Average: 3.5 (4 votes)

How to Become a TRICARE-Authorized Provider

man and woman looking at paper

Source: Navy photo by Mass Communication Specialist Seaman Apprentice Patrick Dionne

TRICARE is the Defense Department’s health care program for active-duty service members, National Guard and reserve members, retirees, their families and survivors.

If you are a civilian health care provider, you may want to consider becoming a TRICARE-authorized provider. When you become a TRICARE-authorized provider you can help ensure service members and their families get the medical care they deserve. By becoming a TRICARE-authorized provider, you can satisfy this need and increase your patient base.

TRICARE Provider Advantages

Becoming a TRICARE-authorized provider can be beneficial for civilian health care providers for the following reasons:

  • Grow your patient base by gaining access to a network with 9.5 million beneficiaries
  • Process claims quickly and easily
    • Nearly 100 percent of correctly filed claims are paid within 30 days and all are paid within 60 days
    • Ability to process claims electronically
  • By law, the TRICARE allowable charge is tied to Medicare’s allowable charge

TRICARE Provider Types

Providers can choose to be network or non-network authorized providers, which changes how they are able to work with TRICARE patients.

Network Providers:

Network providers sign a contract agreement with the managed care support contractor for the region. These providers are placed on the worldwide referral list of TRICARE Network Providers for all TRICARE beneficiaries within their contractor’s region. Network providers:

  • Provide health care to TRICARE beneficiaries at the allowable rate
  • Accept copayment from the patient and bill TRICARE for the remaining amount of the allowable rate
  • File claims for beneficiaries and do not bill the patient directly

Non-Network Providers:

Non-network providers are authorized to see patients in the TRICARE Network. They do not sign a contract and are not listed on the TRICARE worldwide referral list. They choose to participate on a case-by-case basis. There are two types of non-network providers:

  • Participating Providers
    • Accept the TRICARE allowable charge as payment in full for a service, even if the provider charges more for the service with patients who are not TRICARE beneficiaries
    • File claims for beneficiaries and do not bill the patient directly
  • Non-Participating Providers
    • Do not agree to accept the TRICARE allowable charge as payment in full for a service
    • The patient pays the provider the full fee for a service, even if the fee is greater than the TRICARE allowable charge
    • The patient files the claim with TRICARE to get reimbursed for the service up to the allowable charge amount

Becoming a TRICARE Provider

The role of a TRICARE provider is open to any medical doctor or doctor of osteopathic medicine who is state licensed, accredited by a national organization and meets other standards of the medical community. Other health care service professionals may be TRICARE-authorized as well, including licensed clinical psychologists, licensed clinical social workers, certified nurse practitioners, physical therapists, occupational therapists, speech therapists and optometrists.

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 the level of participation the provider chooses. The specific process for becoming a TRICARE-authorized provider depends on the location you are in.

To become a TRICARE-authorized provider, contact the TRICARE regional contractor nearest you:

For more detailed information, please visit the TRICARE Provider Resources page.

Additional Resources

PDF formatted documents require Adobe's free Acrobat Reader software. If you do not already have this software installed on your computer, please download it from Adobe's Website.