Resources & Services: Becoming a TRICARE Provider
SAMHSA Technical Assistance Packet
TRICARE, which is part of the Military Health System, under the auspices of the Assistant Secretary of Defense for Health Affairs, covers an ever growing 9.6 million beneficiaries that include active duty members and families of the Army, Navy, Marine Corps, Air Force, and Coast Guard, as well as retirees from each of the above services and their families. A critical adjunct to the active component are the National Guard and Reserve forces.
Before embarking on the process of becoming a TRICARE authorized provider, there are a few things you may find helpful. TRICARE is the healthcare entitlement that reimburses for medical and behavioral health services outside the confines of a military treatment facility. As an authorized participating provider, you are agreeing to treat TRICARE beneficiaries for the reimbursement allowed by law. You may also choose to non-participate and charge 15 percent over the maximum allowable fee, which will ultimately be paid by the beneficiary. Being so large, TRICARE is separated into three regions (North, South, and West), and is administered by managed-care support contractors. These companies: HealthNet in North, Humana in the South, and TriWest in the West, provide a wide array of provider assistance services, not the least of which is processing and payment of claims.
In the Technical Assistance Packet below, you will find a certification application (to become an authorized provider) for each category in the region folder corresponding to your state of practice. If you run into problems that cannot be resolved by the applicable contractor, please email the TRICARE/SAMHSA liaison at john.sparks@trow.tma.osd.mil
Note from A. Kathryn Power, MEd, Director, Center for Mental Health Services, SAMHSA
I am pleased to present the SAMHSA Technical Assistance Packet for Becoming A TRICARE Provider. SAMHSA has identified eight Strategic Initiatives, with Military Families being one of them, to help individuals with mental and substance abuse disorders and their families build strong and supportive communities, prevent costly and painful behavioral health problems, and promote better health for all Americans. The Military Families Initiative is intended to support America's service men and women — Active Duty, National Guard, Reserve, and Veterans — together with their families by leading efforts to ensure that needed behavioral health services are accessible and that outcomes are positive. One of the specific goals of the Initiative is to improve military families' access to community-based behavioral health care through coordination among SAMHSA, TRICARE, Department of Defense, and the Veterans Health Administration services.
The Technical Assistance Packet (see below) is a result of collaborative work from staff at SAMHSA and the TRICARE West Region in an effort to develop an informative flyer for behavioral health practitioners who may be interested in becoming a TRICARE Provider. The flyer provides useful information on the TRICARE healthcare entitlement, the provider categories that may be authorized, services that may be reimbursed, and the role and expectations of an authorized participating provider for behavioral health.
The packet also contains various forms required in the certification application, and is organized by each of the three TRICARE regions, and includes links to the regional websites and contact information for the TRICARE-SAMHSA liaison.
The information in this packet is a valuable resource for providers interested in applying to become a TRICARE Behavioral Health Care Provider. We anticipate that its utilization will increase appropriate access to crucial resources for military service members, veterans and their families.
SAMHSA Technical Assistance Packet on Becoming a TRICARE Provider
Becoming a TRICARE Provider — Overview Flyer
Application Materials by Region
* below denotes portion of state
TRICARE North
www.hnfs.net
CT, DE, DC, IL, IN, IA*, KY, ME, MD, MA, MI, MO*, NH, NJ, NY, NC, OH, PA, RI, TN*, VT, VA, WV, WI
- TRICARE North Individual Clinical Psychologist Application
- TRICARE North Individual Social Worker Application
- TRICARE North Certification Package for Marriage and Family Therapists and/or Pastoral Counselors
- TRICARE North Individual Mental Health Counselor Application
- TRICARE North Individual Psychiatric Nurse Specialist Application
- TRICARE North Physician/Dentist Individual Application
TRICARE South
www.humana-military.com
AL, AR, FL, GA, LA, MS, OK, SC, TN*, TX*
- TRICARE South Individual Clinical Psychologist Application
- TRICARE South Individual Social Worker Application
- TRICARE South Certification Package for Marriage and Family Therapists and/or Pastoral Counselors
- TRICARE South Individual Mental Health Counselor Application
- TRICARE South Individual Psychiatric Nurse Specialist Application
- TRICARE South Physician/Dentist Individual Application
TRICARE West
www.triwest.com
AK, AZ, CA, CO, HI, ID, IA*, KS, MN, MO*, MT, NE, NV, NM, ND, OR, SD, TX*, UT, WA, WY
- TRICARE West Individual Clinical Psychologist Application
- TRICARE West Individual Social Worker Application
- TRICARE West Certification Package for Marriage and Family Therapists and/or Pastoral Counselors
- TRICARE West Individual Mental Health Counselor Application
- TRICARE West Individual Psychiatric Nurse Specialist Application
- TRICARE West Physician/Dentist Individual Application
