Wrong regional contractor
Applying to Humana Military for a location in the West region, or the reverse, wastes weeks. Region changes have made this more common.
Provider credentialing
Tricare Credentialing Services
Tricare covers active duty service members, retirees and their families through regional contractors. We determine which region your locations fall in, choose between network and non-network participation, and complete the certification.
7-14 daysto onboard your practice end to end
Weeklystatus report on every open application
50 statesMedicare, Medicaid and commercial panels
Tricare at a glance
- East: Humana Military
- West: TriWest Healthcare Alliance
- Network or non-network certified
- Medicare certification usually required
- Typical timeline: 60 to 120 days
The application path we run for this payer
- 1
Intake and gap review
Licenses, DEA, board certificates, malpractice, work history and NPI details are collected and compared against what each target payer asks for.
- 2
Profile setup
CAQH ProView, PECOS and payer portals are created or cleaned up, attested and linked to the correct Tax ID and locations.
- 3
Application submission
Every enrollment is filed in dependency order, with a tracking record for each payer, date and reference number.
- 4
Follow-up on a fixed cadence
Payers are contacted on a schedule. Requests for more information are answered the same business day.
- 5
Approval, contract and handoff
Effective dates, provider IDs and fee schedules are logged and loaded into your billing system.
Tricare is not a single payer. The East region is administered by Humana Military and the West region by TriWest Healthcare Alliance. Each contractor runs its own credentialing, and the region boundaries have shifted, so the first step is confirming which contractor covers each of your locations today.
Practices near military installations see meaningful Tricare volume, and the program has both network providers, who contract with the regional contractor, and non-network certified providers, who can bill without a contract at Tricare's allowable rates. ClainetRCM helps you choose the right status and gets the paperwork done.
Where this usually goes wrong
Medicare enrollment prerequisite
Tricare requires most provider types to be Medicare-certified or Medicare-eligible. Practices without Medicare enrollment stall at the first step.
Network versus certified confusion
A certified non-network provider can bill Tricare but is not in the directory and receives lower cost sharing from patients. Some practices choose it by accident.
What ClainetRCM handles
One coordinator owns the file from intake to effective date.
- Region determination for each practice location
- Network versus non-network participation recommendation
- Humana Military or TriWest network application
- Non-network provider certification where that is the better fit
- CAQH attestation and Medicare enrollment confirmation
- Contract execution, provider ID and effective date loaded into billing
Tricare regions and participation options
| Tricare East | Administered by Humana Military. Covers most states east of the Mississippi plus several central states. |
|---|---|
| Tricare West | Administered by TriWest Healthcare Alliance. Covers the western states and several central states that moved regions recently. |
| Network provider | Contracted with the regional contractor, listed in the directory, paid at negotiated rates, lower patient cost sharing. |
| Non-network certified | Approved to bill Tricare without a contract, paid at Tricare maximum allowable, higher patient cost sharing. |
| Prerequisite | Medicare certification for most provider types. See Medicare provider enrollment. |
Questions about Tricare
Network credentialing with Humana Military or TriWest typically takes 60 to 120 days. Non-network certification is faster, often 30 to 60 days, because it does not involve contracting.
It depends on the state of your practice location, and region assignments have changed. We confirm the current contractor for each of your locations before filing anything.
For most physician and non-physician practitioner types, yes. Tricare requires Medicare certification as a condition of participation. Behavioral health has some exceptions, which we confirm case by case.
Yes. Tricare has specific requirements for psychologists, LCSWs, LPCs, LMFTs and ABA providers, and the ABA program runs under the Autism Care Demonstration with its own rules. See ABA credentialing.
Other payers and enrollment pages
Back to the provider credentialing overview, or continue with a related page.
Medicare Provider Enrollment Services
CMS-855 applications and PECOS filing
Medicaid Provider Enrollment Services
State Medicaid and MCO enrollment
PECOS Enrollment and Account Management
Medicare's online enrollment system
Medicare Revalidation Services
Cycle revalidation without deactivation
Private practices
Practices near installations
Mental health billing
Tricare behavioral health requirements
States we serve
Region assignment by state
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