When using TRICARE Standard and TRICARE Extra, you may receive care from any TRICARE-authorized provider without a referral. Some services will require prior authorization (discussed later in this section). The following section describes the different types of providers. Figure 2.1 provides a brief overview of TRICARE provider types.
Remember, you can use either a network or non-network provider at any time. For example, if an orthopedic surgeon and a physical therapist are treating you, one could be a network provider and the other could be a non-network provider.
Keep track of the type of providers you are seeing. Visits to a network provider (TRICARE Extra) will cost you less out of pocket, and the provider will file claims on your behalf. With a non-network provider (TRICARE Standard), you’ll pay more out of pocket and may have to file your own claims.
To find a TRICARE network or non-network provider, visit the provider locator online. Humana Military also has network provider directories on their Web site to locate providers. If you do not have Internet access, please call Humana Military for assistance with locating a provider.
TRICARE-authorized providers are those who meet TRICARE’s licensing and certification requirements and have been certified by TRICARE to provide care to TRICARE beneficiaries. These include doctors, hospitals, ancillary providers (such as laboratories and radiology centers) and pharmacies. If you see a provider who is not TRICARE-authorized or can never be certified, you are responsible for the full cost of care.
There are two types of TRICARE-authorized providers: Network and Non-network.
Network Providers
Non-network Providers
Have a signed agreement with Humana Military to provide care.
Agree to file claims and handle other paperwork for TRICARE beneficiaries.
You are using the TRICARE Extra option when you visit a network provider.
Do not have a signed agreement with your regional contractor.
There are two types of non-network providers: Participating and Nonparticipating.
Participating
Nonparticipating
Have agreed to file claims for TRICARE beneficiaries, to accept payment directly from TRICARE, and to accept the TRICARE allowable charge as payment in full for their services.
May participate on a claim-by-claim basis.
Have not agreed to accept the TRICARE allowable charge or file claims for TRICARE beneficiaries.
Have the legal right to charge beneficiaries up to 15% above the TRICARE allowable charge for services.
