Regional Contractors
Each TRICARE region has its own regional contractor who is responsible for administering the TRICARE program in each region. The regional contractors establish the provider networks and conduct provider education.
If you're already a TRICARE-authorized provider or if you want to become one, call your regional contractor or visit their website, listed below.
TRICARE Provider Types
TRICARE defines a provider as a person, business, or institution that provides health care. Understanding the different TRICARE provider 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 authorization/certification status verified by the regional contractors in each region.
Network Providers
If you decide to become a network provider, you will sign a contractual agreement with the regional contractor 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.
Non-Network Providers
If you don't want to sign a contract, you can be a non-network provider, but you must be certified by the regional contractor. As a non-network provider you can decide to be a "participating 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.