Question 1

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

Accepted Answer

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

Question 2

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

Accepted Answer

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

Question 3

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

Accepted Answer

A) True 
 B)False

Question 4

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

Accepted Answer

A) True 
 B)False

Question 5

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

Accepted Answer

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

Question 6

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

Accepted Answer

A) True 
 B)False

Question 7

Unlike Medicare,CHAMPVA beneficiaries cannot appeal a denied claim.

Accepted Answer

A) True 
 B)False

Question 8

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:

Accepted Answer

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

Question 9

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

Accepted Answer

TRICARE eligibility is based on the info

Question 10

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

Accepted Answer

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

Question 11

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

Accepted Answer

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

Question 12

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

Accepted Answer

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. 
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 13

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

Accepted Answer

A) True 
 B)False

Question 14

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

Accepted Answer

A) True 
 B)False

Question 15

The TRICARE program is managed by _________.

Accepted Answer

TRICARE Management A

Question 16

List 4 types of services that CHAMPVA does not cover.

Accepted Answer

Routine dental care
Routine vi

Question 17

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

Accepted Answer

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

Question 18

CHAMPVA follows the same claims filing deadline as TRICARE.

Accepted Answer

A) True 
 B)False

Question 19

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

Accepted Answer

The answer of Active duty,retired,or deceased service members are called...

Question 20

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

Accepted Answer

A) True 
 B)False

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

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

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

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

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

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

Unlike Medicare,CHAMPVA beneficiaries cannot appeal a denied claim.

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:

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

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

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

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

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

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

The TRICARE program is managed by _________.

List 4 types of services that CHAMPVA does not cover.

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

CHAMPVA follows the same claims filing deadline as TRICARE.

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

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

The Origins of Health Insurance

Tools of the Trade: A Career as a Health (Medical)Insurance Professional

The Legal and Ethical Side of Medical Insurance

Types and Sources of Health Insurance

Claim Submission Methods

Traditional Fee For Service/Private Plans

Unraveling the Mysteries of Managed Care

Understanding Medicaid

Conquering Medicare’s Challenges

Miscellaneous Carriers: Workers’ Compensation and Disability Insurance

Diagnostic Coding

Procedural, Evaluation and Management, and HCPCS Coding

The Patient

Keys to Successful Claims Management

The Role of Computers in Health Insurance

Reimbursement Procedures: Getting Paid

Hospital Billing and the UB-04

Filters

Exam 10: Military Carriers

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

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

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

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

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

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

Unlike Medicare,CHAMPVA beneficiaries cannot appeal a denied claim.

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:

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

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

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

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

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

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

The TRICARE program is managed by _________.

List 4 types of services that CHAMPVA does not cover.

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

CHAMPVA follows the same claims filing deadline as TRICARE.

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

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

The Origins of Health Insurance

Tools of the Trade: A Career as a Health (Medical)Insurance Professional

The Legal and Ethical Side of Medical Insurance

Types and Sources of Health Insurance

Claim Submission Methods

Traditional Fee For Service/Private Plans

Unraveling the Mysteries of Managed Care

Understanding Medicaid

Conquering Medicare’s Challenges

Miscellaneous Carriers: Workers’ Compensation and Disability Insurance

Diagnostic Coding

Procedural, Evaluation and Management, and HCPCS Coding

The Patient

Keys to Successful Claims Management

The Role of Computers in Health Insurance

Reimbursement Procedures: Getting Paid

Hospital Billing and the UB-04

Filters