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Tricare Provider Enrollment

There are some changes to the Tricare program effective January 1, 2018 that affect the provider enrollment process.  The new “East Region” merges the current north and south regions to make a new singular region.  The U.S. Department of Defense announced that the East region will be managed by Humana Government Business (Humana Military) and the West will be managed by Health Net Federal Services (HNFS).

Civilian providers for Tricare patients have two options for reimbursement for treating members.  Becoming a certified provider allows providers to bill and receive Medicare level reimbursement for services.  Certified only providers are “out-of-network”.  The second option is to go through credentialing and contracting with either HFNS or Humana Military, depending on the providers location, and obtain an in-network participation contract.

Tricare beneficiaries may be referred to civilian providers after the local military hospital or clinic has determined whether or not they can provide services.  Tricare has what is know as “Tricare’s right of first refusal (ROFR)” when it comes to deciding where members are treated.  In addition to the medial networks, MHN Government services provides behavioral health network services to Tricare beneficiaries.

nCred works with providers nationally to assist with the provider enrollment process.  Give us a call today if you need any assistance with the credentialing processes for your healthcare organization.