TRICARE Provider Enrollment Checklist

Are you looking to become a certified TRICARE provider? Whether you’re an individual practitioner or a group practice, enrolling as a TRICARE provider will give you the chance to serve military members and their families. But before you get started, it’s important to understand what’s required for the application process. We compiled this simple TRICARE provider enrollment checklist to streamline this process and help you submit your application today.

What Is TRICARE?

TRICARE is a government healthcare program dedicated to supporting the United States active military members. It applies to all uniformed service members and their families no matter where they currently live. TRICARE offers comprehensive dental, healthcare, and prescription coverage for all beneficiaries. It also offers special programs for certain conditions such as cancer, autism, and lower back pain.

By becoming a TRICARE-authorized provider (certified), both individual and group healthcare providers can file claims and receive payment for TRICARE services. Remember to review all relevant TRICARE news and updates before applying for enrollment. Once you’re ready, you’ll need to decide if you want to become a non-network or in network provider/group, and which region you belong to: Tricare West (HNFS) or Tricare East (Humana Military). To prepare to see TRICARE beneficiaries, simply follow these steps:

1. Gather Your Documents

The first step in TRICARE provider enrollment is to certify that you’re licensed to practice in your state or region. Gather all documents related to your professional credentials, such as your medical license and certifications, along with any applicable business licenses. In addition, you’ll need to provide proof of education and training, such as transcripts, diplomas, and certificates.

You'll need to provide other details like your National Provider Identifier (NPI) number or Medicare/Medicaid provider ID number. You should also have electronic copies of your malpractice insurance policy on hand. Lastly, be sure to have copies of your Tax ID and Social Security numbers when it comes time to enroll.

Before any provider can see a beneficiary, they must become “certified” by submitting the appropriate application. Per Humana Military’s website: “Certification ensures providers meet the licensing and certification requirements of TRICARE regulations and practice for that area of healthcare. Once the certification process is complete, a provider is considered TRICARE-authorized. All providers who render services to TRICARE beneficiaries MUST be TRICARE-authorized to file claims and receive payment for services.” Certification is required for all TRICARE providers. To become a network provider, you must have a contract.

2. Complete All Application Requirements

Once you’ve gathered all the required documentation, it’s time to fill out your TRICARE provider application forms. These forms will ask for details about your practice like demographic information, specialty, language(s) spoken, etc. Depending on your region, there may be other forms you must complete before submitting your application for review.

The exact application process will vary depending on whether you’re applying as an individual practitioner or as part of a group practice. Individual practitioners will need to send in an Individual Provider Enrollment form along with the supporting documentation outlined in step 1. Group practices will need to complete a Group Provider Enrollment form along with forms for each practice location in addition to the supporting documentation mentioned previously.

EAST / HUMANA MILITARY ENROLLMENT: https://www.humanamilitary.com/provider/access/become-a-tricare-provider/get-certified

WEST / HNFS ENROLLMENT: https://www.tricare-west.com/content/hnfs/home/tw/prov/become-a-provider.html

3. Submit Your Application

The last step is to submit your application and all required supporting documents either via (snail)mail, fax, or through your region’s portal.

If you’re applying online through the HNFS web portal, you must first complete their website registration form and submit it via fax. Then, you’ll receive an email with your username and password to activate your online account within 60 days. If you have any questions about this certification process, you may find answers on the HNFS Frequently Asked Questions page.

If applying online through the Humana Military web portal, then you’ll also need to fill out a certification application before you can create an online account. Be sure to read Humana Military’s Frequently Asked Questions document if you have any questions about this certification process.

If sending paper applications via mail or fax, remember to fill out all fields completely before sending off your forms. Remember that any cosigners must also sign where indicated prior to submission. Also make sure to keep copies of applications before mailing them. Once the proper office reviews and approves your application, you’ll officially be enrolled, contracted, and eligible to begin treating TRICARE patients.

Ask Us about TRICARE Provider Enrollment

Becoming a TRICARE-certified provider is no small task! It involves many steps, from gathering all required documents and fulfilling application forms to submitting your application and consistently following up with the region who's processing everything.

If you have questions about TRICARE enrollment, then we encourage you to give us a call, send us an email, or contact us online. We’ll gladly help you gather and review your credentials, complete all required forms, and submit your application for TRICARE enrollment today.