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Find a TRICARE Provider
When using TRICARE Standard and TRICARE Extra, you may receive care from any TRICARE-authorized provider without a referral. Some services 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.
TRICARE Provider Types
TRICARE defines a provider as a person, business, or institution that provides health care. For example, a doctor, hospital, or ambulance company is a provider. Providers must be authorized under TRICARE regulations and have their status certified by TRICARE regional contractors to provide services to TRICARE beneficiaries.
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 TRICARE network provider and the other could be a non-network provider. Keep track of the types 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 will 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. You can also locate a provider in your region by using the network provider directory. Figure 2.1 TRICARE Provider Types
TRICARE-authorized Providers
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TRICARE-authorized providers meet TRICARE licensing and certification requirements and are certified by TRICARE to provide care to TRICARE beneficiaries. TRICARE-authorized providers include doctors, hospitals, ancillary providers (laboratories and radiology centers), and pharmacies. If you see a provider who is not TRICARE-authorized, you are responsible for the full cost of care. There are two types of TRICARE-authorized providers: Network and Non-Network.
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TRICARE Network Providers |
Non-network Providers |
- Using a TRICARE network provider is your best option.
- You are using the TRICARE Extra option when you visit a network provider.
- Regional contractors have established networks, even in areas far from military treatment facilities.
- TRICARE network providers:
- Have a signed agreement with Humana Military to provide care
- Agree to handle claims for you
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- Non-network providers do not have a signed agreement with Humana Military and are, therefore, considered “out of network.”
- There are two types of non-network providers: Participating and Nonparticipating.
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| Participating |
Nonparticipating |
Using a participating provider is your best option if you are seeing a non-network provider.
Participating providers:
- May choose to participate on a claim-by-claim basis
- Have agreed to file claims for you, accept payment directly from TRICARE, and accept the TRICARE-allowable charge (less any applicable patient cost-shares paid by you) as payment in full for their services
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If you visit a nonparticipating provider, you may have to pay the provider first and later file a claim with TRICARE for reimbursement.
Nonparticipating providers:
- Have not agreed to accept the TRICARE-allowable charge or file your claims
- Have the legal right to charge you up to 15 percent above the TRICARE-allowable charge for services (You are responsible for paying this amount in addition to any applicable patient cost-shares.)
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Health Care Provider Types
There are many health care provider types with which to familiarize yourself:
- Specialty care providers: Specialty care includes providers such as obstetricians (childbirth doctors), orthopedic surgeons (bone doctors), and gastroenterologists (stomach and intestine doctors).
- Ancillary care providers: Ancillary care includes providers such as ambulances, laboratories, radiologists (doctors who look at X-rays), and home health care providers.
- Facilities: Facilities are medical centers or buildings that offer medical and surgical services. Examples of facilities are hospitals, birthing centers (facilities with nurse-midwives that offer a more natural childbirth experience), skilled nursing facilities (facilities such as rest homes where patients need 24-hour medical support), and ambulatory surgery centers (facilities where patients receive minor surgeries and are released to go home the same day).
- Behavioral health care providers: Behavioral health care includes a broad range of providers and treatment. Psychiatric nurse specialists, counselors, therapists, and social workers are good starting points for determining the level and type of behavioral health care you need. Refer to “Behavioral Health Care Services” in the Covered Services, Limitations, and Exclusions section for more information about behavioral health care provider types.
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