Medical Management Guide, 2009, Version 3.0 - Tricare

Medical Management Guide Version 3.0 Appendix C - DefinitionsPage 161Appendix C - DefinitionsAbsent SickAn Active Duty (Army, Navy, Air Force, and Marine Corps) member hospitalized in other than a U.S. MilitaryTreatment Facility and for whom administrative responsibility has been assigned to an MTF. Includes “absentsick moved to an MTF” and “total absent sick.”Resources:DoD Manual 6015.1-M, Glossary of Healthcare Terminology (January 1999):http://www.dtic.mil/whs/directives/corres/pdf/601501m.pdf.See CD-ROM Resource AppendixC-Def1AccreditationA formal process by which an agency or organization evaluates and recognizes an institution or program ofstudy as meeting certain predetermined criteria or standards.Resources:DoD Manual 6015.1-M, Glossary of Healthcare Terminology (January 1999):http://www.dtic.mil/whs/directives/corres/pdf/601501m.pdf.See CD-ROM Resource AppendixC-Def1AppealsAn administrative review of program determinations made under the provisions of law and regulation. Anappeal cannot challenge the propriety, equity, or legality of any provision of law or regulation.Resources:Code of Federal Regulations (CFR), Title 32 — National Defense, Section 199, Part 10 (199.10): Appeal andhearing procedures: http://www.tricare.mil/FR05/C10.PDF.Benchmark/BenchmarkingBenchmark: A TRICARE clerical and automated systems test using claims and other documents created orapproved by TMA and processed by the contractor. The contractor’s output is compared to predeterminedresults prepared or approved by TMA to determine the accuracy, completeness, and operational characteristics