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Where is information about TRICARE patient eligibility stored?


A) DEERS
B) CHAMPUS
C) PHS
D) CHAMPVA

E) A) and C)
F) C) and D)

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Identify the term that describes the maximum amount CHAMPVA will pay for a procedure.


A) CMAC
B) PCM
C) MTF
D) TMAC

E) B) and D)
F) None of the above

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Individuals age__________ and over who are eligible for both Medicare and TRICARE are offered the opportunity to receive health care at a MTF through TRICARE for Life.


A) 55
B) 70
C) 60
D) 65

E) B) and D)
F) None of the above

Correct Answer

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TRICARE will pay only for services that are rendered by __________ providers.


A) authorized
B) hospital
C) military
D) civilian

E) All of the above
F) B) and C)

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A nonparticipating provider in TRICARE sees a patient and provides services for three allowed charges that total $400. Calculate the maximum amount they may charge the patient.


A) $400
B) $500
C) $340
D) $460

E) A) and D)
F) None of the above

Correct Answer

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What is the TRICARE term for coinsurance?


A) capitation
B) allowable charge
C) copayment
D) cost-share

E) A) and D)
F) All of the above

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How much does a not active-duty family member have to pay to join TRICARE Prime for an individual?


A) $578.16
B) $1,000
C) $0
D) $289.08

E) All of the above
F) A) and D)

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Identify the best practice for filing paper TRICARE claims.


A) Check the NUCC instructions.
B) Check with the QIC.
C) None of these are correct.
D) Check with each payer for specific information required on the form.

E) A) and B)
F) None of the above

Correct Answer

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Which of the following services are covered under TRICARE Prime?


A) all of these
B) maternity care
C) outpatient care
D) surgery

E) None of the above
F) A) and C)

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What is the TRICARE program annual catastrophic cap for active-duty families?


A) $5,000
B) $1,000
C) $3,000
D) $500

E) All of the above
F) A) and B)

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TRICARE programs are subject to an annual __________, a limit on the total medical expenses that beneficiaries are required to pay in one year.


A) catastrophic cap
B) allowable charge
C) beneficiary limit
D) expense quota

E) All of the above
F) A) and D)

Correct Answer

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Which of the following may act as a PCM under TRICARE Prime?


A) group of providers only
B) military provider only
C) civilian provider only
D) military, civilian, or group provider

E) A) and B)
F) B) and C)

Correct Answer

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Who among the following providers may a CHAMPVA beneficiary use under the plan?


A) a provider who has signed a HIPAA agreement
B) a provider on the Medicare exclusion list
C) a provider who is not licensed to perform the service being delivered
D) a provider licensed to perform the service being delivered

E) All of the above
F) B) and C)

Correct Answer

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What makes up the TRICARE system?


A) all military hospitals only
B) all military hospitals, clinics, and treatment facilities
C) all military treatment facilities only
D) all military clinics and hospitals

E) A) and B)
F) A) and C)

Correct Answer

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A nonparticipating provider in TRICARE sees a patient and provides two services, one with an allowed charge of $120 and the other for $220. Calculate the maximum amount they may charge the patient.


A) $391
B) $253
C) $220
D) $340

E) A) and B)
F) B) and C)

Correct Answer

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Which of the following services is covered under TRICARE Prime?


A) unproven treatments
B) cosmetic surgery
C) experimental procedures
D) x-ray services

E) A) and C)
F) All of the above

Correct Answer

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The TRICARE program that offers benefits to Medicare-eligible military retirees and family members is


A) TRICARE Extra.
B) CHAMPUS.
C) TRICARE for Life.
D) TRICARE Standard.

E) A) and D)
F) A) and B)

Correct Answer

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What regulations cover the CHAMPVA, MHS, and TRICARE programs?


A) HIPAA
B) CHAMPUS
C) DEERS
D) TRICARE

E) B) and C)
F) All of the above

Correct Answer

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What is the purpose of TRICARE Prime annual catastrophic cap?


A) to eliminate government spending by making the patient responsible for 50% co-share
B) to limit the maximum reimbursement a provider will receive each year
C) to limit the maximum amount a sponsor will pay each year
D) to limit the maximum benefit a sponsor will receive each year

E) A) and D)
F) All of the above

Correct Answer

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