Deck 10: Military Carriers

Question 1

Congress authorized the creation of the Emergency Maternal and Infant Care program (EMIC)during:

A) the Civil War.
B) World War I.
C) World War II.
D) the Korean War.

Answer 1

World War II.

Question 2

TRICARE's Medicare-wraparound coverage available to all Medicare-eligible TRICARE beneficiaries is called TRICARE:

A) Gap.
B) for Life.
C) Comp.
D) Extra.

Answer 2

for Life.

Question 3

The amount on which TRICARE figures a beneficiary's cost share (coinsurance)for covered charges is called:

A) TRICARE's allowable charge.
B) CHAMPUS Maximum Allowable Charge.
C) TRICARE's limiting.
D) both a and b

Answer 3

CHAMPUS Maximum Allowable Charge.

Question 4

The acronym for the computerized data bank that lists all active and retired military service members is:

A) DoD.
B) MTF.
C) DEERS.
D) UNISIS.

Question 5

The worldwide healthcare system for the military is currently called:

A) CHAMPUS.
B) TRICARE.
C) UNISIS.
D) CHAMPION.

Question 6

The deadline for submitting TRICARE claims is within _____ of services rendered,after which no payment is made.

A) 6 months
B) 1 year
C) 18 months
D) 2 years

Question 7

Many veterans with service-connected conditions can qualify for cost-free healthcare services if they meet the conditions of a:

A) means test.
B) physical disability analysis.
C) financial assessment.
D) both a and c

Question 8

If a TRICARE-eligible beneficiary has other healthcare coverage,such as employer group or private insurance,TRICARE considers this:

A) unlawful.
B) dual eligibility.
C) coordination of benefits.
D) other health insurance (OHI).

Question 9

CHAMPVA allows professional charges to be submitted on paper using the ____________ claim form and following TRICARE/CHAMPVA guidelines.

A) CMS-1500
B) CMS-1450
C) CHAMPVA Form L-10
D) any of the above

Question 10

The TRICARE option that is structured similar to a preferred provider organization (PPO)is:

A) CHAMPVA.
B) TRICARE Standard.
C) TRICARE Extra.
D) TRICARE Prime.

Question 11

The military program that helps provide medical,educational,housing,community support,and personnel services to families with special needs is the:

A) Early and Periodic Screening, Diagnosis, and Treatment (EPSDT).
B) Exceptional Family Member Program (EFMP).
C) State Children's Health Insurance Program (SCHIP).
D) TRICARE Plus.

Question 12

The designated contractor who processes TRICARE medical claims for care received within a particular state or region is called a:

A) TRICARE carrier.
B) fiscal intermediary.
C) claims processor.
D) coordinating contractor.

Question 13

Identify the benefit program designed for spouses or dependents of veterans who are 65 or older.

A) Medicare United
B) TRICARE for Life
C) CHAMPVA for Life
D) TRICARE-CHAMPVA Connect

Question 14

All CHAMPVA claims,whether electronic or paper,should be sent to the VA Health Administration Center in:

A) Washington, D.C.
B) Sacramento, Calif..
C) Denver, Colo..
D) Philadelphia, Pa.

Question 15

CHAMPVA eligibility can be lost in all of the following situations except when a:

A) widow younger than age 55 remarries.
B) spouse divorces his or her sponsor.
C) sponsor or family member becomes eligible for Medicare.
D) dependent child enrolled in college full time becomes 18.

Question 16

The name of the total healthcare infrastructure of the U.S.uniformed services is called the _____ Health System.

A) Military
B) Global
C) American
D) United

Question 17

The TRICARE program is managed by _____ under the authority of the Office of the Assistant Secretary of Defense for Health Affairs (OSD/HA).

A) the Congress
B) a group of physicians
C) a committee of state governors
D) TRICARE Management Activity (TMA)

Question 18

The three basic plans under TRICARE include all of the following,except:

A) Extra.
B) Global.
C) Prime.
D) Standard.

Question 19

By law,CHAMPVA is always a secondary payer,except for CHAMPVA supplemental policies and:

A) Medicare.
B) Medicaid.
C) TRICARE.
D) TRICARE for Life.

Question 20

Which of TRICARE's program options is similar to a health maintenance organization (HMO)?

A) CHAMPVA
B) TRICARE Standard
C) TRICARE Extra
D) TRICARE Prime

Question 21

Categories of eligibility under TRICARE's three plans includes all of the following,except:

A) medal of honor recipients.
B) active duty service members (ADSMs).
C) spouses and unmarried dependents of ADSMs.
D) parents and parents-in-law of ADSMs or uniformed services retirees.

Question 22

There is one overseas region divided into three main areas.These are ______________,___________,and ____________.

Question 23

The TRICARE program is managed by _________.

Question 24

TRICARE is organized into ____ geographic regions in the United States and overseas.

A) 3
B) 4
C) 5
D) 6

Question 25

The responsibilities of a TRICARE regional contractor include all of the following,except:

A) establishing provider networks.
B) operating TRICARE service centers.
C) overseeing conduct on military bases.
D) providing healthcare services and support.

Question 26

The annual upper limit an individual or family has to pay out-of-pocket for covered health services in any fiscal year is called a:

A) premium limit.
B) cost share.
C) catastrophic cap.
D) deductible allowance.

Question 27

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

A) letter of intent.
B) certificate of credible coverage.
C) release of information.
D) nonavailability statement.

Question 28

Once the sponsor reaches age 65,_____________ must be in effect no later than the sponsor's retirement date to avoid a break in TRICARE coverage.

A) Medicare Part A
B) Medicare Part B
C) TRICARE for Life
D) other health insurance (OHI)

Question 29

Enrollees are responsible for certain __________ for care that is covered under TRICARE Standard.

A) cost shares
B) catastrophic caps
C) charges above the TAC
D) late fees

Question 30

Adult children of military members and retirees younger than 26,unmarried,and not eligible for employer-sponsored healthcare may become eligible for the ______ as long as their sponsor is still eligible for TRICARE.

A) TRICARE for Life Program
B) CHAMPVA for Life Program
C) TRICARE Young Adult Program
D) TRICARE Civilian Plan

Question 31

Under ___________ (effective for plan years starting on or after January 1,2014)preexisting condition exclusions are prohibited for all health plan insurance issuers.

A) HIPAA
B) COBRA
C) The Affordable Care Act
D) Defense Enrollment Eligibility Rule

Question 32

TRICARE pays for only certain covered services,supplies,and procedures,which are referred to as:

A) TRICARE allowable charges.
B) TRICARE authorized charges.
C) certified military charges.
D) ADSM recommended charges.

Question 33

A hospital or institutional provider,physician,or other provider of services or supplies specifically allowed to provide benefits under TRICARE is commonly referred to as a:

A) TRICARE authorized provider.
B) TRICARE contractual provider.
C) TRICARE participating provider.
D) TRICARE approved provider.

Question 34

Identify which of the following provides health benefits to beneficiaries living and traveling out of the country while eligible for TRICARE.

A) TRICARE Worldwide
B) TRICARE Overseas Program
C) TRICARE Abroad
D) TRICARE Eurasia

Question 35

Which of the following is not an authorized method for submitting claims to TRICARE electronically?

A) EFT
B) eZ TRICARE
C) EDI gateway
D) Claims clearinghouse

Question 36

Non-PAR providers may charge up to ____% above the TRICARE allowable charge (TAC)for their services.

A) 10
B) 15
C) 20
D) 25

Question 37

If there are no problems with the claim,the contractor sends a written notice to both the beneficiary and provider,known as a/an __________.

A) EFT
B) EOB
C) NAS
D) TAC

Question 38

TRICARE's 11 United States' regions have merged to form just three,which are the _________ region,the _________ region,and the _________.

Question 39

Active duty,retired,or deceased service members are called ____________________.

Question 40

The three basic plan options included in the TRICARE program are TRICARE __________,TRICARE __________,and TRICARE __________.

Question 41

Active duty,guard,and reserve members are automatically enrolled in TRICARE Prime.

Question 42

Explain the Exceptional Family Member Program (EFMP)and define an "exceptional family member."

Question 43

Identify eligible categories of individuals included under the TRICARE program.

Question 44

TRICARE offers supplemental programs to beneficiaries with certain health concerns or conditions.Name three of these programs.

Question 45

TRICARE's allowable charge is also known as CHAMPUS Maximum Allowable Charge.

Question 46

TRICARE offers eligible beneficiaries five basic options to choose from.

Question 47

In the event a provider or beneficiary disagrees with the manner in which a CHAMPVA claim was processed,a/an _____________ may be filed.

Question 48

To be eligible for CHAMPVA,the individual must meet what specific criteria?

Question 49

TRICARE is administered on a global basis.

Question 50

Parents and parents-in-law are among those family members who are eligible for TRICARE.

Question 51

Individuals who are eligible for CHAMPVA benefits are not TRICARE eligible.

Question 52

What is a nonavailability statement (NAS)?

Question 53

In the CHAMPVA program,no prior approval is necessary for referrals to specialists or for diagnostic tests as long as they are considered ________________.

Question 54

In general,after the annual deductible is met,CHAMPVA covers _____ % of most healthcare services and supplies that are medically and/or psychologically necessary.

Question 55

CHAMPVA is administered by __________________________.

Question 56

The 1966 amendments to the Dependents Medical Care Act initiated what later became CHAMPUS,which was replaced with TRICARE in 1998.

Question 57

The name of the firm that processes about 65% of claims and handles customer service for the TRICARE healthcare program is _____________________.

Question 58

List 4 types of services that CHAMPVA does not cover.

Question 59

What is the Military Health System's mission?

Question 60

What procedure should the health insurance professional use to confirm eligibility for benefits under one of the military's healthcare programs?

Question 61

Individuals covered by TRICARE Standard no longer need approval from their MTF to seek inpatient care at civilian hospitals in most situations.

Question 62

CHAMPVA follows the same claims filing deadline as TRICARE.

Question 63

An ID card alone is not always sufficient to prove current TRICARE eligibility.

Question 64

ADSMs enrolled in Prime receive most care at military treatment facilities (MTFs).

Question 65

One advantage to submitting TRICARE claims electronically is that claims are sent directly into the TRICARE processing system.

Question 66

All military medical facilities have implemented HIPAA's privacy rules.

Question 67

TRICARE claims must be submitted electronically without exception.

Question 68

None of the TRICARE options will pay for the ADSM's medical care received from a civilian provider.

Question 69

Non-PARs cannot balance bill TRICARE Standard enrollees for any additional charges above the TRICARE allowable charge (TAC).

Question 70

TRICARE-authorized providers are not required to participate in a TRICARE network;however,they must be certified as authorized TRICARE providers.

Question 71

The deadline for submitting military claims varies from region to region.

Question 72

If the needed treatment is not available at an MTF,TRICARE eligibles must always obtain a nonavailability statement (NAS).

Question 73

If Medicare finds a service is not medically necessary or appropriate,CHAMPVA does not provide coverage either.

Question 74

Unlike Medicare,CHAMPVA beneficiaries cannot appeal a denied claim.

Question 75

The spouse or dependent child of a veteran who is rated as having a permanent and total service-connected disability is eligible for CHAMPVA.

Question 76

OHI does not include TRICARE supplemental insurance or Medicaid.

Question 77

All CHAMPVA claims are sent to one place-the VA Administration in Washington,D.C.

Question 78

In some cases,beneficiaries may be responsible for paying for services from a nonparticipating provider first,then filing their own claims in order to receive reimbursement from TRICARE.

Question 79

TRICARE Plus is available only to those enrolled in a TRICARE Prime option,a civilian HMO,or Medicare HMO.

Question 80

Providers who accept assignment on CHAMPVA claims must accept the CHAMPVA allowable rate as payment in full and cannot balance bill.