Tricare providers, claims filing, and referrals and prior authorizations are available to military families around the world who have Tricare insurance. Tricare offers two types of authorized providers: Network and Non-Network providers. Though Tricare has network providers, you can choose an out-of-network provider. However, if you choose a network provider, it will accept payments from Tricare as the full payment and file claims for you. If you see an out-of-network provider, you will need to file claims in most cases.
There may come a time when you need specialty care that your general physician or primary care manager (PCM) does not provide. Depending on your Tricare plan, you may need to get a referral or prior authorization. If you need to see a specialty provider, your PCM will work with your regional contractor for both referral and prior authorizations as they are needed. If you would like to learn more about using Tricare insurance, you can continue to read the sections below or download our free guide.
How to Find TRICARE Providers
The Tricare provider portal on the Tricare website is the most convenient way to find providers. Through the portal, you can search for different types of providers, regardless of if they are network or non-network providers.
There are two types of Tricare-authorized providers: Network and Non-Network providers. Tricare network providers accept payments from Tricare as the full payment for any of the covered health care services that you get. However, it does not include out-of-pocket costs. They also file claims for you.
Though Tricare offers network providers, you are not required to see one. If you wish, you can see a non-network provider. According to Tricare, there are two types of non-network providers available, which are participating and nonparticipating providers. A participating provider accepts payment from Tricare as the full payment for the covered health care services that you obtain. They also file claims for you. A nonparticipating provider does neither.
To find a network or non-network provider, you must first determine which region applies to you, since regional contractors establish provider networks in each region. You can find providers in your region online through the Tricare website. You can also call the phone number for your region. When you are ready, you can make an appointment with a Tricare doctor through the Tricare website.
Find out everything you need to know about Tricare providers by downloading our free guide.
How to File a TRICARE Claim
If you have a Tricare insurance plan, your Tricare provider will file your medical claims on your behalf in most instances. However, there are situations in which you will need to file a claim, such as if you are traveling, receive a health care service from a non-participating provider, or you have a Tricare for Life plan and you see a Medicare, non-participating provider.
If you need to submit a Tricare claim and are in the U.S. or a U.S. territory, you must file the claim within one year from the date of service. If you are overseas, you must do so within three years from the date of service. To do so, you must obtain a copy of the request for medical payment form. Then, you must attach a readable copy of the provider’s bill to your signed payment form. Information that must be included includes the provider’s name and address, and the date, place, description, diagnosis, and amount charged for each service. Finally, you must sign the form and mail both documents to the claims address in the region in which you reside. Most Tricare claims are processed within 30 days.
Once your Tricare reimbursement form and paperwork are approved, you will be reimbursed for Tricare-covered services at the Tricare allowed amount. If your claim is denied and you believe it has been done so inappropriately, either in part or in whole, you or another party may file an appeal. To do so, you must visit the Tricare website and determine which issues apply to your case.
Learn About TRICARE Referrals and Prior Authorizations
A Tricare referral is when your provider or PCM sends you to a different provider for a health care service that he or she does not provide. Prior authorization means that you are getting the health care service approved by the regional contractor in your region before you show up for your appointment.
Getting a Tricare referral depends on who you are and your Tricare plan. If you need to see a specialty provider, your PCM will work with your regional contractor for both referral and prior authorizations as they are needed. To get a referral, your PCM will work with your regional contractor to find a referral in your region. The contractor will then refer you to a military hospital or clinic. If neither is available, you will then be referred to a network provider in your region. If you are enrolled in a Tricare Prime Plan, your PCM will work with your regional contractor to obtain prior authorization. For all other Tricare plans and supplemental insurance plans, you will need to contact your regional contractor. For more information on Tricare referrals and prior authorizations, download our free guide.
Lastly, you can view or check the status of your Tricare prior authorization form or referral form online through the Tricare website. To do so, you must visit your regional contractor’s website. You will then need to register for secure services if you have not done so already. Then, you will need to sign into your account. From there, you will be able to view or check your referrals and prior authorizations.
If your Tricare prior authorization is approved, your regional contractor will send you and your provider an authorized letter outlining specific instructions. Then, you can schedule an appointment with a provider listed in the authorized letter.