What is TRICARE program management organization?

Health Care Administration & Operations
Disability Evaluation
Health Care Program Evaluation
Information for Providers
Military Hospitals and Clinics
TRICARE Health Plan
TRICARE Pharmacy Operations
Quality, Patient Safety & Access Information (for Patients)
Quality & Safety of Health Care (for Health Care Professionals)
Uniform Business Office
Veterans Health Care Services
Warrior Care

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TRICARE Health Plan Functions
Customer Service
Who runs the TRICARE program?
What is the TRICARE program?
What is the system called that TRICARE claims processors?
What does the acronym TRICARE stand for?

The TRICARE Health Plan (THP) manages and oversees an integrated health care delivery system in the East and West U.S. TRICARE regions. The THP Director reports to and operates under the authority, direction, and control of the Director, Defense Health Agency (DHA). The THP Director has visibility of both the contract and Direct CareDirect care refers to military hospitals and clinics, also known as “military treatment facilities” and “MTFs.”direct care assets, and coordinates with the Services to develop an integrated health plan. THP includes:

TRICARE Policy and Benefits
TRICARE Dental Care
Performance Analysis, Transition and Integration
Medical Benefits and Reimbursement
Reserve and Service Member Support
TRICARE Overseas Area Offices

Objectives

Deliver more comprehensive primary care and integrated health services using advanced patient-centered medical home
Coordinate care over time and across treatment settings to improve outcomes in the management of chronic illness, particularly for patients with complex medical and social problems.
Match personnel, infrastructure and funding to current missions, future missions and population demand
Establish more inter-Service standards / metrics, and standardize processes to promote learning and continuous improvement.
Create enhanced value in military medical markets using an integrated approach specified in five-year business performance plans.
Align incentives with health and readiness outcomes to reward value creation

TRICARE Health Plan Functions

We deliver health care to 9.6 million TRICARE beneficiaries through an integrated network comprised of military hospitals and clinics and civilian providers, and ensure consistency of care in accordance with statute via policy and regulations, benefit determination, and benefit design.

Manage the TRICARE Contracts

Customer Service

Last Updated: October 12, 2022

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Term	Definition
beneficiary counseling and assistance coordinator (BCAC)	individual availaable at a military treatment facility (MTF) to answer questions, help sove healthcare-related problems, and assist beneficiaries in obtaining medical care through TRICAE, was previously called health benefits advisor (HBA).
beneficiary sErvices representative (BSR)	Employed at a TRICARE Service Center, provider informaton about using TRICARE and assists with other matters affecting access to health care (e.g., appointment scheduling).
catastrophic cap benefit	protects TRICARE beneficiaries from devastating financial loss due to serious illness orlong-term treatment by establishing limits over which payment is not required.
catchment area	the region defined by code boundaries within a 40-mile radius of a military treatment facility.
CHAMPUS Reform Initiative (CRI)	conducted in 1986; resulted in a new health program called TRIARE, which includes three option: TRICARE Prime, TRICARE Extra, MAC for reimbursement.
common access card (CAC)	identification card issued by the Department of Defense (DoD), which TRICARE enrollees show to receive healthcare services.
critical pathway	sequence of activities that can normally be expected to result in the most csot-effective clinial course of treatment.
debt colection assistance officer (DCAO)	indiviudals located at military treatment facilities to assist beneficiaries in resolvng healthcare collectoin-related issues.
Defense Enrollment Eligibility Reporting System (DEERS)	computer sywstem taht contains up-to-date Degense Department Workforce personnel information.
demonstration project	testa and establishes the feasibility of implementing a new porgram during a trial period, after which the program is evaluated, modified, and/or abandoned.
DSM (Diagnostic and Statistical Manual)	calssifies health disorders and isbased on ICD; published and is based on ICD; published by the American Psychiatric Association.
emergency care	care for the sudden and unexpected onset of a medical or mental health condition that is threatening to life, limbl, or sight.
fiscal year	for the federal government, October 1 of one year to September 30 of the next.
Health Affairs (HA)	refers to the Office of the Assistant Secretary of Defense for Health Affairs, which is responsible for both military readinaess and peacetime health caer.
healthcare finder (HCF)	registered nurse or physician assistant who assists primary care provdiers with preauthorizations and referrals to healthcare services in a military treatment facility or civilian provider network.
lead agent (LA)	servers as a federal healthcare team created to work with regional military treatment facility commanders, uniformed service headquarters' staffs, and Health Affairs(HA) to support the mission of the Military Health Servics System (MHSS).
Military Health Services System (MHSS)	entire health-care system of the U.S. uniformed servicesand includes military treatment facilities (MTFs) as well as various programs in teh civilian healthcae market, such as TRICARE.
military treatment facility (MTF)	healthcare facility operated by the military that provides inpatient and.or ambulatory (outpatient and emergency department) care to eligible TRICARE beneficiaries; capabilities of MTFs vary from limited acute care clinics to teaching and tertiary care me
nonavailability statement (NAS)	certificate issue dby a military treatment facility that cannot provide needed care to TRICARE Standard beneficiaries.
nurse advisor	available 24/7 fpr advoce amd assistance with treatment alternatives abdto discuss whether a TRICARE sponsor should see a provider based on a discussion of symptoms.
other health insurance (OHI)	insurance policy considered primary to TRICARE (e.g., civilian insurance plan, workers' compensation, liability insurance plan).
practice guidelines	decision-making tools used by providers to determine appropriate health care for specific clincial circumstances.
primary care manager (PCM)	provider (e.g., physician) who is assigned to a sponsor andpartof the TRICARE provider network.
Program Integrity (PI) Office	responsible for the worldwide surveillance of fraud and abuse activities involving purcheased care for beneficiaries in the Military Health Services System.
TRICARE	healthcare program for active duty memebers of the military and tehir qualified family memebers, CHAMPUS-eligible retirees and their qualified family members, and eligiblesujrvivors of members of the uniformed services.
TRICARE beneficiary	includes sponsors and dependents of sponsors.
TRICARE Extra	allows TRICARE Standard users to save 5 percent of their TRICARE Standard cost-shares by using healthcae providers in the TRICARE network.
TRICARE Management Activity (TMA)	formerly OCHAMPUS; the office that coordinatets and administers the TRICARE program and is accountable for quality health care provided to members of the uniformed services and their families.
TRICARE Prime	managed care option simialar to a civilian health maintenance organization (HMO).
TRICARE Program Management Organization	manages TRICARE programs and demonstration projects.
TRICARE Service Center (TSC)	business offices staffed by one or more beneficiary services representatives and healthcare finders who assist TRICARE sponsors with healthcare needs and answer questions about the program.
TRICARE sponsor	uniformed service personnel who are either active duty, retired, or deceased.
uniformed services	U.S. military branches that include the Army, Navy, Air Force, Marines, Coast Guard, Public Health Service, and the North Atlantic Treaty Organization (NATO).

Who runs the TRICARE program?

TRICARE is managed by the Defense Health Agency under leadership of the Assistant Secretary of Defense (Health Affairs).

What is the TRICARE program?

What is TRICARE? TRICARE is the uniformed services health care program for active duty service members (ADSMs), active duty family members (ADFMs), National Guard and Reserve members and their family members, retirees and retiree family members, survivors, and certain former spouses worldwide.

What is the system called that TRICARE claims processors?

Tricare and Champva.

What does the acronym TRICARE stand for?

What does TRICARE stand for?.

What is TRICARE program management organization?

Objectives

TRICARE Health Plan Functions

Customer Service

ch. 16

Who runs the TRICARE program?

What is the TRICARE program?

What is the system called that TRICARE claims processors?

What does the acronym TRICARE stand for?

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