Tricare only reimburses authorized providers. Tricare-authorized providers must meet Tricare licensing and certification standards.  This means providers must be licensed in their respective states and not banned from participation in federal healthcare programs. 

Certified providers are considered non-network Tricare-authorized providers unless they choose to join the Tricare network. Non-network providers may also choose to accept assignment (that is, participate) on a case-by-case basis.

Tricare West: Certification Applications

Tricare East: Certification Applications

Network Providers

Network providers sign an agreement with the applicable Tricare contractor (East or West).  Network providers agree to file claims and handle paperwork for Tricare beneficiaries and agree to accept the Tricare allowable charges as payment in full for services.  Network providers must also carry malpractice insurance.

Non-Network Providers

Non-network providers do not sign an agreement with the applicable contractor, they can be participating or non-participating. 

Participating Providers

May choose to participate on a claim-by-claim basis, agree to accept payment directly from Tricare and accept the Tricare allowable charge as payment in full for their services.

Non-Participating Providers

Non-participating providers do not agree to accept Tricare allowable charges or file claims on behalf of beneficiaries. Non-participating providers the legal right to charge beneficiaries up to fifteen (15%) percent above the Tricare allowable charge for services.

Note: When a Tricare Prime beneficiary is referred to a nonparticipating, non-network provider, the beneficiary is only responsible for applicable copayments/cost-shares, but not for any balance billing amount.

Reference

Tricare Provider Manuals

TRICARE Policy Manual 6010.60-M Ch. 11 § 1.2