Information for Providers
Being a TRICARE provider means that you're treating America's heroes—the people making sacrifices to keep America strong and safe. On behalf of the Department of Defense, the men and women of our Armed Forces and their families, as well as our retired families, we want to thank you for your desire to become a TRICARE provider. Becoming a TRICARE provider brings with it a higher volume of patients as network providers are placed on the worldwide referral list for all TRICARE beneficiaries.
What's New?
TRICARE Patient Transfer Pilot Began on July 25, 2016
We want to evaluate the collaboration between our military hospitals and clinics, the regional contractors and civilian emergency departments. The TRICARE Patient Transfer Pilot will help us see if we can successfully transfer clinically-stable TRICARE beneficiaries from civilian emergency departments to military facilities for inpatient care and treatment. >>Learn More
2016 Applied Behavior Analysis Maximum Allowable Amount Announced
On Dec. 1, 2015, TRICARE announced the 2016 rates for applied behavior analysis to take effect in Spring 2016.
Managed Care Support Contractors
Each TRICARE region has its own managed care support contractor (MCSC) who is responsible for administering the TRICARE program in each region. The MCSCs establish the provider networks and conduct provider education.
If you're already a 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. or if you want to become a TRICARE-authorized provider, call your MCSC or visit the website, listed below.
| Region |
Managed Care Support Contractor |
| North |
- Health Net Federal Services
- www.hnfs.com
- 1-877-TRICARE (1-877-874-2273)
|
| South |
|
| West |
|
| Overseas |
|
Claims Processors
PGBA
PGBA is the claims processor for the North, South and West regions. For assistance, please contact the Provider EDI & XPressClaim Help Desk:
Wisconsin Physicians Service
Wisconsin Physicans Serivce (WPS) is the claims processor for TRICARE For Life claims in the United States and U.S. Territories. For assistance please contact WPS Customer Service:
Overseas Claims
Claims for covered medical services delivered outside the United States and U.S. Territories (TFL claims are filed with WPS as noted above) are filed with the TRICARE Overseas Program claims processor. >>View Overseas Claims Submission Guidelines