organization (PPO)-type of TRICARE option in which the individual does not have to enroll or pay an annual fee. On a visit by visit basis, the individual may seek care form an authorized network provider and receive a discount on services and reduced cost-share copayment. TRICARE Prime is a voluntary health maintenance organization (HMO)-type option for TRICARE beneficiaries. Fordney, Marilyn. Insurance Handbook for the Medical Office - E-Book (p. 611). Elsevier Health Sciences. Kindle Edition.

What reimbursement instructions should be followed in case a patient is also covered by an OHI? What happens if the OHI refuses to compensate the claim? A claim must be filed if a patient has an additional private insurance policy that provides double coverage. Refusal by the beneficiary to claim benefits from other health insurance coverage results in a denial of TRICARE benefits. In double coverage situations, TRICARE pays the lower of the following:

• The amount of TRICARE-allowable charges remaining after the double coverage plan has paid its benefits
• The amount TRICARE would have paid as primary payer

There must be coordination of benefits (COB) so that there is no duplication of benefits paid between the double coverage plan and TRICARE. Fordney, Marilyn. Insurance Handbook for the Medical Office - E-Book. Elsevier Health Sciences. Kindle Edition. How is the uniformed services common access card used? The issuing station’s number appears on the identification card to identify the home station where the beneficiary’s case file is kept. The identification card number is the veteran’s VA file number with an alpha suffix. The suffix is different for each beneficiary of a sponsor. All dependents 10 years of age or older are required to have a uniformed services (military) identification and privilege card for Veterans Health Administration.