Network Provider

Healthcare provider contracted with TRICARE.

A network provider is a healthcare provider (doctor, hospital, lab, etc.) who has a contract with TRICARE. These providers agree to TRICARE's reimbursement rates and rules, which typically results in lower costs and simplified billing for beneficiaries.

Benefits of using network providers: • Lower out-of-pocket costs (reduced cost-shares) • No balance billing above the allowable charge • Provider files all claims for you • Streamlined appointment scheduling • Guaranteed acceptance of TRICARE

Network vs. Non-Network: • Network: Contracted, lower costs, files claims, accepts allowable charge • Non-Network: Not contracted, higher costs, may require you to file claims, can charge up to 15% above allowable

Cost example (TRICARE Select) For a $200 allowable charge: • Network provider: 20% cost-share = $40 • Non-network provider: 25% cost-share ($50) + potential 15% balance billing ($30) = up to $80

Finding network providers: • Use your regional contractor's online directory • Call the contractor for assistance • Verify current network status before appointments • Check if accepting new TRICARE patients

Always confirm a provider's network status before scheduling, as participation can change. Using network providers maximizes your TRICARE benefits and minimizes out-of-pocket expenses.