Any TRICARE-authorized providerAn authorized provider is any individual, institution/organization, or supplier that is licensed by a state, accredited by national organization, or meets other standards of the medical community, and is certified to provide benefits under TRICARE. There are two types of TRICARE-authorized providers: Network and Non-Network. DS who hasn't joined the network is a non-network provider. When you see a network provider, your provider will file claims for you and in most circumstances, you'll pay less.
Find a Non-Network Provider
Your regional contractor hosts a list of non-network providers in each region who have filed claims with TRICARE.
If a provider listing doesn't include a phone number, check your local telephone directory.
When You'll See a Non-Network Provider
You'll see non-network providers when using TRICARE Select, TRICARE Reserve Select, TRICARE Retired Reserve, TRICARE Young Adult-Select or if enrolled in TRICARE Prime Remote and there are no network providers available in your remote location.
If enrolled in TRICARE Prime, you may see a non-network provider only if:
- You decide to use the point-of-service option, or
- It's approved by your regional contractor because no other providers are available.
Participating vs. Non-Participating Providers
There are two types of non-network providers: participating and non-participating.
Participating Providers—Your Less Expensive Option
Participating providers accept the TRICARE allowable chargeThe maximum amount TRICARE pays for each procedure or service. This is tied by law to Medicare's allowable charges. as payment in full for their service and will accept the payment directly from TRICARE. What this means for you is:
- You only have to pay your cost share when you visit the doctor.
- The provider will collect the remaining amount directly from TRICARE.
- You will not have to file claims
Because participating providers are non-network and do not have an agreement with TRICARE, they may participate on a case-by-case basis
Non-Participating Providers—Your Most Expensive Option
Non-participating providers won't accept the TRICARE allowable charge as the payment in full and they won't normally file claims with TRICARE. What this means for you is:
- You'll probably be required to pay the full amount to the provider and file a claim with TRICARE for a reimbursement (minus your cost share).
- The provider has the legal right to charge up to 15% more than the TRICARE allowable charge. Any charges above the allowable charge are your responsibility and will not be reimbursed.
If you are interested in becoming a TRICARE provider, visit the Information for Providers page.
Last Updated 6/26/2019