Humana-Military.com

Behavioral Health Care Providers      


TRICARE covers services delivered by qualified, TRICARE-authorized behavioral health care providers practicing within the scope of their license to diagnose or treat covered behavioral health disorders. TRICARE encourages beneficiaries to receive behavioral health care at Military Treatment Facilities (MTFs), but beneficiaries may be referred to network providers if MTF care is not available.

The TRICARE behavioral health care outpatient network consists of TRICARE-authorized psychiatrists and other physicians, psychologists, social workers, marriage and family therapists, certified psychiatric nurse specialists, licensed or certified Mental Health Counselors (MHCs), and pastoral counselors.

To join the TRICARE network, a TRICARE-authorized provider must complete the credentialing process and sign a contract with ValueOptions for behavioral health. The following lists credentialing criteria for specific behavioral health care providers. See the Important Provider Information section for general credentialing criteria.

Psychiatrists and addictionologists must:
  • Have an unrestricted license as an MD or DO in the state where services are provided or have received special state licensure if employed by a college or university.
  • Have one of the following: board certification in psychiatry, evidence of having completed a residency program in psychiatry or certification from the American Society of Addiction Medicine (ASAM).
  • Have a current Drug Enforcement Administration (DEA) certificate.
  • Submit an Education Council for Foreign Medical Graduates (ECFMG) Certificate if a graduate of a foreign medical school.
  • Be a participating Medicare provider.
Family practice and pediatric MDs and DOs must meet the following behavioral health criteria:
  • Must meet the licensure, DEA and ECFMG criteria listed above for psychiatrists and addictionologists.
  • Must have board certification in family practice or pediatrics with subcertification in developmental behavioral pediatrics or neurodevelopmental disabilities, or must provide evidence of completion of a residency program in family practice or pediatrics and a fellowship in developmental behavioral pediatrics, neurodevelopmental pediatrics or behavioral medicine.
Psychologists must:
  • Have an unrestricted license to practice as a clinical psychologist in the state where services are provided.
  • Have a doctoral degree in psychology (i.e., PhD, EdD or PsyD) from an accredited college or university.
  • Be a participating Medicare provider
Prescriptive privileges for psychologists (PhD): In select states within the United States, licensed clinical psychologists can obtain prescriptive privileges.

Nurse practitioners must:
  • Have an unrestricted license to practice as a nurse practitioner with psychiatric nursing as the specialty in the state where services are provided.
  • Must have a master’s degree from an accredited college or university in a program recognized by the American Nursing Association (ANA).
  • Be a participating Medicare provider.
Psychiatric nurses must:
  • Have an unrestricted license to practice at the highest level of independent practice in the state where services are provided.
  • Have a master’s degree in psychiatric nursing from an accredited college or university in a program recognized by the American Nursing Association (ANA).
  • Be certified by the American Nurses Credentialing Center (ANCC).
Social workers must:
  • Have an unrestricted license to practice at the highest level of independent practice in the state where services are provided.
  • Have a master’s degree in social work from a graduate school of social work accredited by the Council on Social Work Education.
  • Be a participating Medicare provider.
Marriage and family therapists must:
  • Have an unrestricted license to practice at the highest level of independent practice in the state where services are provided.
  • Have a master’s degree from an accredited educational institution in an appropriate behavioral science field or mental health discipline.
TRICARE-certified Mental Health Counselors (MHCs) and other clinicians must:
  • Have an unrestricted license to practice at the highest level of independent practice in the state where services are provided.
  • Possess a master’s or higher level degree from a mental health counseling program of education and training accredited for Mental Health Counseling or Clinical Mental Health Counseling by the Council for Accreditation of Counseling and Related Education Programs (CACREP) and have passed the National Counselor Examination (NCE) or possess a master’s or higher level degree from a mental health counseling program of education and training accredited for Mental Health Counseling or Clinical Mental Health Counseling by CACREP or from an educational institution accredited by a regional accrediting organization recognized by the Council for Higher Education Accreditation and have passed the National Clinical Mental Health Counseling Examination (NCMHCE).
MHCs and other clinicians must:
  • Have an unrestricted license to practice at the highest level of independent practice in the state where services are provided.
  • Have a master’s degree in mental health counseling or allied mental health field from a regionally accredited institution.
Note: Effective January 1, 2015, TRICARE will no longer recognize this category of provider.

Pastoral counselors must:
  • Have an unrestricted license to practice as a pastoral counselor in the state where services are provided. In states that do not offer licensure, a pastoral counselor must be (or must meet all the requirements to become) a fellow or diplomat member in the American Association of Pastoral Counselors (AAPC).
  • Have a master’s degree in mental health counseling or allied mental health field from a regionally accredited institution.
ValueOptions does not credential Applied Behavior Analysis (ABA) providers, but those providers must contact ValueOptions to participate in the DoD Enhanced Access to Autism Services Demonstration. Providers who provide only Extended Care Health Option (ECHO) services are only required to be TRICARE-certified and do not need to contact ValueOptions. For more information on ECHO and the DoD Enhanced Access to Autism Services Demonstration, refer to the TRICARE Program Options section.

The TRICARE behavioral health care inpatient network consists of hospitals, inpatient psychiatric units, Partial Hospitalization Programs (PHPs), Residential Treatment Centers (RTCs) and Substance Use Disorder Rehabilitation Facilities (SUDRFs).

ValueOptions also credentials the following types of facilities and health care delivery organizations:
  • General hospitals with psychiatric services
  • Acute freestanding psychiatric hospitals
  • RTCs
  • SUDRFs
  • PHPs

Back to Top

 
Created: May 15, 2013