Contracting For A TRICARE Provider: A Guide for 2026 | TRICARE.com

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## Quick answer Contracting for a provider refers to the process where a healthcare professional or facility signs a formal agreement with a TRICARE regional contractor (Humana Military or TriWest) to join the TRICARE network. For providers, this means agreeing to TRICARE’s allowable charge as payment in full; for beneficiaries, it means lower out-of-pocket costs and simplified billing.

In detail

The TRICARE provider system is divided into three tiers: **Network**, **Non-Network (Participating)**, and **Non-Network (Non-Participating)**. When a provider "contracts," they are moving into the Network tier.

### The Two Regional Contractors As of 2026, the TRICARE network is managed by two primary entities: * **TRICARE East:** Managed by **Humana Military**. * **TRICARE West:** Managed by **TriWest Healthcare Alliance** (effective Jan 1, 2025).

Providers must apply to the specific contractor for their region to begin the credentialing and contracting process.

### Types of Providers and Contracting Status 1. **Network Providers:** These providers have signed a formal contract with Humana Military or TriWest. They agree to: * Accept the TRICARE allowable charge as payment in full. * File claims for the patient. * Follow TRICARE’s clinical guidelines and referral requirements. 2. **Non-Network Participating Providers:** They do not have a permanent contract but agree to accept the TRICARE allowable charge on a case-by-case (claim-by-claim) basis. 3. **Non-Network Non-Participating Providers:** They have no agreement with TRICARE. They can charge up to 15% above the TRICARE allowable charge. The patient is responsible for this extra balance (balance billing).

### The Contracting Process for Providers Providers wishing to join the network must complete two distinct steps: * **Credentialing:** The contractor verifies the provider’s licenses, certifications, and malpractice history. This can take 30–90 days. * **Contracting:** The provider signs the "Network Participation Agreement." This document outlines the reimbursement rates (usually a percentage of the CHAMPUS Maximum Allowable Charge, or CMAC).

### Impact on Patient Costs (2026 Rates) Contracting status directly dictates how much a beneficiary pays. For example, under **TRICARE Select** (Group A, Active Duty Family Member): * **Network Primary Care Visit:** $26 copay (2026 rate). * **Non-Network Visit:** 20% of the allowable charge, plus any balance billing from non-participating providers.

## Who this applies to * **TRICARE Prime Enrollees:** Must use contracted network providers for all non-emergency care unless a Point-of-Service (POS) fee is paid. * **TRICARE Select Enrollees:** Have the freedom to see any provider, but pay significantly less when choosing a contracted network provider. * **Healthcare Providers:** Doctors, therapists, and hospitals who wish to attract military families must undergo the contracting process to be listed in the TRICARE Provider Directory. * **TRICARE For Life (TFL) Beneficiaries:** Usually rely on Medicare-contracted providers, but must ensure providers are not "opted out" of Medicare and are TRICARE-authorized.

Common scenarios

### Scenario 1: The New Network Specialist Sarah is a TRICARE Select beneficiary in the East Region. She needs a dermatologist. Dr. Smith just finished **contracting with Humana Military**. Because Dr. Smith is now a network provider, Sarah pays a flat **$38 copay** (2026 rate) for the specialist visit. If Dr. Smith were not contracted, Sarah might have to pay 20% of the bill plus an additional 15% above the allowable charge.

### Scenario 2: The West Region Transition A physical therapy clinic in San Diego previously worked with HNFS. Since **TriWest Healthcare Alliance** took over the West Region in 2025, the clinic had to ensure their contract was active with TriWest. Because they completed the contracting paperwork, a TRICARE Prime active-duty spouse can continue seeing them with a $0 copay and an active referral.

### Scenario 3: Behavioral Health Access A counselor wants to specialize in treating military families. They submit a "Joining the Network" application to TriWest. Once the contract is signed, they appear in the online Provider Directory, allowing Prime beneficiaries to be referred to them by their Primary Care Manager (PCM).

## Related terms * **CMAC (CHAMPUS Maximum Allowable Charge):** The maximum amount TRICARE will pay for a specific medical procedure. * **Credentialing:** The process of validating a provider's professional qualifications. * **Balance Billing:** When a non-contracted provider bills the patient for the difference between the TRICARE allowable charge and their actual fee (limited to 15%). * **Provider Directory:** The searchable online list of all contracted network providers, maintained by Humana Military or TriWest. * **Participation Agreement:** A legal document signed by a provider to follow TRICARE rules for a specific period or service.

## Sources * **TRICARE.mil (Official Site):** https://www.tricare.mil/Providers/BecomingaTRICAREProvider * **Humana Military (East):** https://www.humanamilitary.com/provider/ * **TriWest Healthcare Alliance (West):** https://www.triwest.com/en/provider/ * **Defense Health Agency (DHA):** https://health.mil/Military-Health-Topics/Business-Support/Rates-and-Reimbursement/Provider-Reimbursement-Rates