Exam 15: Tricare Medical Billing

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.

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

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

An individual who qualifies for TRICARE is known as a(n): A)member. B)beneficiary. C)sponsor. D)enrollee.

If a TRICARE beneficiary receives services from a nonauthorized provider, the physician can bill: A)only the usual, customary, and reasonable amount. B)only the authorized contracted amount. C)only the limiting charge. D)any amount for the services.

Under the TRICARE Prime point-of-service option, charges for visits to non-network providers are: A)not paid by TRICARE. B)subject to a $6 or $12 copay. C)paid 80% by TRICARE and 20% by the beneficiary. D)paid 50% by TRICARE and 50% by the beneficiary.

Under TRICARE Prime, a PCM is a: A)primary care manager. B)physician case manager. C)preventive care manager. D)physician consulting manager.

Under TRICARE Standard, the group of beneficiaries that pays 20% cost share for outpatient services includes: A)former spouses of active-duty service members. B)families of active-duty service members. C)families of deceased personnel. D)retirees from the military.

Under TRICARE Prime, the primary care manager provides all of the following services EXCEPT: A)preventive care. B)nonavailability statements when required. C)care for routine illnesses. D)referral to specialists.

TRICARE Senior Prime/TRICARE for Life acts as the primary payer when the covered individual also has Medicare coverage.

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

TRICARE Extra is more expensive than TRICARE Prime but less costly than TRICARE Standard.

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.

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

In the TRICARE program, what is DEERS?

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.

The TRICARE fiscal year begins on: A)January 1. B)July 1. C)September 1. D)October 1.

Under TRICARE Standard, the group of beneficiaries that pays 25% cost share for outpatient services includes all of the following EXCEPT: A)former spouses of active-duty service members. B)retired service members and their families. C)families of deceased personnel. D)families of active-duty service members.

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