How to Become a TRICARE-Accepting Provider

More civilian providers are accepting new TRICARE Standard patients. Findings from the Department of Defense (DoD) Survey of Physician Acceptance of TRICARE Standard show that in Fiscal Year 2007, 84 percent of physicians in 53 hospital service areas (HSA) were accepting new TRICARE Standard patients.

TRICARE is the DoD health care program for uniformed service members and their families. TRICARE patients, including active duty service members, their families and National Guard and Reserve members and retirees, live farther from military installations and often rely on civilian physicians for their health care. Because the DoD is concerned that it might be more difficult for these patients to find TRICARE-accepting providers, TRICARE leaders are reaching out to state officials, medical associations and individual physicians to educate these organizations and professionals about accepting TRICARE. Increasing the number and types of providers across the nation will remain a high priority, especially in remote areas. Today, more than 222,000 health care providers accept TRICARE.

Advantages to Becoming a TRICARE Provider

With approximately 9.4 million beneficiaries, TRICARE offers a large pool of patients, and thus, a steady revenue stream.
TRICARE is an industry leader in claims payment timeliness.
- Ninety-nine percent of clean claims are processed within 30 days.
- Ninety percent of claims are processed within 15 days.
- Seventy percent of claims are filed electronically.
- The average turnaround time for electronic claims is five days.
By law, TRICARE pays amounts comparable to those mandated for Medicare.
- TRICARE has some flexibility to pay more for specific services in certain locations.
- If a provider participates in Medicare, a natural follow-on would be to participate in or become a network provider for TRICARE.
TRICARE offers flexibility — providers can join the network or accept assignment on a case-by-case basis.

Table 1: Three Options for Providers

Provider Type	Definition	Qualifications
Certified Providers	A “certified” (or authorized) provider is a doctor, hospital or medical supplier who has met all best standards of the medical community.	Verified as having met standards by a TRICARE regional contractor Properly licensed and credentialed by the state and accredited by a national organization Specifically placed on a list of providers as certified and authorized to provide benefits under TRICARE Is not a TRICARE network provider
Participating Providers	A “participating” provider is a certified provider who is said to “accept TRICARE,” “accept assignment” or “accept TRICARE on assignment.”	Agrees to accept the maximum TRICARE allowable charge as payment-in-full for services Files the claim for the patient Receives the payment check from TRICARE Chooses to “participate” or not on a case-by-case basis Is not a TRICARE network provider
Network Providers	A network provider is a TRICARE-certified provider who has agreed to serve TRICARE beneficiaries as part of a contractor-operated group of health care providers and facilities.	Signs a contract agreement with the managed care support contractor for the region Agrees to accept a negotiated rate as payment-in-full for medical care or services Agrees to file the claim for the beneficiary Provides services to TRICARE Prime and TRICARE Standard beneficiaries Receives a higher volume of patients Placed on the worldwide referral list of TRICARE Network Providers for all TRICARE beneficiaries within their contractor’s region

Source: [1]Become a Certified TRICARE Provider

How to Sign Up

TRICARE has three geographical regions in the United States, each with a TRICARE regional contractor that sets the terms and conditions for credentialing and certifying a provider for whatever level of participation the provider chooses.

To become a TRICARE-certified provider in the north region, please contact Health Net Federal Services [2]
To become a TRICARE-certified provider for the south region, please contact Humana Military Healthcare Services [3]
To become a TRICARE-certified provider for the west region, please contact TriWest Healthcare Alliance [4]

TRICARE Health Service Regions

West
1-888-TRIWEST
1-888-874-9378
TRIWEST Healthcare Aliance

North
1-877-TRICARE
1-877-874-2273
Health Net Federal Services

South
1-800-444-5445
Humana Military Healthcare Services

TRICARE Overseas
1-888-777-8343
WESTPAC
Europe
Latin America/Canada
Puerto Rico/Virgin Islands
www.tricare.osd.mil/overseas [5]

As the nation enters its eighth year of war, Admiral Mike Mullen, the military’s highest ranking officer, says he is concerned about the health of the armed forces, “We have asked our young men and women to deploy in ways they never could have imagined. Whether they are active duty, reserve, or guard, they have stood up to the challenge.” The care of our soldiers — at war and when they come home—deserves our full attention.

Additional Resources

Sources

¹More Civilian Providers Accepting TRICARE Standard; Officials Continue Work to Expand Network April 4, 2008.
²Become a Certified TRICARE Provider [11], last accessed 2/8/11
³Miles, Donna. “Mullen Encourages Troops to Seek Mental Health Care When Needed.” American Forces Press Service, February 5, 2009.

Thu, 2011-06-02