TRICARE Facts
Providers
Different TRICARE plans give plan members access to certain types of physicians and facilities at differing levels of care. Below is an explanation of the groups of doctor with whom you can make an appointment, depending on which TRICARE plan you have.
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Network Providers
A network provider is a physician, nurse, lab, hospital, etc., who has contracted with TRICARE to serve TRICARE beneficiaries. TRICARE Standard, TRICARE Extra (and any other TRICARE health plan using Standard or Extra rules) are authorized to use these providers. Because network providers can charge any amount they want for care, TRICARE Extra and Standard users must fulfill deductibles and cost-share. You must file your own claims when using a network provider.
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Participating Providers
Providers are physicians, nurse, labs, hospitals, etc., who are under contract with TRICARE. The providers have agreed to charge only a TRICARE approved amount for their services. Participating providers file the claim for you and they receive the payment check from TRICARE.
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Authorized Providers
An authorized provider is a civilian doctor, hospital or supplier who has been certified by a regional TRICARE contractor. They are properly licensed by the state they work in and accredited by a national organization. Authorized providers may charge you up to 15% more than what TRICARE allows for your care.
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Military Treatment Facilities
A Military treatment facilities (MTF) ia a military-run hospital, clinic or medical center. Your main source of care will be your Primary Care Manager (PCM), who you will see before being referred to any specialist.
