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.
What is the TRICARE Prime Demo program?
TRICARE Prime Demo is a pilot program launching in 2026 in Atlanta and Tampa. Managed by CareSource, it eliminates referral requirements and waives enrollment fees for participants.
Which states changed TRICARE regions in 2025?
In 2025, six states moved from the TRICARE East Region to the West Region: Arkansas, Illinois, Louisiana, Oklahoma, Texas, and Wisconsin.
Does TRICARE cover telehealth visits?
Yes, TRICARE covers telehealth and virtual care visits for a wide range of medical and mental health services with the same cost-shares as in-person visits.
Do I need a referral for mental health care with TRICARE?
TRICARE Prime requires a referral from your PCM for most mental health care. TRICARE Select allows direct access to network mental health providers without a referral.
Does TRICARE cover annual wellness visits?
Yes, TRICARE covers annual wellness exams and preventive care services at no cost for all beneficiaries when received from a network provider.
Do I need travel insurance if I have TRICARE?
TRICARE provides some coverage while traveling within the U.S. and limited coverage overseas. Supplemental travel insurance may be needed for medical evacuation and non-covered services abroad.
Does TRICARE cover weight loss programs?
TRICARE covers medically necessary weight loss treatments including bariatric surgery (with strict criteria), nutrition counseling, and obesity screening. Commercial weight loss programs are not covered.
Does TRICARE cover allergy testing and shots?
Yes, TRICARE covers allergy testing, allergy shots (immunotherapy), and allergy medications when medically necessary. Referrals may be required under TRICARE Prime.
How many physical therapy visits does TRICARE allow?
TRICARE does not impose a strict limit on physical therapy visits. However, continued treatment must be medically necessary, and authorization may be required for extended courses of care.
Does TRICARE cover dermatology and skin conditions?
Yes, TRICARE covers dermatology visits and treatment for medical skin conditions. Cosmetic procedures like elective mole removal and skin treatments for appearance only are not covered.
Does TRICARE cover genetic testing?
TRICARE covers genetic testing when medically necessary, including BRCA testing for cancer risk, prenatal genetic screening, and testing for hereditary conditions when ordered by a provider.
Does TRICARE cover home births?
TRICARE covers home births when attended by a TRICARE-authorized certified nurse-midwife (CNM). The pregnancy must be low-risk, and specific requirements must be met for coverage.
Does TRICARE cover ambulance and air evacuation?
Yes, TRICARE covers ground and air ambulance services when medically necessary. Coverage includes emergency transport, inter-facility transfers, and air evacuation for critical situations.
What substance abuse treatment does TRICARE cover?
TRICARE covers substance abuse treatment including inpatient rehabilitation, outpatient counseling, detoxification, and medication-assisted treatment (MAT) for alcohol and drug use disorders.
Does TRICARE cover therapy?
Yes, TRICARE covers mental health therapy including individual, group, and family counseling with licensed providers. Referrals may be required under TRICARE Prime.
Does TRICARE cover hearing aids?
Yes, TRICARE covers hearing aids and related services when prescribed by an authorized provider for diagnosed hearing loss.
Does TRICARE cover allergy testing?
Yes, TRICARE covers allergy testing and treatment including skin tests, blood tests, and allergy immunotherapy (allergy shots) when ordered by a TRICARE-authorized provider.
Does TRICARE cover genetic testing?
TRICARE covers genetic testing when medically necessary for diagnosing conditions, guiding treatment decisions, or screening for hereditary disorders with appropriate clinical indications.
Does TRICARE cover vasectomy?
Yes, TRICARE covers vasectomy as a covered surgical benefit. Standard copays and cost-shares apply based on plan type and provider network status.
Does TRICARE cover tubal ligation?
Yes, TRICARE covers tubal ligation (female sterilization) as a covered surgical and preventive care benefit with no cost-share for most beneficiaries.
Does TRICARE cover orthotics?
Yes, TRICARE covers custom orthotics and orthotic devices when prescribed by a TRICARE-authorized provider for a diagnosed medical condition.
Does TRICARE cover telehealth?
Yes, TRICARE covers telehealth services including virtual visits with providers for medical and mental health care. Costs are the same as in-person visits.
Does TRICARE cover second opinions?
Yes, TRICARE covers second opinions from another qualified provider. Under TRICARE Prime, a referral may be needed; TRICARE Select allows direct access to another provider.
Does TRICARE cover substance abuse treatment programs?
Yes, TRICARE covers substance abuse treatment including inpatient rehabilitation, outpatient counseling, detoxification, medication-assisted treatment, and intensive outpatient programs.
Does TRICARE cover birth control?
Yes, TRICARE covers all FDA-approved birth control methods including oral contraceptives, IUDs, implants, injections, and emergency contraception at no cost-share.
What is TRICARE Select?
TRICARE Select is a self-managed preferred provider plan similar to a PPO that offers more flexibility in choosing providers without referrals, but with higher out-of-pocket costs.
What is a referral in TRICARE?
A referral in TRICARE is an authorization from your primary care manager (PCM) that allows you to see a specialist. Referrals are required under TRICARE Prime but not TRICARE Select.
What is the TRICARE US Family Health Plan?
The US Family Health Plan is a TRICARE Prime option offered through select healthcare networks in specific geographic areas, providing comprehensive coverage through designated providers.
What is a network provider in TRICARE?
A network provider is a doctor, hospital, or other healthcare provider that has a contract with a TRICARE regional contractor to provide services at negotiated rates.
What is a non-network provider in TRICARE?
A non-network provider is a TRICARE-authorized provider who does not have a contract with the regional contractor, resulting in higher costs and the beneficiary potentially filing their own claims.
What is a point-of-service option in TRICARE?
The point-of-service option allows TRICARE Prime enrollees to see non-network providers without a referral, but with significantly higher out-of-pocket costs.
What is TRICARE Extra?
TRICARE Extra was a former preferred provider option that offered discounts for using network providers. It was replaced by TRICARE Select on January 1, 2018.
How to file a TRICARE claim?
Network providers file claims for you. For non-network providers, submit a claim form (DD Form 2642) with an itemized bill to your regional contractor within one year of service.
How to find a TRICARE provider?
Use your regional contractor's online provider directory (Humana Military or TriWest) to search by location, specialty, and network status, or call their customer service line.
How to get a referral in TRICARE?
Request a referral from your primary care manager (PCM) during an appointment or by contacting your PCM's office. The PCM evaluates your need and submits the referral electronically.
How to find a TRICARE dentist?
Search the United Concordia provider directory online or call their customer service to find a dentist participating in the TRICARE Dental Program in your area.
How to choose a PCM for TRICARE Prime?
Choose a PCM by reviewing available providers in your area through your regional contractor's directory, considering factors like location, specialty, office hours, and patient reviews.
How to get mental health care through TRICARE?
Access TRICARE mental health care by contacting your PCM for a referral (Prime), going directly to a network provider (Select), or calling the Military Crisis Line for emergencies.
How to use TRICARE at urgent care?
Visit any TRICARE-authorized urgent care facility for non-emergency conditions. No referral is needed. Standard outpatient copays apply based on your plan.
How to find a TRICARE-approved pharmacy?
Find TRICARE network pharmacies using the Express Scripts pharmacy locator tool online or through the Express Scripts mobile app, or call 1-877-363-1303.
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