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Humana Military uses network providers and non-network providers to deliver care to TRICARE beneficiaries in the South Region. Humana Military always refers beneficiaries to network providers first. Only when a network provider is unavailable will a beneficiary be referred to a non-network provider.
Network providers are “preferred providers.” They will get the most business from TRICARE beneficiaries. The following overview will help you better understand the differences between network and non-network providers and tell you how to go about becoming a network or “preferred” provider.
All Providers Must Be Authorized
All providers, regardless of whether they are network or non-network providers, must be authorized to provide care to TRICARE beneficiaries, meaning they must meet certain minimum eligibility requirements and participate in a verification process by PBGA, LLC,(PGBA) the company that pays TRICARE claims.
Network Providers
Network providers have a contractual agreement with Humana Military to provide care to TRICARE beneficiaries. In exchange for being a “preferred provider,” network providers agree to accept the negotiated rate as payment in full for services rendered, agree to adhere to appointment access standards and always file claims for TRICARE beneficiaries.
Non-Network Providers
Non-network providers have no contractual relationship with Humana Military to provide care to TRICARE beneficiaries but are certified to do so. There are two types of non-network providers: participating and nonparticipating.
Participating providers are those who have agreed to treat TRICARE beneficiaries on a case-by-case basis, have agreed to accept the TRICARE maximum allowable amount as payment in full and file claims for TRICARE beneficiaries.
Nonparticipating providers have no agreement to treat TRICARE beneficiaries although they are certified to do so. They may file claims for beneficiaries but are not required to file them. They are the last option for care for TRICARE beneficiaries.
To Become a Network Provider
If you wish to become a network provider, you may call PGBA at 1-800-403-3950 or visit www.humana-military.com and fill out an “online inquiry” located under “Becoming a TRICARE Provider” in the “Provider Resources” section.
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