TRICARE Provider Types:  Which One is Right for You?

        
When you use TRICARE Standard, you are free to receive care from any TRICARE-authorized provider. To help you understand the different types of providers that are available, here’s what you need to know.

Each TRICARE region—North, South and West—offers a civilian provider network. The network includes civilian doctors, hospitals and other health care providers who meet special TRICARE credentialing standards.

If you choose to obtain care from a network provider, you’ll be using the TRICARE Extra option and your cost-shares will be lower. Another benefit of using a network provider is convenience, as they are required to file claims for you.

A non-network provider does not have an established TRICARE network contractual relationship with Humana Military, but is authorized to provide care to TRICARE South beneficiaries.

There are two types of non-network providers: participating and nonparticipating. These providers may determine whether they are participating with TRICARE or not on a claim-by-claim basis.

Participating non-network providers agree to accept the TRICARE reimbursement rate as payment in full for a service (your cost-share is one portion of this payment), and they will submit claims to TRICARE for you. TRICARE pays participating providers; you are responsible for applicable cost-shares.

Nonparticipating non-network providers do not agree to accept TRICARE reimbursement rates as payment in full for services. They may or may not file your claims, and you’ll most likely be required to pay the provider and then file your own claim with TRICARE for reimbursement (see “Filing TRICARE Standard Claims”). Moreover, nonparticipating providers may charge you up to 15 percent above the TRICARE-allowable charge, in addition to your normal cost-share. This amount cannot be reimbursed when you file your claims, nor does it count toward your TRICARE deductible or catastrophic cap.

Non-authorized providers are not certified by TRICARE to render services to TRICARE beneficiaries. Note: If you receive care from a non-authorized provider, you will be responsible for the entire bill for the health care services you receive.
        

Before visiting a provider, it is important to verify his or her network status. Remember, by using a network provider, you can save 5 percent on your cost-shares under the TRICARE Extra option. To locate a provider in your area, consult TRICARE's online provider locator or visit Humana Military's Find a Provider directory.