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TRICARE Non-Network Physician/Dentist Individual Application First Name: MI: Last Name: Gen: Title: Social Security Number: NPI# Physical Address (Street Address): Billing Address (If Different):.

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TRICARE defines a provider as a person, business, or institution that provides health care. Understanding the different TRICARE provider types will help you decide what type of TRICARE provider you want to see.

1-800-538-9552. TYY/TDD: 1-866-363-2883.

A non-network provider is a civilian provider who is authorized to provide care to TRICARE beneficiaries, but has not signed a network agreement. Non-network providers meet TRICARE licensing and certification requirements, and are certified by TRICARE to provide care to TRICARE beneficiaries.

Non-participating providers won't accept the TRICARE allowable charge as the payment in full and they won't normally file claims with TRICARE. What this means for you is: You'll probably be required to pay the full amount to the provider and file a claim with TRICARE for a reimbursement (minus your cost share).

To become TRICARE-certified, you must submit a certification application. ABA certification applications. Facility/Ancillary certification applications. Practitioner certification applications. Clinic or group practice certification application. Telemedicine only certification applications.

To become a TRICARE non-network provider, you must meet TRICARE regulations and licensing requirements ing to your area of health care and the state in which you practice. Visit our Becoming a Non-Network Provider page to learn more and complete an application.

Using Select Step 1: Find a Doctor. Once enrolled, you can visit any TRICARE-authorized provider. ... Step 2: Make an Appointment. Schedule an appointment with any provider. ... Step 3: Pay for the Care. If you visit a network provider, you will only need to pay your cost-share.

East Region. Louis area), New Hampshire, New Jersey, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas (excluding El Paso area), Vermont, Virginia, West Virginia, and Wisconsin. Eurasia-Africa Area.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232