System of estimating costs of health care services by reviewing past trends in cost and use of the services. Also called trended .

1. Process of sorting a group of sick or injured patients according to their need for medical care. 2. Fee charged by health care facilities for emergency and other patients.
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A method of ranking sick or injured people according to the severity of their sickness or injury in order to ensure that medical and nursing staff facilities are used most efficiently.

Three-option managed health care program offered to spouses and dependents of service personnel with uniform benefits and fees implemented nationwide by the federal government. It also covers retirees, reservists on active duty after 30 days, widows, and widowers. Formerly known as Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) . 2. In the Medicare Secondary Payer guidelines, TRICARE is considered a group health plan.

Civilian health care organization selected by the U.S. federal government to serve as Managed Care Support Contractor (MCSC) for TRICARE in a specific region. This contractor supplements all military direct care for TRICARE beneficiaries in the region. The contractor also provides health services and support to TRICARE Prime members and organizes the preferred provider network (PPN).

Preferred provider organization type of TRICARE option in which the individual does not have to enroll or pay an annual fee. On a visit-by-visit basis, the individual may seek care from an authorized network provider and receive a discount on services and reduced cost-share (copayment).

Health care program that offers additional TRICARE benefits as a supplementary payer to Medicare for uniformed service retirees, their spouses, survivors age 65 or older, and certain former spouses. TFL became effective October 1, 2001. Also known as TRICARE Senior Prime .

Organization that administers the TRICARE program; formerly known as the Office of Civilian Health and Medical Programs of the Uniformed Services (OCHAMPUS) .

Voluntary health maintenance organization–type option for TRICARE beneficiaries. TRICARE Prime works like a civilian health maintenance organization (HMO) to control costs. Beneficiaries are assigned a primary care manager (PCM) at a military treatment facility (MTF). (In some areas, PCMs are civilian network providers.) The PCM handles all routine health care. If the beneficiary needs care that the PCM does not offer, he or she will give the beneficiary a referral. Then the managed care support contractor (MCSC) finds the most appropriate provider and location for additional care. With TRICARE Prime, beneficiaries have expanded health care benefits in addition to the core benefits and freedom to choose civilian providers (at a higher cost) when they use the point-of-service (POS) option.