the process wherein healthcare providers agree to accept the amount paid by the carrier as payment in full (after the patient satisfies his/her cost sharing responsibilities as outlined in the insurance policy).
catastrophic cap (cat cap)
a maximum cost limit placed on covered medical bills under TRICARE. The monetary limit that a family of an active duty member would have to pay in any given year.
The facility that Handles TRICARE claims for healthcare recieved within a particular state or region.
the allowed services, supplies, and procedures for which Medicare & TRICARE (and most other insurers) would pay. Covered charges include medical and psychological services and supplies that are considered appropriate care and are generally accepted%2
nonavailability statement (NAS)
a document of certification from the military treatment facility (MTF) that says it cannot provide the specific health care that the beneficiary needs at that facility. The statements must be entered electronically in the Defense Department's DEERS computer files by the MTF.
primary care manager (PCM)
a healthcare provider or a team of healtcare providers that the enrollee ( under the TRICARE Prime plan) must see first for all routine medical care, similar to a primary care provider or gatekeeper in civilian managed care plans.
under TRICARE, a regional director is the individual responsible for supervision of all healthcare delivery activities within their region, including administration and management of the healthcare support contracts. They also provide support to military treatment facility commanders, while sustaining quality care and improving customer satisfaction across the healthcare delivery system.
when uniformed service members and their families who are located 50 miles or more from a military treatment facility
military service members in the Army and National Guard Reserves
under the TRICARE plan,a service member, whether active duty, retired or deceased