- 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
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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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]. |