Tricare Prime: Providers

Good Morning everyone!

Today we are going over Tricare Prime providers.

Tricare uses providers called Tricare Authorized providers.  These providers meet Tricare's licensing and certification requirements and have been certified by Tricare to provide care to Tricare's beneficiaries.

There are two types of Tricare Authorized providers.  Network and Non-Network.

Network providers have a signed agreement with Tricare and have agreed to handle claims for you.

Non-Network providers do NOT have a signed agreement with Tricare.  You would only see a Non-Network provider if your regional provider approved it, it is an emergency or if you are using the point-of service option(future post on this).

There are two types of Non-Network providers.  Participating and Non-Participating.

Participating providers are your best option if using Non-Network providers because they may choose to participate on a claims by claims basis, have agreed to file claims for you, accept payment from Tricare directly and accept the Tricare allowable charge* as payment.

With Non-Participating, be prepared to pay them first and later file a claim with Tricare yourself.  They have not agreed to accept Tricare allowable charge* and also have the legal right to charge you up to 15% above the Tricare allowable charge for service*.
                                                               *The amount Tricare allowed for a covered service or supply.

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