Become a Non-Network Provider
Non-network providers do not have signed agreements with Health Net Federal Services, LLC (HNFS) and are, therefore, considered “out of network.” Providers may choose to participate on a case-by-case basis.
In addition to meeting state regulatory board licensing and/or certification requirements, non-network providers must also meet TRICARE policy requirements.
Note: TRICARE Prime beneficiaries must have approval from HNFS to seek care from non-network providers.
There are two types of non-network providers: participating and nonparticipating.
- Participating providers may choose to participate on a by-claim basis. They agree to file claims for TRICARE beneficiaries, accept payment directly from TRICARE and accept the TRICARE allowable charge as in full for their services.
- Nonparticipating providers do not agree to accept the claim-TRICARE allowable charge or file claims for TRICARE beneficiaries. They have the legal right to charge beneficiaries up to 15 percent above the TRICARE allowable charge payment for services.
- Single case agreements (SCAs) are only used in very limited and unique circumstances and do not apply to applied behavior analysis (ABA) providers.
| Provider Type |
Certification Application |
|---|
| Doctors, dentists, therapists, counselors, and nurses |
Individual Certification Application |
Providers who have two or more individual providers working under a Tax ID Number
Note: If your group or location is already TRICARE-certified and you wish to add a
new doctor, select Individual Application (above).
|
Group Certification Application |
Ambulances, portable X-ray suppliers, durable medical equipment (DME), durable
equipment (DE) or assistive technology (AT) suppliers, clinical labs, and State Vaccine
Program entities |
Supplier Certification Applications |
| Hospitals, ambulatory surgical centers, freestanding kidney dialysis centers, skilled nursing facilities, birthing centers, hospice, and home health agencies |
Institutional Applications |
Radiation therapy, cardiac catheterization clinics, freestanding sleep disorder diagnostic
centers, independent physiological laboratories, freestanding MRI centers, comprehensive outpatient rehabilitation facilities, freestanding bone marrow transplant centers, diabetic self-management education program (ADA accredited); home infusion facilities, and pediatric home health agencies |
Corporate Service Provider Certification Application |
| Applied behavior analysis providers |
ABA Provider Certification Applications |
All non-network provider certification applications should be sent via mail or fax to:
TRICARE West – Provider Data Management
PO Box 202106
Florence, SC 29502-2106
Fax: 1-844-730-1373
Once all information is received, processing time can take up to 30 days.
