Applying YouP KiUDWIC LO 11.2] Case 11.1 Fill in the blanks in the following payment situations: Participating Provider Physician's standard fee TRICARE fee TRICARE pays 80% Patient pays 20% Provider adjustment (write-off) S350.00 $265.00 s 212 s S3 249 Nonparticipating Provider (Acepts Asignment) Physician's standard fee TRICARE fee TRICARE pays 80% Patient pays 20% Provider adjustment (write-off) $285.00 S165.00 2 s35 s 120 Nonparticipating Provider (Does Not Accept Assignment) Physician's standard fee TRICARE fee Limiting charge Total provider can collect $130.00 95.00 TRICARE pays patient Patient out-of-pocket expense Provider adjustment (write-off) 240 Chapter 11 TRICARE AND CHAMPVA Applying YouP KiUDWIC LO 11.2] Case 11.1 Fill in the blanks in the following payment situations: Participating Provider Physician's standard fee TRICARE fee TRICARE pays 80% Patient pays 20% Provider adjustment (write-off) S350.00 $265.00 s 212 s S3 249 Nonparticipating Provider (Acepts Asignment) Physician's standard fee TRICARE fee TRICARE pays 80% Patient pays 20% Provider adjustment (write-off) $285.00 S165.00 2 s35 s 120 Nonparticipating Provider (Does Not Accept Assignment) Physician's standard fee TRICARE fee Limiting charge Total provider can collect $130.00 95.00 TRICARE pays patient Patient out-of-pocket expense Provider adjustment (write-off) 240 Chapter 11 TRICARE AND CHAMPVA