HCR 230 Describing TRICARE Presentation

HCR 230 Describing TRICARE Presentation - TRICARE network...

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Click to edit Master subtitle style  5/10/11 Describing TRICARE By  Candace Smith HCR 230
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 5/10/11 What is TRICARE? TRICARE is the health care program serving  active duty service members, National Guard  and Reserve members, retirees, their families,  survivors and certain former spouses  worldwide.
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 5/10/11 Eligibility Requirements TRICARE serves approximately 9.6 million  beneficiaries worldwide. To be eligible for  TRICARE, you must be registered in the  Defense Enrollment Eligibility Reporting  System or DEERS.
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 5/10/11 Covered and Non-covered  Services TRICARE covers many services and  procedures including, but not limited to: Ambulatory surgery   Diagnostic testing  Durable medical equipment  Family planning  Hospice care  Inpatient care
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 5/10/11 Network and Non-network  Providers Network Providers Providers who are authorized to treat TRICARE  patients may also contract to become part of the 
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Unformatted text preview: TRICARE network. Non-Network Providers Providers who choose not to join the network, but TRICARE will not pay for the services. The patient is 100 percent responsible for the charges. Participating and Non-Providers who participate agree to accept the TRICARE allowable charge as payment in full for services. A provider who chooses not to participate may not charge more than 115 percent of the allowable charge. Reimbursement Providers who participate in the basic TRICARE plan are paid the amount specified in the Medicare Fee Schedule for most procedures. References Valerius, J., Bayes, N., Newby, C., & Seggern, J. (2008). Medical insurance: An integrated claims process approach (3rd ed.). Boston: McGraw-Hill....
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  • Spring '11
  • Volk
  • Master subtitle style, health care program, TRICARE allowable charge, Candace Smith HCR, Defense Enrollment Eligibility

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