Study

Review

  •   0%
  •  0     0     0

      Back   Restart
  • What is the Current Clean Claims processing time?
    60-90 days from submission date
  • How long is the EOC period for an ADSM?
    6 months
  • What is the secured provider portal for civilian providers?
    Availity
  • Caller states they recieved a bill for an MRI and they never had an MRI. what do you do?
    Suggest FWA
  • When you look in the RADS tool or benefits, if something is Limited, does it need an auth/referral?
    Yes. It MAY be covered with an auth/referral if it shows as limited.s
  • How many days does it take before a reservist becomes activated?
    30 or more
  • a flat healthcare rate
    copayment
  • On a prime plan, can an OBGYN create a new referral instead of the PCM if they need to?
    Only if it is for the same condition and within the EOC timeframe
  • How much would ambulatory surgery cost for a Tricare Prime Group A bene?
    network: 77 oon: POS
  • What is the processing timeframe for an Urgent Referral Request?
    1 buis day
  • What is a warm transfer?
    When you transfer someone, but you go with them to introduce them to the new agent before dropping off.
  • How long is the processing time currently for an ATD ?
    10 buisness days
  • t or f: TRR has prime like benefits where you have to have direct care.
    f. it is like select
  • a cost that has to be hit before Triwest will pick up cost shares
    the deductible
  • Which Tricare Prime plan is only in 7 select regions?
    USFHP
  • All T Plans have premiums and enrollment fees
    True
  • How long is the EOC period for a retiree?
    365 days
  • the most a member will pay annually for healthcare costs
    Catastrophic cap
  • Which system do we COMPLETE a PCM change in?
    Opsconnect but I will also accept DOES
  • t or f: A topic must be created for every call
    true
  • Who determins eligibility?
    BOS
  • Is an Optometrist covered under Medical Care?
    No. It is vision only
  • What tool assists to determine if an Auth or Referral is neccessary?
    RADS
  • Which plan provider temporary coverage for 180 days to help cover an illness or injury as someone leaves the service?
    TAMP
  • a percentage of a health cost
    cost share
  • What is the processing timeframe for a Routine Referral Request?
    1-2 business days of receiving the request from the provider,
  • Who do TPR ADSMs contact if thier reconsideration request for services was denied?
    DHA-GL
  • If I am attempting to get permission for a medical service or device, what is that called?
    Authorization
  • How long does a provider have to submit a claim?
    90 days
  • I am a TRR member and I need a prescription filled before I travel, what do you do?
    Fill the prescription at the nearest Military Pharmacy or find the closest Network Pharmacy.
  • To what date will Triwest accept HNFS issued referrals and auths?
    expiration date or June 30th whichever comes first
  • Which plan provides temp coverage as someone is separating from their plan (is allot like COBRA)
    CHCBP
  • when Exactly is open enrollment?
    second monday in November to the second monday in december
  • Who is our prescription vendor?
    Express scripts
  • TRR, TFL, TYA are the T-Plans
    False, TRR, TRS, TYA
  • What is a DBN?
    the 11 digit number on the back of ID cards
  • which tool is used for locating civilian providers?
    Provider Directory
  • Is an ophthalmologist covered under Medical Care
    Yes - specialty care.
  • For active to retired, what is the QLE timeframe?
    365 days from the day of the retirement posted in Does
  • What does the green highlight mean in CareRadius?
    It means that is a mandatory field to fill.
  • What is the Clean Claim processing timeframe?
    30 days
  • What is the typical QLE timeframe?
    90 days
  • What is the HEAT model?
    Hear them out, Empathize, Apologize, Take Ownership
  • What is a cold transfer?
    When you transfer someone to another line without introducing them first
  • Which tool do you view your sched in?
    Verint
  • Who reports Eligibility?
    DEERS
  • How long is the EOC period for an ADFM?
    365 days
  • Arkansas, Louisiana, Oklahoma, Texas and Wisconsin are all the states that moved in the transition
    False. Missing Illinois
  • Is asthma considered as a qualifying condition for a disease management program?
    Yes
  • What is a referral?
    When PCM/provider places a request to send a member to a specialist
  • If an authorized letter for a claim is not in the system, what do we do?
    Route to Clinical Operations through the Outlook Mailbox @clinicaloperations
  • T or f: If I am a non-network, participating provider I don't file your claims.
    False
  • What is the dual eligibility Tricare and Medicare wrap around coverage?
    TFL
  • What is the deductible for an E4, Group B, Tricare Select Bene?
    $64 individ and 128 per family
  • When a prime member requests a civilian provider, that request has to go through this.
    ROFR: Right of First Refusal
  • What system is the system you will take calls with?
    Amazon Connect
  • How long does a claim have to Reprocess?
    45 days
    • Your experience on this site will be improved by allowing cookies.