TRICARE Provider Types

When you use TRICARE, make sure you see only a TRICARE-authorized provider.  Being authorized means the doctor, hospital, etc. meets the Department of Defense’s licensing requirements; it also means the provider is certified to serve TRICARE beneficiaries.  If you see a provider who is not so authorized, you are responsible for the full cost of your care, which could be considerably higher than what it would be otherwise under the program.

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Military Treatment Facility Providers

Often referred to as MTF providers, these care for those enrolled in TRICARE Prime, TRICARE Prime Overseas and TRICARE Young Adult Prime Option, as well as those who are referred to MTF’s.

MTF providers chiefly serve active-duty service members and their dependents; others are served based on unused capacity only.

TRICARE Network Providers

Providers that are part of the TRICARE network:

  • Have agreed with TRICARE to provide you care
  • Have agreed to file claims (instead of you)
  • Have agreed to accept the TRICARE allowable amount as full payment (for those on TRICARE Extra)

If you are under TRICARE Prime, you will receive most of your care from either TRICARE network providers, or providers in a military treatment facility (MTF).

If you are on TRICARE Standard and Extra, you use the Extra option when you see a network provider.  This saves you money;.

TRICARE Non-Network Providers

There are two types of non-network TRICARE providers: participating and non-participating.  It is to your advantage to see participating providers, as explained below.

Participating providers:

  • Have agreed to accept the TRICARE allowable amount as full payment
  • May agree to participate on a per-claim basis

Non-participating providers:

  • May have you pay upfront (and you file for TRICARE reimbursement later)
  • Have not agreed to accept TRICARE allowable amount as payment in full
  • Have not agreed to file claims for you
  • Are permitted by law to charge up to 15% above the TRICARE allowable amount (You are responsible for this as well as your cost share)

 

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