Know your TRICARE Network providers

Knowing the difference between a TRICARE network provider and a non-network provider, a participating and a non-participating provider, and an authorized or certified provider is important for TRICARE beneficiaries.

Network Providers

To become part of TriWest’s network, a provider must sign a contract with TriWest, agreeing to serve TRICARE beneficiaries and to accept the negotiated rate or TRICARE (CHAMPUS) maximum allowable charge (TMAC) as payment in full for his or her services.

Non-network Providers

Non-network providers have not signed a contract with TriWest. However, they are certified and may be paid under TRICARE for health care services. There are two kinds of non-network providers:

• Participating — Participating providers participate in TRICARE and agree on a case-by-case basis to accept assignment. "Accepting assignment" means that they accept the TMAC as their full fee for care.
• Non-participating — A non-participating provider furnishes health care services or supplies to TRICARE beneficiaries but has not signed a contract and does not agree to accept assignment.

Authorized Providers

Any provider, whether a physician or other individual health care professional, hospital or other institution, must be authorized to provide health care services to TRICARE beneficiaries. To be authorized, a physician must meet TRICARE’s licensing and certification requirements and hold a valid license to practice medicine in the state where he or she practices.