Types of TRICARE Providers

Uploaded by tricarehealth on 18.11.2011

Welcome to TRICARE TV.
Bringing you the information you need to get the health care you deserve.
I’m Annemarie.
Today we’ll explain what a TRICARE authorized provider is
and what civilian provider types are best to choose
for the health plan you’re using.
So what is a TRICARE authorized provider?
Any civilian doctor, team of doctors, nurse-practitioner, physician assistant, hospital, clinic, laboratory, ambulance company or
supplier of medical equipment that has been approved by TRICARE to deliver medical services or supplies to you.
Remember, TRICARE can only pay for care received from an authorized TRICARE provider.
Now, let’s discuss the four types of TRICARE providers.
Under the category of TRICARE authorized provider we have two types of providers: network and non-network.
Under non-network, you have: participating and non-participating.
TRICARE network providers have signed a contract to accept the TRICARE allowable
charge as payment in full and will file claims for TRICARE beneficiaries.
TRICARE non-network providers have not signed a contract.
Non-network participating providers will accept the TRICARE allowable charge in full,
may or may not file the claim for the beneficiary
and participate on a case-by-case basis.
Non-network, non-participating providers do not accept the TRICARE allowable charge
as payment in full, may or may not file the claim for the beneficiary
and may practice balanced billing,
that is bill you for charges that exceed the TRICARE allowable charges.
So what’s the best option for you?
Getting care from a TRICARE network provider.
Beneficiaries using TRICARE Standard, TRICARE Reserve Select or TRICARE Retired Reserve will pay less for care received from network providers.
However, those beneficiaries and beneficiaries using TRICARE prime remote because
there is no network provider in their area, can use any non-network provider, understanding that they may pay more for care.
TRICARE Prime beneficiaries must receive care through their primary care manager or PCM.
If their PCM cannot provide the type of care the beneficiary needs,
they may be referred to a specialist in the TRICARE network.
TRICARE Prime beneficiaries who wish to see a non-network provider
may see one under the TRICARE point of service option,
understanding that it may be their most expensive option.
Other considerations: TRICARE for Life beneficiaries may visit any participating or non-participating Medicare provider.
US Family Health Plan beneficiaries have designated providers and will not receive care from MTFs or TRICARE authorized providers.
When it comes to locating a provider that accepts TRICARE,
your best resource is your regional contractor.
Get links to their provider locators, phone numbers and
helpful resources by visiting: www.tricare.mil/findaprovider and www.tricare.mil/contactus.
That’s it for this episode of TRICARE TV.
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