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.
Tricare divides its network providers based on geographic regions, including the East and West regions in the United States, each managed by different healthcare contractors to facilitate healthcare services to its members.
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.
Non-participating, non-network providers have not agreed to accept Tricare’s negotiated rates and may charge up to 15% over the Tricare allowable charge. Beneficiaries might need to pay upfront and file for reimbursement, and these providers are not required to submit claims to Tricare on behalf of the beneficiary.
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 specific designated geographic areas, not six regions of the US. It operates through networks of community-based, non-profit healthcare providers.
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
Tricare for Life beneficiaries can receive care from any Medicare-participating or Medicare-non-participating provider. Medicare is the primary payer, and Tricare is the secondary payer to cover costs that Medicare does not. You can always find a Medicare provider near your locality from their official website.
6. Veterans Affairs Facilities
Veterans Affairs (VA) facilities do not typically function as part of the Tricare network. VA facilities primarily serve veterans, and Tricare beneficiaries usually receive care from Tricare-authorized providers except under certain conditions, such as emergencies. 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.
7. Dentists
Tricare offers dental services for active duty 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. Network providers will accept the contractual fee in full as payment for all covered healthcare services.
Tricare Overseas Program (TOP) has a network of providers outside the United States. Beneficiaries should seek care from TOP-authorized providers to minimize out-of-pocket expenses. Network arrangements vary by location and the specific TOP option.
They offer claimless and cashless services to people under TOP (Tricare Overseas Program) Prime and TOP Prime Remote.
Beneficiaries under the Tricare Overseas Program Select may need to file their claims when receiving care from non-network providers, as these providers are not obligated to file claims on behalf of Tricare beneficiaries.
The TRICARE contractors have created different provider networks, including mental health providers in each region. You can locate the nearby 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 services like therapy and psychological counseling. If you select a supplier outside the network, you may need to pay additional fees.
Conclusion
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.
FAQs
What is the telemental health service of Tricare?
Tricare covers telemental health services that utilize real-time audio and video technology. Beneficiaries can access these services through providers who are part of Tricare’s network and have been authorized by Tricare's regional contractors to deliver telemedicine services.
Does Tricare cover my care?
To be eligible for coverage by Tricare, healthcare services must be received from Tricare-authorized providers. These providers are required to be licensed in the state where they practice and meet Tricare’s certification and credentialing requirements to ensure they adhere to the standards set by the medical community.
See Also
What is Tricare Open Enrollment
Does Walgreens Deliver Prescriptions
Dental Grants for Low Income Adults
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