Question 1

Form Locator 1a, Insured's ID Number, should include the:
A)patient's Social Security number.
B)patient's TRICARE-issued ID number.
C)sponsor's Social Security number.
D)sponsor's military rank and number.

Accepted Answer

The answer of Form Locator 1a, Insured's ID Number, should...

Question 2

The TRICARE regional healthcare finder (HCF) provides preventive services and care for routine illnesses or injuries.

Accepted Answer

The answer of The TRICARE regional healthcare finder (HCF) provides...

Question 3

Under TRICARE Prime, visits to civilian network providers require a copayment dependent on the military rank of the sponsor.

Accepted Answer

Visits to civilian network providers under TRICARE Prime require a copayment, which varies based on the military rank of the sponsor.

Question 4

TRICARE claims must be submitted no later than:
A)30 days from the date of service.
B)90 days from the date of service.
C)6 months from the date of service.
D)1 year from the date of service.

Accepted Answer

TRICARE claims must be submitted no later than 1 year from the date of service. This allows beneficiaries and providers ample time to ensure all services are accurately billed and reimbursed.

Question 5

Due to confidentiality regulations, TRICARE claims examiners do NOT provide information to parents or guardians of minors in regard to healthcare services that are related to:
A)abortion.
B)alcoholism or drug abuse.
C)sexually transmitted disease.
D)all of the above.

Accepted Answer

The answer of Due to confidentiality regulations, TRICARE claims examiners...

Question 6

The claims processor for all TRICARE Senior Prime/TRICARE for Life claims is:
A)Blue Cross/Blue Shield.
B)the Veteran's Administration (VA) Health Administration Center.
C)the Wisconsin Physicians Service (WPS).
D)dependent on the location of the provider.

Accepted Answer

The claims processor for all TRICARE Senior Prime/TRICARE for Life claims is the Wisconsin Physicians Service (WPS).

Question 7

If a TRICARE Standard beneficiary receives care from a provider who does NOT accept assignment, he or she is responsible for the provider's additional charges up to 115% of the allowable charge.

Accepted Answer

TRICARE Standard beneficiaries may choose to receive care from a non-network provider who does not accept assignment. In this case, the beneficiary is responsible for paying the provider's additional charges, which may be up to 15% above the TRICARE allowable charge. This is known as the "balance billing" provision.

Question 8

Under TRICARE Standard, if care is available from a military treatment facility (MTF) but the patient prefers to receive similar care at a civilian facility, he or she can do so after obtaining a nonavailability statement (NAS).

Accepted Answer

The answer of Under TRICARE Standard, if care is available...

Question 9

The TRICARE claims processor for the northern region of the United States is:
A)Blue Cross/Blue Shield.
B)Health Net Federal Services, Inc.
C)the Veteran's Administration (VA) Health Administration Center.
D)the Wisconsin Physicians Service (WPS).

Accepted Answer

The answer of The TRICARE claims processor for the northern...

Question 10

Paper claims for CHAMPVA may be submitted to:
A)Blue Cross/Blue Shield.
B)the Veteran's Administration (VA) Health Administration Center.
C)the Wisconsin Physicians Service (WPS).
D)This is dependent on the location of the provider.

Accepted Answer

The answer of Paper claims for CHAMPVA may be submitted...

Question 11

If a Veteran's Administration (VA) facility cannot provide necessary medical care for a veteran, an authorization for services will specify all of the following EXCEPT the:
A)provider the patient must see.
B)medical services that the VA approves.
C)length of period of treatment.
D)amount the VA will pay.

Accepted Answer

The authorization for services typically specifies the medical services that the VA approves, the length of the period of treatment, and the amount the VA will pay, but it does not specify the exact provider the patient must see.

Question 12

Which claim form must physician offices use to submit claims to TRICARE?
A)CMS-1450
B)CMS-1500
C)UB-04
D)CMS-5100

Accepted Answer

Physician offices must use the CMS-1500 claim form to submit claims to TRICARE. The CMS-1450 (UB-04) is used for institutional providers such as hospitals. CMS-5100 is not a valid claim form.

Question 13

The CHAMPVA program is administered by the:
A)Centers for Medicare and Medicaid Services (CMS).
B)Department of Defense (DoD).
C)Veteran's Administration (VA) Health Administration Center.
D)Veteran's Administration (VA) hospital network.

Accepted Answer

The CHAMPVA program is administered by the VA Health Administration Center, specifically the CHAMPVA program office. The Centers for Medicare and Medicaid Services administers Medicare and Medicaid programs. The Department of Defense administers military healthcare benefits. The VA hospital network provides healthcare services to veterans, but is not responsible for the CHAMPVA program.

Question 14

An individual who qualifies for TRICARE coverage is known as a sponsor.

Accepted Answer

TRICARE coverage is for military members, retirees, and their dependents, but the term "sponsor" specifically refers to the service member or retiree who provides eligibility for their dependents, not the individuals who qualify for coverage in general.

Question 15

For inpatient care at a military facility, TRICARE Senior Prime/TFL beneficiaries pay:
A)$0.
B)$11 per day.
C)$11 per admission.
D)20% of the charges.

Accepted Answer

The answer of For inpatient care at a military facility,...

Question 16

TRICARE beneficiaries who use nonauthorized providers may be responsible for paying their entire bill.

Accepted Answer

TRICARE only covers care provided by authorized providers. If a beneficiary chooses to see a nonauthorized provider, they may be responsible for paying the entire bill.

Question 17

The TRICARE program covers active-duty service members, retirees, family members, and survivors of eligible armed services members.

Accepted Answer

TRICARE does cover active-duty service members, retirees, family members, and survivors of eligible armed services members.

Question 18

A doctor of osteopathy is considered an authorized service provider for TRICARE.

Accepted Answer

According to the TRICARE website, doctors of osteopathy (DO) are authorized service providers for TRICARE.

Question 19

Under TRICARE Standard, most enrollees pay an annual deductible but no cost share for outpatient charges.

Accepted Answer

TRICARE Standard does require an annual deductible and cost-sharing for outpatient charges. The amount of cost-sharing will depend on the type of service received and where it was obtained.

Question 20

All active-duty uniformed services members are required to enroll in one of the TRICARE Prime plan options.

Accepted Answer

All active-duty uniformed services members are required to enroll in one of the TRICARE Prime plan options.

Quiz 15: Tricare Medical Billing

Form Locator 1a, Insured's ID Number, should include the: A)patient's Social Security number. B)patient's TRICARE-issued ID number. C)sponsor's Social Security number. D)sponsor's military rank and number.

The TRICARE regional healthcare finder (HCF) provides preventive services and care for routine illnesses or injuries.

Under TRICARE Prime, visits to civilian network providers require a copayment dependent on the military rank of the sponsor.

TRICARE claims must be submitted no later than: A)30 days from the date of service. B)90 days from the date of service. C)6 months from the date of service. D)1 year from the date of service.

Due to confidentiality regulations, TRICARE claims examiners do NOT provide information to parents or guardians of minors in regard to healthcare services that are related to: A)abortion. B)alcoholism or drug abuse. C)sexually transmitted disease. D)all of the above.

The claims processor for all TRICARE Senior Prime/TRICARE for Life claims is: A)Blue Cross/Blue Shield. B)the Veteran's Administration (VA) Health Administration Center. C)the Wisconsin Physicians Service (WPS). D)dependent on the location of the provider.

If a TRICARE Standard beneficiary receives care from a provider who does NOT accept assignment, he or she is responsible for the provider's additional charges up to 115% of the allowable charge.

Under TRICARE Standard, if care is available from a military treatment facility (MTF) but the patient prefers to receive similar care at a civilian facility, he or she can do so after obtaining a nonavailability statement (NAS).

The TRICARE claims processor for the northern region of the United States is: A)Blue Cross/Blue Shield. B)Health Net Federal Services, Inc. C)the Veteran's Administration (VA) Health Administration Center. D)the Wisconsin Physicians Service (WPS).

Paper claims for CHAMPVA may be submitted to: A)Blue Cross/Blue Shield. B)the Veteran's Administration (VA) Health Administration Center. C)the Wisconsin Physicians Service (WPS). D)This is dependent on the location of the provider.

Which claim form must physician offices use to submit claims to TRICARE? A)CMS-1450 B)CMS-1500 C)UB-04 D)CMS-5100

The CHAMPVA program is administered by the: A)Centers for Medicare and Medicaid Services (CMS). B)Department of Defense (DoD). C)Veteran's Administration (VA) Health Administration Center. D)Veteran's Administration (VA) hospital network.

An individual who qualifies for TRICARE coverage is known as a sponsor.

For inpatient care at a military facility, TRICARE Senior Prime/TFL beneficiaries pay: A)$0. B)$11 per day. C)$11 per admission. D)20% of the charges.

TRICARE beneficiaries who use nonauthorized providers may be responsible for paying their entire bill.

The TRICARE program covers active-duty service members, retirees, family members, and survivors of eligible armed services members.

A doctor of osteopathy is considered an authorized service provider for TRICARE.

Under TRICARE Standard, most enrollees pay an annual deductible but no cost share for outpatient charges.

All active-duty uniformed services members are required to enroll in one of the TRICARE Prime plan options.