TRICARE PROVIDERS

Who is a TRICARE Provider

TRICARE providers are Health Care entities (either person, business, hospital, or Pharmacy) that provide healthcare services to individuals participating in TRICARE.

Providers must be authorized (under TRICARE regulations) and certified (by the regional contractors) to provide care to TRICARE beneficiaries.

Beneficiaries who seek care from non-TRICARE-authorized providers have to foot the full cost of care (except in situations of a life-threatening emergency).

What are the TRICARE provider types

There are two types of TRICARE-authorized providers:

• Network and
• Non-network.

TRICARE Provider Network

This is any TRICARE-authorized provider contracted by your regional contractor to provide health care. TRICARE network providers will:

• They will accept negotiated rates TRICARE as payment in full
• File claims on the beneficiary’s behalf
• No charge for services above the required out-of-pocket costs

Humana Military and Health Net Federal Services, LLC are stateside regional contractors. International SOS Government Services, Inc. is the overseas contractor. These three contractors have established a network of providers.

For beneficiaries living overseas, TRICARE network providers will only file claims for those in TRICARE Overseas Program (TOP) Prime, TOP Prime Remote, and active duty service members on leave or temporary duty.

If enrolled in a TRICARE Prime or the TRICARE Young Adult-Prime Option:

• Your Primary Care Manager(PCM) and specialty care providers will likely be from a military hospital or clinic, or (if not enrolled at a military hospital or clinic) a civilian network provider.
• You will be given a referral to network providers in the region’s specialty health care if you cannot be treated at a military hospital or clinic.
• To see civilian specialists or non-network providers, you’ll need pre-authorization from your regional contractor or you will be required to pay more out of pocket under the point-of-service option.

Those enrolled in TRICARE Prime Remote,

• Can see a network provider if one is available in any of your remote locations.

If enrolled for TRICARE Select, TRICARE Reserve Select, or TRICARE Retired Reserve,

• You are allowed to receive care from any TRICARE-authorized provider without a referral. Also, you pay less for services sought from network providers.
• You have total control and the freedom to get care from any TRICARE-authorized provider without a referral. You still may need pre-authorization for some services. Your out-of-pocket costs will vary according to the type of provider seen.

TRICARE Non-Provider Network

These are providers who don’t have a signed agreement with the regional contractor.

Two types of non-network providers:

• Participating and
• Non-Participating

Participating

A participating provider accepts a direct payment from TRICARE as the full payment for health care services provided to beneficiaries, less any out-of-pocket costs.  Generally, they tend to be the best bet if seeing a non-network provider

Participating providers May sometimes choose to participate on a claim-by-claim basis. They will file claims for you and if overseas, may also file claims for you.

Within the U.S territory, they may charge up to 15% above the TRICARE-allowable charge.

For services Outside the U.S. and U.S. territories, there may be no limit to the amount that nonparticipating providers may bill, and the beneficiary is responsible for paying any amount that exceeds the TRICARE-allowable charge.

Non-participating

Non-participating providers don’t have a signed agreement with the regional contractor (hence they do not accept the TRICARE-allowable charge nor file your claims).

They are considered “out of network”. This has the implication that you may have to settle with the provider and later claim reimbursement from TRICARE.

Non-participating providers Have the legal right to charge you up to 15 percent above the TRICARE-allowable charge for services (Remember, you will need to clear this amount including any other applicable patient costs).

TRICARE Provider Locator

TRICARE Find Doctor

Contractors have established adequate provider networks in each region. Beneficiaries can use the Find a Doctor tool to find a provider.

It’s possible to go directly to your TRICARE contractor’s network provider directory and search for a TRICARE provider in your applicable area.

TRICARE Provider Login

Regional contractors manage the TRICARE Health care services in each TRICARE region (North, South, and West).

Use the links below to visit the contractor’s network provider directory, and search for a TRICARE provider in your area:

• East Region (Catered by Humana Military)
• West Region (Catered by Health Net Federal Services, LLC)
• Overseas Region (Catered by International SOS Government Services, Inc.)
• US Family Health Plan

If living or traveling in the Philippines, you may use the Philippine Provider Search tool to locate a provider near you. Please take note that you must be attended to by a Philippine Preferred Provider Network provider or certified provider.

To find a comprehensive list of TRICARE-authorized providers, please visit www.tricare.mil/findaprovider

Changing PCM TRICARE

Changes to your PCM can be made either by:

• Online
• Mail or
• Phone

Online

Follow the steps below to initiate the change:

• Visit milConnect
• Once on the site, please Sign In (the button is located at the top of the page).
• Once signed in, find the Family Members list, then select the PCM that’s changing.
• Look for the Medical Enrollments tab, and click “Change PCM” button.
• On the “Change PCM” page, click the reason for changing PCM.
• Find the “Change PCM – click Provider Type” page, and then select provider type.
• On the “Change PCM – Search for a PCM” page, enter search criteria- search for a new PCM.
• On the “Change PCM – Assign a PCM” page, click to select the new PCM.
• On the “Change PCM – Confirm PCM Changes” page, you can confirm new PCM details

Mail

Mail via post (using the address found on Page 3 of the form) the “TRICARE Prime Enrollment, Disenrollment and PCM Change Form” with the new PCM’s name and address to the regional contractor.

Complete only the part that relates to PCM change. Use the appropriate form applicable to you.

• East Form
• West Form
• USFHP Forms

This change is effective only when the regional contractor processes the PCM change. Kindly Visit milConnect to confirm if the change was effected.

Please note, TRICARE enrollment cards are no longer found on milConnect nor sent through US mail. To access care at a provider, you only need to produce your military-issued family ID and let them know that you are enrolled in TRICARE.

 Phone

 Please Call the Regional Contractor applicable to your region:

• East Region: Humana Military (1-800-444-5445)
• West Region: Health Net (1-844-866-9378)

USFHP Members can call Designated Provider on:

1. Brighton Marine Health Center (1-800-818-8589)
2. CHRISTUS Health (1-800-678-7347)
3. Johns Hopkins Medicine (1-800-808-7347)
4. Martin’s Point Health Care (1-888-674-8734)
5. Pacific Medical Centers (1.888.472.2633)
6. Saint Vincent Catholic Medical Centers (1-800-241-4848)

TRICARE Portal Login

Secure Patient Portal

It’s a secure system that helps users manage their individual or family health care online.

This online system can:

• Make, Cancel or reschedule appointments
• Get E-Visits
• Make requests for prescription refills
• Request prescription renewals
• Access lab tests results
• Access selected radiology reports
• As a source of receiving information and services when you separate from active duty or reserves
• Review and download personal health information

TOL Secure Patient Portal (“TRICARE Online” or “TOL”).

This is the current secure patient portal that registered users use to access their online health care information and services at military hospitals and clinics.

TRICARE is in the process of upgrading from the TOL Patient Portal to MHS GENESIS.

Until the MHS GENESIS is fully deployed, expect some overlap of services between the TOL Patient Portal and MHS GENESIS.

MHS GENESIS Patient Portal

This is the proposed new secure patient portal for TRICARE.

MHS GENESIS Features

This portal will provide a direct view and 24/7 access to your current medical and dental health records.

• Review, download and transmit health data
• Manage appointments
• Make prescription refills
• View medical notes and certain lab/test results
• Exchange messages securely with your health care team
• Filling an online pre-visit, or dental health history questionnaire (active duty only).
• Look up health information relating to your health concerns, results, and prescriptions

How to Use MHS GENESIS

Save the new portal location: https://my.mhsgenesis.health.mil. Login is only possible with a DS Premium Level 2 Account. Enter your username and password

Logging in to the Secure Patient Portal

If your military hospital or clinic uses:

• TOL, Please click>> TRICARE Online to log in.
• MHS GENESIS, Please click>> MHS GENESIS to log in.
• If unsure what portal to use, please visit the hospital website here: >>Military Hospitals and Clinics

When you click “Patient Portal” , the system will automatically direct you to the relevant portal (either TOL or MHS GENESIS).

You can’t register for MHS GENESIS unless you have a DoD Self-Service Logon (DS Logon) Premium (Level 2) account.

Bottom Line

Beneficiaries have access to several types of providers regardless of their TRICARE plan. It’s wise to understand the different provider options as they have a bearing on out-of-pocket costs and the filing of claims.

Remember, an active duty service member can only seek care in the TRICARE network when under referral and pre-authorization (the only exception is when seeking outpatient mental health services at a military hospital or clinic).