Assignment 2: TRICARE

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Assignment 08 TRICARE or what started out as CHAMPUS, stands for the Civilian Health and Medical Program of the Uniformed services and was established under public law, in 1966. TRICARE was developed on people in the armed forces having a difficult time paying for any medical attention they needed for their families. There now are seven different types of TRICARE coverage including standard, prime, senior prime, extra, young adult, reserve select and reserved retired. Members of TRICARE insurance can either be seen at a TRICARE approved civilian providers or Military Treatment facility. TRICARE does several things different from other insurance coverage including deductible timelines and using cost share instead of coinsurance. The TRICARE …show more content…
Cost share refers to the amount of healthcare charges that are the responsibility of the family member or the sponsor. A sponsor would be the beneficiary or policy holder of the TRICARE health plan. Depending on which type of TRICARE plan fits the beneficiary and their family best, is dependent on what types of benefits received TRICARE Standard is a fee for services program that covers services provided by a civilian physician, only when a Military Care facility cannot. TRICARE Prime is similar to an HMO in a way that is a managed care plan. TRICARE Prime offers additional preventative care such as physical exams. TRICARE Prime Remote is a program for active duty members that are assigned to a station 50 or more miles away from a military treatment facility. Prime remote is similar to TRICARE Prime in the fact the benefits are the same except Prime Remote asks for no out of pocket costs. TRICARE Extra is coverage for active duty members and TRICARE prime member, and receives first priority at military treatment facilities. TRICARE senior prime and TRICARE for life are for individuals over age 65 that are eligible for TRIARE as well as MEDICARE. TRICARE for life is similar to a MEDICARE HMO with more attention towards wellness and …show more content…
In the medical field it is important to gather and submit the right personal information as well as know all of the insurance that person is covered under to ensure proper reimbursement. Also in the medical field, a medical office specialist needs to be positive they’re using the right CPT or ICDM codes to ensure the proper services are being provided and also the right amount they are charging. A medical offices specialist is also responsible for following up on submitted claims to ensure reimbursement is made. To follow up , depending on if the claim was in paper format or electronic, the office specialist needs to make sure the claim has been submitted to the insurance company and give the proper amount of time for the provider to credit the amount needed to be made. If the claim was a paper claim, a quick telephone call or fax can be made, also depending on the information needed. An electronic claim can also sometimes be checked over the phone or fax, but in most cases the status is shown online. The appeals process for reimbursement is a very complex process between each insurance carrier and the provider that’s in contract with. Some common reasons for claim denials include a policy containing only a certain number of services which the patient has exceeded and doesn’t know, insurance wanting additional information on the service rendered and won’t pay
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