TRICARE Provider Types
TRICARE defines a provider as a person, business, or institution that provides health care. Understanding the different TRICARE provder types will help you decide what type of TRICARE provider you want to be. At a minimum, all TRICARE providers must be authorized/certified under TRICARE Regulation and must have their authorized/certification status verified by the managed care support contractors (MCSCs) in each region.
There are two types of TRICARE-authorized providers: Network and Non-Network Providers
If you decide to become a network provider, you will sign a contractual agreement with the MCSC in your region. You will:
- Agree to provide care to TRICARE beneficiaries at a negotiated rate.
- Accept the beneficiaries' copayment or cost share as payment in full.
- File claims with TRICARE for the remaining amount.
If you don't want to sign a contract, you can be a non-network provider, but you must be certified by the MCSC. As a non-network provider you can decide to be a "partcipating provider" or a "non-participating provider."
- Participating providers agree to file claims for beneficiaries, to accept payment directly from TRICARE and to accept the TRICARE allowable charge as payment in full for their services.
- Non-participating providers do not agree to accept the TRICARE allowable charge or file beneficiary claims.
Non-network providers can choose to participate on a claim-by-claim basis. You don't have to be participating or non-participating all of the time.