Get Health Net Federal Services Tricare Non-network Psychiatric Nurse Specialist Provider Application 2018-2025

Completing the Health Net Federal Services Tricare Non-Network Psychiatric Nurse Specialist Provider Application is an essential step for providers aiming to deliver services under the TRICARE program. This guide offers detailed instructions on navigating the online form, ensuring that all required information is accurately provided.

Follow the steps to successfully complete the application.

1. Click ‘Get Form’ button to obtain the form and open it in the editor. This will allow you to access the application online and begin filling it out.
2. Fill in your personal information. Start by providing your first name, middle initial, last name, gender, title, and social security number. Ensure that all information is accurate and legible.
3. Enter your National Provider Identifier (NPI) number. This unique identifier is critical for your claims and payments.
4. Indicate whether you are employed by the US Government and whether you sign your own claim forms. If you answer 'No', make sure to attach the appropriate signature authorization forms.
5. Complete the solo practice information if you maintain a solo practice. Provide your solo practice tax ID, NPI, and the date you began using this tax ID number, as well as your physical and billing addresses.
6. If you work with a group practice or institution, fill out the group practice information section. Include the group practice's name, tax ID, NPI, effective date of the group’s tax ID number, and the dates you began practicing with them.
7. Provide your licensure details, including your license number and its issue and expiration dates. Ensure that this aligns with TRICARE's requirements.
8. Enter your educational background, specifically your degree earned, graduation date, and the university attended, confirming you meet educational qualifications.
9. Choose to document your clinical experience or the relevant ANCC certification if applicable. Provide the required certification numbers and the issue and expiration dates.
10. Sign the application form, certifying that the information you provided is accurate and conforms to TRICARE's standards.
11. Once you have completed all sections of the application, save your changes. If needed, download, print, or share the form based on your submission preferences.

Begin the process of completing your application online today to ensure your eligibility for TRICARE services.