TRICARE defines a provider as a person, business, or institution that provides health care. For example, doctors are individual providers, hospitals are institutional providers, and ambulance companies are corporate providers. Providers of any type shall be authorized under TRICARE regulations in order for TRICARE to cost-share claimed services, and Humana Military must certify providers to deliver health care to TRICARE beneficiaries in the South Region.
Note: Federal government employees—including active duty service members (ADSMs)—who are health care providers are generally not TRICARE-authorized to provide care to TRICARE beneficiaries in civilian facilities. TRICARE only reimburses TRICARE-authorized civilian providers.
Figure 2.3 provides an overview of TRICARE provider types.
Military Treatment Facilities
An MTF is a military hospital or clinic usually located on or near a military base. The civilian TRICARE provider network supplements MTF resources and may work closely with MTFs to ensure that patients get the care they need. To locate an MTF, visit
TRICARE's MTF Locator.
MTF Right of First Refusal
An MTF has the “right of first refusal” for TRICARE Prime referrals within their catchment area for inpatient admissions, specialty appointments, and procedures requiring written prior authorization, provided the MTF is able to deliver the service requested by the patient’s civilian provider. This means TRICARE Prime enrollees must first try to obtain care at MTFs. MTF staff members review referrals to determine if they can provide care within access standards. If the service is not available within access standards, the MTF refers the beneficiary to a TRICARE network provider.
Note: The right of first refusal does not apply to TRICARE Prime Remote (TPR) and TRICARE Prime Remote for Active Duty Family Members (TPRADFM).
Corporate Services Provider Class
The Corporate Services Provider Class consists of institutional-based or freestanding corporations and foundations that provide professional, ambulatory, or in-home care, as well as technical diagnostic procedures. Some of the provider types in this category include:
- Cardiac catheterization clinics
- Comprehensive outpatient rehabilitation facilities
- Diabetic outpatient self-management education programs (American Diabetes Association® accreditation required)
- Freestanding bone-marrow transplant centers
- Freestanding kidney dialysis centers
- Freestanding magnetic resonance imaging centers
- Freestanding sleep-disorder diagnostic centers
- Home health agencies (pediatric or maternity management required)
- Home infusion (Accreditation Commission for Health Care accreditation required)
- Independent physiological laboratories
- Radiation therapy programs
Network corporate services providers are certified during the credentialing process. Non-network corporate services providers must apply to become TRICARE-authorized. Qualified non-network providers can download the Application for TRICARE-Provider Status/Corporate Services Provider at
PGBA's web site.
Note: The claim form must identify the individual provider who actually renders care.
Corporate services providers who deliver home health care are exempt from prospective payment system billing rules. For more information about corporate services provider coverage and reimbursement, refer to the TRICARE Policy Manual, Chapter 11, Section 12.1 at the
TRICARE Manuals Online web site.
Department of Veterans Affairs Health Care Facilities
TRICARE transmits network provider information to the Department of Veterans Affairs (VA) and to the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA). On a case-by-case basis, the VA may contact a TRICARE network provider to request care for a VA patient or CHAMPVA beneficiary. If the provider accepts the request, he or she should inform Humana Military. For VA patients, the provider works with the referring VA Medical Center (VAMC) to coordinate health care services, medical documentation, and reimbursement. The VA patient must give the TRICARE provider VAMC referral information and reimbursement instructions at the time of service.
For more information or assistance, call Humana Military at 1-800-444-5445.
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