Tricare Provider Agreement Form


For more information, visit our claims filing page. If you don`t have a www.tricare-west.com account, use automated self-service tools at 1-844-866-WEST (1-844-866-9378). Maternity benefits: Hospitals participating in an annual survey conducted by Leapfrog Group may be entitled to an incentive payment of up to 3% on the basis of the declared hospital benefit compared to state-recognized benchmarks for maternity care. This is part of TRICARE`s maternity benefit pilot and the Health Defence Agency is responsible for calculating incentifle payments. If the links above are not working properly, download the forms above from here: www.mytricare.com/internet/tric/tri/mtc_nprov.nsf/sectionmap/Elct… If your group has delegated registration information, visit our Delegate Suppliers page. Certification is a unique process. There is no certification process in progress once you become TRICARE non-network provider. For more information, visit the Tricare West Region Provider Provider Handbook. For changes to the ABA supplier`s SPECIALTY (e.g. B RBT To BCaBA or BCaBA to BCBA), you must submit a full group of TRICARE suppliers. Behavioural technicians (certified and unreased) can see patients on their national or government certification date, as long as the group has a network agreement executed up to that date. We recommend that suppliers wait 45 days after filing a service table to file claims to allow processing.

By delegating most of the registration information process to the supplier group and not to HNFS, the login information process is optimized. Groups are able to submit practitioners to a group of TRICARE Roster vendors (instead of an individual information provider), allowing faster processing time to get practitioners through the network approval process and load them into HNFS systems. For special updates, fill out the requirement form for non-network special information and send it. You can check the status of your claims online by registering on our Secure portal. To view status information, the National Provider Identifier (NPI) must match the billing NPI in your account www.tricare-west.com. Medicare participation is not required to be a non-network tricare provider. It can take up to 30 days for an application without a network provider to process. If the link above is not working properly, download the form above from here: 204.28.103.156/enrollmentandagrementments/hospitalanddoctortradin…