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Figure 2.2 TRICARE Provider Types     
         

TRICARE-authorized Providers

  • TRICARE-authorized providers are those who meet TRICARE’s licensing and certification requirements and have been certified by TRICARE to provide care to TRICARE beneficiaries. These include doctors, hospitals, ancillary providers (such as laboratories and radiology centers ) and pharmacies.
  • There are two types of TRICARE-authorized providers: Network and Non-network.
 
Network Providers1            		    
Non-network Providers2
  • Have a signed agreement with Humana Military to provide care.
  • Agree to file claims and handle other paperwork for TRICARE beneficiaries.  
  • Do not have a signed agreement with Humana Military.
  • There are two types of non-network providers: Participating and Nonparticipating.
Participating Nonparticipating
  • Have agreed to file claims for TRICARE beneficiaries, to accept payment directly from TRICARE, and to accept the TRICARE-allowable charge as payment in full for their services.
  • May choose to participate on a claim-by-claim basis.
  • Have not agreed to accept the TRICARE-allowable charge or file claims for TRICARE beneficiaries.
  • Have the legal right to charge beneficiaries up to 15 percent above the TRICARE-allowable charge for services.
1All network providers are required to have malpractice insurance.
2To become a network provider, visit “Becoming a TRICARE Network Provider” or contact Humana Military at 1-800-444-5445.
Last Reviewed: August 9, 2010