Network Provider
Quick Definition
Healthcare provider contracted with TRICARE.
Video Explanation
Full Definition
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.
Related Questions
What is the difference between TRICARE Prime and TRICARE Select?
TRICARE Prime is a managed care option with a primary care manager and lower costs. TRICARE Select offers more flexibility to choose providers with higher out-of-pocket expenses.
How do I find a TRICARE provider?
Use the online provider directory on your regional contractor's website or call them directly for assistance.
Does TRICARE cover mental health services?
Yes, TRICARE covers mental health services including therapy, counseling, and psychiatric care with the same cost-shares as medical services.
What preventive care services does TRICARE cover?
TRICARE covers comprehensive preventive care at no cost including annual checkups, vaccines, cancer screenings, and wellness visits.
What preventive care does TRICARE cover?
TRICARE covers annual physicals, immunizations, cancer screenings, well-child visits, and other preventive services at no cost with network providers.
What is the difference between network and non-network providers?
Network providers accept TRICARE rates and file claims for you. Non-network providers may charge more, and you may need to file claims yourself.
How does TRICARE cover urgent care visits?
TRICARE covers urgent care for non-emergency situations needing same-day care. Network urgent care centers are preferred with lower copays.
Related Terms
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