Complete the right TRICARE East provider certification application, understand participation-agreement requirements, and check your application’s status.
If you provide care to TRICARE beneficiaries in the East Region, you must be TRICARE-certified before you can file TRICARE claims or receive payment for TRICARE services. Certification verifies that you meet the licensing and credential requirements for your provider type.
Certification does not make you a TRICARE East network provider. Network enrollment is a separate process with Humana Military.
Make sure the application covers every state where you provide TRICARE services. One application can include multiple state locations that use the same TIN.
Submit the application and keep the confirmation details.
The application asks for your NPI, practice and location information, license or certification information, and supporting documents. Your provider type can require additional documentation. Follow the application’s requirements rather than assuming the same documents apply to every specialty.
Some TRICARE-certified provider types must sign a participation agreement, whether they are network or non-network. This includes certified marriage and family therapists, Autism Corporate Service Providers, and many facility types.If your application includes a participation agreement, read its payment and billing terms before you sign. For certified marriage and family therapists, the agreement requires accepting the TRICARE allowable charge as payment in full, filing claims for the beneficiary, and collecting only applicable deductibles and cost-shares.See Humana Military’s current list of provider types that require participation agreements to confirm whether your provider type is included.
Humana Military’s certification FAQ describes approximately 90 days for paper applications. Use the online application when one is available for your provider type; the paper estimate is not an approval deadline for every application. If you submitted online, use the Provider Certification Status Portal with the NPI associated with the application. For a facility or Autism Corporate Service Provider application, the portal asks for the NPI and offers the location ZIP code as an optional field.After 90 days without certification, first check provider self-service for the provider at the submitted location. If absent, send a secure message to the TRICARE Community Liaison for your area. Secure messaging requires an account linked to your tax ID. For additional help, call 800-444-5445.
Certification establishes your authorization to provide TRICARE services. It does not enroll you in the TRICARE East network. Humana Military’s current network availability varies by provider category; use its network information to see whether it is accepting requests for your specialty.
This guide covers the payer’s certification process. It does not determine whether a specific client’s services are covered, whether a claim will be approved, or the reimbursement amount. Those decisions remain with TRICARE.If you receive approval or a payer request that affects a claim through Thrizer, contact Thrizer support through your Thrizer account and include the approval or correspondence.Return to provider registration and certification to compare the BCBS and TRICARE paths.
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