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Medical claims are processed by the national Tricare Dual Eligible Fiscal Intermediary Contractor. Pharmacy claims are processed by the Tricare Pharmacy Contractor (Express Scripts) and Overseas Tricare for Life claims are processed by the Tricare Overseas Program Contractor (as of September 2010 this will be International SOS using Wisconsin ...
Under TRICARE, seven managed care support contracts were awarded covering DoD's 12 health care regions. [7] TRICARE has been restructured several times, with contract regions having been redrawn , Base Realignment and Closure, and by adding "TRICARE For Life" benefits in 2001 for those who are Medicare-eligible. [8]
Defense Enrollment Eligibility Reporting System (DEERS) is a computerized database for United States Service members, military retirees, 100% VA Disabled Veterans, dependents, DoD active Contractors, and others worldwide who are entitled to Public Key Infrastructure and TRICARE eligibility.
Express Scripts was purchased by New York Life Insurance Company in 1989 and became a publicly traded company in 1992. [19] In 1993, Express Scripts signed on both FHP International and Maxicare Health Care and corporate clients Lockheed, Service Merchandise, and Ingersoll-Rand.
It also serves as proof of eligibility for medical care delivered either directly within the military health system or non-military providers via the TRICARE medical system. [1] The modern military identification card is a smart card commonly known as a Common Access Card (CAC) used by servicemembers and DoD civilians. It works with specialized ...
In 1996, TriWest Healthcare Alliance was established in order to compete for a U.S. Government contract to manage civilian health care benefits under the newly established TRICARE program within the 16-state TRICARE Central Region, also known as Regions 7 and 8. In 1996, TriWest was awarded the contract for the TRICARE Central Region and began ...
EDI Health Care Claim Status Request (276) is a transaction set that can be used by a provider, recipient of health care products or services or their authorized agent to request the status of a health care claim. EDI Health Care Claim Status Notification (277) is a transaction set that can be used by a healthcare payer or authorized agent to ...
Recent claim experience—whether better or worse than average—is a strong predictor of future costs in the near term. But the average health status of a particular small employer group tends to regress over time towards that of an average group. [91] The process used to price small group coverage changes when a state enacts small group ...