To join the TRICARE network, with the exception of VA providers, a TRICARE-authorized provider must complete the credentialing process and sign a contract with Humana Military.
Humana Military’s credentialing process requires primary-source/acceptable source verification of the provider’s education/training, board certification, license, professional and criminal background, malpractice history and other pertinent data.
To meet the minimum credentialing criteria established by Humana Military, individuals must:
Refer to the TRICARE Policy Manual for more information
- Have graduated from a school appropriate to their profession and completed postgraduate training appropriate to their practicing specialty
- Have a current, valid, unrestricted and unprobated professional state license* in the state(s) they practice within
- Have a current, valid, unrestricted and unprobated Drug Enforcement Agency (DEA) registration, if applicable to their practicing specialty
- Have a current, valid, unrestricted and unprobated state controlled dangerous substance registration, if applicable to their practicing specialty and the state they practice within
- Have current professional liability insurance or meet the state/ local guidelines
- Be able to participate in federal healthcare programs.
- Not have been convicted of a felony related to controlled substances, healthcare fraud, or a child or patient abuse
- Not have any physical or behavioral health condition that cannot be accommodated without undue hardship or without reasonable accommodation
- Not have untreated chemical/substance dependency
- Not have any unexplained gaps of six months or more in their work history during the past five years
Providers requiring credentialing include:
- Medical Doctors
- Doctors of Osteopathic Medicine (DO)
- Doctors of Dental Medicine (DMD) (must practice oral and maxillofacial surgery)
- Doctors of Dental Surgery (DDS) (must practice oral and maxillofacial surgery)
- Doctors of Podiatric Medicine (DPM)
- Doctors of Optometry (OD)
- Nurse Practitioners (NP)
- Physician Assistants
- Master's level clinical social workers
- Master's level clinical nurse specialists or psychiatric nurse practitioners
- Other behavioral health specialists who are licensed, certified or registered by the state to practice independently
Credentialing is also required for the following institutional providers:
- Acute inpatient facilities
- Free-standing surgical centers
- Home health agencies
- Skilled Nursing Facilities (SNF)
- Behavioral healthcare facilities providing behavioral health or substance abuse services in the following settings:
To meet the minimum credentialing criteria established by Humana Military, facilities must:
- Have a current signature and date on the application
- Have a current, valid, unrestricted and unprobated state license
- Have current acceptable liability insurance
- Be able to participate in federal healthcare programs, including Medicare, Medicaid and all other plans and programs that provide health benefits funded directly or indirectly by the United States (other than the Federal Employees Health Benefits Plan) as reported by the Office of the Inspector General (OIG) or the General Services Administration (GSA)
- Have acceptable accreditation status appropriate to the facility
The provider must wait to receive final notification of contract execution and credentialing approval from Humana Military before providing care to TRICARE beneficiaries as a network provider.
Humana Military monitors each network provider’s quality of care and adherence to DoD, TRICARE and Humana Military policies. Network providers must be re-credentialed at least every three years.