Medical Insurance Procedures Flashcard | Flashcards-library.com

The Tricare plan that provides benefits under a fee-for-service or cost sharig type of option is known as:

The TRICARE plan that provides benefits under a preferred provider organization (PPO) type of option is known as:

The TRICARE plan that provides benefits under a health maintenance organization (HMO) type of plan is known as:

THe plan that provides benefits for vetrans with 100% service related disabilities and their families is known as:

An individual who qualifies for TRICARE is known as:

An individual who is in the uniformed services and brings TRICARE coverage to the family is called a:

To be eligible for TRICARE, all sponsors and family members must be enrolled in DEERS, which stands for:

The TRICARE fiscal year begins on:

The TRICARE fiscal year ends on:

If a TRICARE beneficiary receives services from a nonauthorized provider, the physician can bill:

Authorized TRICARE providers include all of the following:

Authorized nonphysician providers of TRICARE include all of the following:

Under TRICARE Standard, the category of beneficiaries that pays 25% cost share for outpatient services include all of the following:

Under TRICARE Standard, the catagory of beneficiaries that pays 20% cost share for outpatient services include:

The annual catastrophic cap for active duty famlies under TRICARE Standard is:

The annual catastrophic cap for retirees under TRICARE Standard is:

Services covered under TRICARE Standard include all of the following :

Noncovered services under TRICARE Standard include all of the following:

When a TRICARE beneficiary cannot receive services from a military treatment facality(MTF), the:

Under TRICARE, what does NAS stand for?

Under TRICARE what does MTF stand for

The TRICARE plan with the lowest out-of-pocket cost for beneficiaries is:

Uner TRICARE Prime, a PCM is a:

The enrollment for TRICARE Prime is:

The TRICARE plan that offers a point-of-services option for care received outside the network is:

The copay for visits to civilian providers under TRICARE Prime is based on:

Under the point-of-service option of TRICARE Prime, charges for visits to providers outside of the TRICARE Prime network are:

Access standards of care for TRICARE Prime enrollees include a drive time of within:

Under the access standards of care fro TRICARE Prime enrollees, appointment wait time for routine care should not exceed :

Under the access standards of care for TRICARE Prime enrollees, the wait time for urgent care should not exceed:

Under the access care standards of care for TRICARE Prime enrollees, appointment wait-time for wellness/preventive care should not exceed:

Under TRICARE Prime, the primary care manager provides all of the following services:

Active duty services members are not eligible to enroll in:

Prioty access to medical treatment facilities is given to beneficiaries of:

The cost share for beneficiaries in TRICARE Extra is:

Enrollment is not required for:

Specialty care referrals for TRICARE Prime Remote are handled by the:

TRICARE beneficiaries older than 65 are eligible for TRICARE for Life if they have:

Fro inpatient care at a civilian network facility, TRICARE Senior Prime members pay:

If a beneficiary has both TRICARE for Life & Medicare:

For inpatient care at a military facility, TRICARE Senior Prime members pay:

The CHAMPVA program is administered by the:

If the Vetrans Administration facility cannot provide necessary medical care, an authorization for services will specify all of the following:

The claims processor for all TRICARE for Life claims is:

Paper calims for CHAMPVA are submitted to:

The TRICARE claims payer for the northern region of the united states is:

TRICARE claims must be submitted no later than:

Form locator 1a, insured's ID number, should include the:

The Palmetto Government Benefits Administrator provides information to parents of minors about the following:

The Palmetto Government Benefits Administration does not provide information to parents of minors for:

The only state that allows private employers to choose wheather or not to provide workers compensation is:

OSHA stands for the:

Employers that are regulated by OSHA include:

If an employss feels that his work environment is unsafe, he may file a complaint to the:

The programs administered by the Office of Workers Compensation Programs include all of the following:

The act that covers maritime workers injured or killed on navigable waters of the United States is known as:

All states provide workers' compensation coverage for:

Employers can obtain Workers' compensation insurance policies through all of the following:

Examples of compensable injures include all of the following:

A health problem that results from exposure to a workplace health hazard such as fumes is called a(n):

A worker may not receive benefits for a generally covered injury if any of the following are true:

An employee who is injured on the job, requires treatment, but is not able to return to work within several days, will receive injury:

An employee who is injured on the job, requires treatment, is not able to return to work, and is not expected to be able to perform his regular job in the future, will receive injury:

An employee who is injured on the job, requires treatment, & is able to return to work after retraining, will receive injury:

The category of workers' compensation benefits that will pay for medical expenses only is called injury

The retraining of an employee so that he can return to work after a workers compensation injury is called

In all categories of workers' compensationclaims, the injured worker will receive compensation for:

The documentation that describes the degree of permanent damage done to the workers body as a whole as a result of a workers' compensation injury is called the:

The form that is used transmission of information about the employss's limitation in performing his job duties is called the:

The report that affirms that the worker is fit to return to work & resume his normal job responsibilities is called the:

An impartial doctor who helps resolve workers compensation disputes is called a:

A worker & insurance company that decide that a different designated doctor is desired must make an agreement within:

All communication with a designated doctor about a worker's injuries must be made directly with the:

Maximum medical improvement is the earlier of the point in time that an injured worker has improved as as likely or:

The permanent physical damage to a workers body from a work related injury or illness is known as:

Ombudsman can provide all of the following services :

An injured worker or insurance company must dispute an impairment rating within:

The four types of workers' compensation benefits include:

Medical benefits for an injured worker begin:

All of the following are types of income benefits

In order to receive temporary income benefits, an injured worker must have lost some or all income for more than:

If an injured worker has an impairment rating of 8%, the worker would receive impairment income benefits for:

Supplemental income benefits are paid for a maximum of:

An injured worker is entitles to lifetime income benefits for all of the following conditions:

The spouse of a worker killed on the job is eligible for death benefits:

Dependent children of a worker killed on the job are eligible fo receive deathe benefits until they:

If an individual has both an employer-sponsored disability plan and the government program:

An individual who becomes disabled not due to an injury at work is eligible for:

Social Security Disablity Insurance is paid for by:

To qualify for Social Security Disability Insurance, individuals must be unable to work because of a medical condition that is expected to last at least:

The prosoective approval of health care based solely on medical necessity is called:

Workers compensation claims must be submitted to the insurance carrier on or before the:

A workers' compensation insurance carrier must pay, reduce, deny, or determine to audit a claim no later than:

If a workers' compensation claim is denied, the provider can request a review by:

An employer who misrepresents the amount of payroll or classification of employees in order to reduce workers' compensation payments commits:

A worker who works full time at an unreported job but draws workers' compensation benefits commits:

A managed care provider who does not provide a sufficient level of treatment because of a capitation agreement is referred to as committing:

Fees for workers' compensation services that are not provided by managed care plan are based on: