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

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.

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 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 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 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.