TRICARE only reimburses appropriate covered services for eligible beneficiaries provided by TRICARE-authorized providers. TRICARE-authorized providers must meet TRICARE licensing and certification standards and must comply with regulations specific to their health care areas.
Certified providers are considered non-network TRICARE-authorized providers unless they choose to join the TRICARE network. Non-network providers may also choose to “accept assignment” (i.e., participate) on a case-by-case basis. If a non-network provider accepts assignment, he or she is considered a participating non-network provider and agrees to accept the TRICARE-allowable charge as payment in full for covered services and file claims for TRICARE beneficiaries. Nonparticipating non-network providers do not have to accept the TRICARE-allowable charge or file claims for beneficiaries.
Providers may see TRICARE patients and file claims with TRICARE to initiate the certification process. However, behavioral health care providers, non-Medicare-certified providers, skilled nursing facilities, and others must submit certification forms to PGBA, LLC (PGBA). To download forms, visit
PGBA's provider portal, and click on the “Forms” tab.
Additionally, freestanding partial hospitalization programs (PHPs), residential treatment centers (RTCs), and substance use disorder rehabilitation facilities (SUDRFs) must first be certified by KePRO the TRICARE Quality Monitoring Contractor. These providers should call KePRO at 1-877-841-6413 to speak with TRICARE certification representatives and request information. Once KePRO certifies the facility, the provider must complete the ValueOptions, Inc. (ValueOptions), contracting process. Call ValueOptions at 1-800-700-8646 for more information.
Note: Separate TRICARE certification of hospital-based PHPs is not required. When a hospital is a TRICARE-authorized provider, the hospital’s PHP is also considered a TRICARE-authorized provider. However, freestanding PHPs must be certified and enter into a participation agreement with TRICARE and obtain the required authorization prior to admitting patients. Freestanding PHPs that are interested in becoming TRICARE-authorized must contact KePRO.
To join the TRICARE network, a TRICARE-authorized provider must complete the credentialing process and sign a contract with Humana Military. The credentialing process requires primary-source verification of the provider’s education, board certification, license, professional background, malpractice history, and other pertinent data. The provider must wait to receive final notification of contract execution from the local TRICARE representative before providing care to TRICARE beneficiaries as a network provider. Humana Military monitors each network provider’s quality of care and adherence to DoD, TRICARE, and Humana Military policies. Network providers must be recredentialed every three years.
Note: Behavioral health care providers—including freestanding PHPs, RTCs, and SUDRFs—must also be credentialed by ValueOptions. For more information or to apply to join the TRICARE network, call ValueOptions at 1-800-700-8646 or send an e-mail to
provhelptricare@jax.valueoptions.com.
For more information about TRICARE certification and credentialing, visit “
Join the Network.”
