Tricare Network Providers – Overview
Tricare can identify a business, person, or institution that delivers health care as a Tricare provider. You must understand the different types of Tricare providers to determine which type will suit you.
7 Different Types of Tricare Providers
1. Authorized Network Providers
A network provider is any Tricare-authorized healthcare provider who has agreed to terms of service with your local contractor. Typically, the Tricare network providers accept a negotiated rate as full payment and submit necessary claims on your behalf.
A network provider will never charge extra fees or require you to sign documents.
There are two types of Tricare authorized network providers: east network providers and west network providers.
You only need to pay your co-payment or cost-share with a network provider. Your provider can collect the remaining amount from Tricare.
2. Authorized non-network providers
Non-network providers are Tricare-approved providers without an official connection with your local Tricare contractor. They mostly require upfront payments and do not file your claims like authorized network providers.
There are two types of authorized non-network providers. Participating non-network providers can accept Tricare’s negotiated charges as payment in full for care. They can receive direct payments from Tricare and file certain claims on behalf of the beneficiary.
Authorized Non-participating, Non-network Providers do not file claims for the beneficiaries and do not receive payments from Tricare directly. The recipient may need to pay a non-participating provider directly before receiving care.
3. Military Hospital or Clinic
The Department of Defense generally manages Military clinics or Hospitals. You can receive different treatment facilities and healthcare services here.
They can file the claims on behalf of the beneficiaries. You do not have to pay additional fees for most of their services. Some people may also receive direct care if there is room.
4. US Family Health Plan
The US Family Health Plan is a TRICARE Prime option available in six regions of the US through networks of community-based and nonprofit healthcare systems.
Active duty family members, survivors, qualified former spouses, medal of Honor recipients, National Guard or Reserve members, qualified non-activated National Guard or Reserve members, retired service members, and their families can apply for this program.
5. Providers who accept Medicare
If you are a US resident, you can go to any Medicare provider, whether they participate in Tricare For Life or not. You can always find a Medicare provider near your locality from their official website.
6. Veterans Affairs Facilities
The majority of Veterans Affairs (VA) institutions work as network providers. However, you must verify with your local contractor before scheduling an appointment.
You do not require a referral or authorization to receive emergency treatment at a VA facility.
Tricare offers dental services for active duty service members and National Guard and Reserve members, including the Army Reserve, Army National Guard, Air National Guard, Navy Reserve, Marine Corps Reserve, Air Force Reserve, and U.S. Coast Guard Reserve.
They also offer a voluntary dental insurance program called FEDVIP dental program for retired service members and their families and survivors.
Choosing a network provider may reduce your out-of-pocket expenses. With a network provider, you do not have to file a claim; they may do the work for you. The contractual fee will be accepted in full by network providers as payment for all covered healthcare services.
Network providers also have a contract with the Tricare overseas contractor for people who live overseas.
They offer claimless and cashless services to people under TOP (Tricare Overseas Program) Prime and TOP Prime Remote.
However, these network providers do not file the claims for members who are under Tricare Overseas Program Select.
The TRICARE contractors have created different provider networks, including mental health providers in each region. You can locate the nearby Tricare mental health provider through the Tricare contractor’s network provider directory.
Different types of Tricare mental health providers are –
- East Region (Humana Military)
- West Region (Health Net Federal Services, LLC)
- Overseas Region (International SOS Government Services, Inc.)
- US Family Health Plan
There is no need for pre-authorization or a referral for substance use disorder or outpatient mental health care and treatments except psychoanalysis.
They can offer you services like therapy and psychological counseling. You may need to pay additional fees if you select a supplier that is not part of the network.
You can choose your Tricare provider depending on your requirements and eligibility. The Tricare Network provider offers multiple benefits for eligible members.
People who live overpass and meet the basic eligibility requirements can also apply for the Tricare network provider program.
What is the telemental health service of Tricare?
Your Tricare benefits also offer a telemental health service using live video and audio. You can select your service from a network of telemedicine providers supplied by your regional contractor.
Does Tricare cover my care?
You must seek treatment from a Tricare-authorized provider if you want health coverage from Tricare. These providers must have a state-issued license, approval from an international body, or meet the benchmarks of the medical community.