Network authorized vs. non-network authorized providers

February 16, 2021

All TRICARE-authorized providers meet TRICARE licensing and certification requirements and are certified by TRICARE to provide care to TRICARE beneficiaries. TRICARE-authorized providers may include doctors, hospitals, ancillary providers (e.g., laboratories, radiology centers), and pharmacies that meet TRICARE requirements. If you see a provider that is not TRICARE-authorized, you are responsible for the full cost of care. Find a list of TRICARE-authorized providers

There are two types of TRICARE-authorized providers: network and non-network:

Network provider

  • Contractually required to submit claims for beneficiaries for services rendered. Beneficiaries cannot file a claim themselves for services rendered by a network provider.
  • May accept copay/cost-share from beneficiaries prior to services rendered.

NOTE: Beneficiaries should not pay up-front for services rendered by a network provider unless it is their copay/cost-share.

Non-network provider

  • Do not have a signed agreement with TRICARE and are considered out-of-network.
  • There are two types of non-network providers: participating and nonparticipating.
    Participating non-network provider:
    Provider may choose to participate on a claim-by-claim basis. They have agreed to accept payment directly from TRICARE and accept the TRICARE-allowable charge (less any applicable patient costs paid by beneficiary) as payment in full.
    Beneficiaries may have to pay up-front for services rendered and file their own claim. These providers have not agreed to file your claim. The providers also have a legal right to charge up to 15% above the TRICARE-allowable charge for services (beneficiaries are responsible for paying this amount in addition to any applicable patient costs)

Reporting suspected fraud and abuse:

To find contact information and to access the online submission form, please visit Humana Military's fraud and abuse page