| A | B |
|---|
| Secondary claim | Claim that the secondary insurer receives after the primary insurer pays its monetary obligation |
| Credible coverage | Basic benefits offered by the Medicare Part D Prescription Drug Plan. A Medicare beneficiary who does not choose to enroll in a Part D plan must acquire a "certificare of cedible coverage" to avoid a penalty if he or she decides to sign up after the open-enrollment period |
| Nonavailability statement | A document of certification from the military treatment facility (MTF) that says it cannot provide the specific healthcare that the beneficiary needs at that facility. The statement must be entered electronically in the U.S. Department of Defense (DoD) Defense Enrollment Eligibility Reporting System (DEERS) computer files by the MTF. |
| DEERS | Computerized data bank that lists all active and retired military service members. The data bank is checked before processing claims to ensure that patients are eligible for TRICARE benefits |
| TRICARE | Regionally-based managed healthcare program for active duty personnel and eligible family members, retirees and family members younger than age 65, and survivors of all uniformed services |
| TRICARE Extra | Preferred provider option through which, rather than an annual fee, a yearly deductible is charge. Healthcare is delivered through a nerwork of civilian healthcare providers who accept payments from TRICARE ad provide services at negotiated, discounted rates. |
| Claims processor | Facility that handles TRICARE claims for healthcare received with a particular state or region. |
| Longshore and Harbor Worker's Compensation Act | Act that provides worker's compensation to specified employees of private maritime employers |
| Ombudsman | Individual who is responsible for investigating and resolving worker's complaints against the employer or insurance company that is denying benefits |
| EOB | Document prepared by the carrier that gives details of how the claim was adjudicated. It typically includes a comprehensive listing of patient information, dates of service,payments, or reasons for nonpayment. |
| Insurance claims register | Columnar sheet used to record claims information. This is used as an alternative to a suspension file |
| Benefit cap | Maximum benefit amount paid for any one incident or any one year |
| Remittance advice | Paper or electronic form sent to Medicare to the service provider that explains how payment was determined for a claim (or claims). Formerly called explanation of benefits (EOB) |
| No-fault insurance | In worker's compensation insurance, benefits are paid to the injured (or ill) worker regardless of who is to blame for the accident or injury |
| Casual employee | Employee who is not entitled to paid holiday or sick leave, has no expectations of ongoing employment. |
| Sponsor | The service member, whether in active duty, retired or deceased |
| Catastrophic cap | Annual upper limit a family will hve to pay TRICARE Standard-covered services in any fiscal year |
| Vocational rehabilitation | The goal is to return the injured worker to some sort of suitabel, gainful employment that he or she can reasonable achieve |
| Federal Employment Compensation Act | Provides worker's compensation for nonmilitary federal employees |
| Certificate of credible coverage | Serves as evidence of prior healthcare coverage under TRICARE |
| Suspension files | A series of files set up chronologically and labeled according to the number of days since the claim was submitted |
| Occupational therapy | A treatment focuses on helping individuals achieve independence in all areas of their lives |
| Earned income | Income from employment |
| Employment network | Organization that has agreed to provide services undet the Ticket to Work program |
