TRICARE Program
Eligibility
Individuals are entitled to medical benefits under TRICARE:
Enrollment
Those entitled to medical benefits under TRICARE are automatically enrolled in the TRICARE Standard program. Identification Card All dependents 10 years or older are required to have a Uniformed Services ID card for TRICARE Standard. Preauthorization
If services are not available in a MTF, then the Health Care Finder (HCF) will assist with the referral or preauthorization process. An HCF is a health care professional (nurse), who helps obtain preauthorization for care. There's no preauth for TRICARE for Life (TFL) program. Benefits TRICARE Standard patients usually seek care from a military hospital near their home. The military physician may refer the patient to a civlian source if the service hospital that is managing the TRICARE Standard patient cannot provide a particular service or supplies. Beneficiary may seek care from a private physician's office/hospital if there is no service within the catchmen area. Authorized Providers of Health Care An authorized provider is a physician or other individual authorized provider of care of a hospital or supplier approved by TRICARE. Reimbursement is obtained if provider is "certified" by credentialing process. Appeals Before appealing a TRICARE claim, if the patient wishes the provider to appeal, then the patient must complete an Appointment of Appeal Representative form. |
Military Treatment Facility - a uniformed services hospital.
Catchment Area - a specific geographic region defined by ZIP and is based on an area of approximately 40 miles in radius surrounding each U.S. MTF. FISCAL YEAR
Begins Oct 1, ends Sept 30 Non-authorized providers TRICARE patients are responsible for the entire bill. Primary Care Manager PCM - physician who is responsible for coordinating & managing beneficiary's health care. |