Tricare varies by region. You have three different areas for provider credentialing with Tricare: Tricare North, Tricare South, and TriWest. To apply to Tricare, you have to narrow it down to what specific region you are going to be in.
North Carolina and up is Tricare North, while North Carolina and down would be Tricare South. Coincidentally, North Carolina is split right down the middle for Tricare provider credentialing. If you are unsure, you can just give them your zip code.
Tricare does not handle any provider credentialing itself; everything is outsourced. Applying to Tricare is a two-step process.
First, You have to apply to be Tricare certified. That is done through the online Tricare application. The second step is to become credentialed and contracted, but that is done through your outside company.
For Tricare North, you are going to go through a company called MHN Behavioral Health – a Healthnet Company. MHN is very familiar with Tricare and will walk you through the entire process. You get your certification, and you actually become certified while you are applying for credentialing with MHN.
In the southern region, however, it is totally different. You are going to apply for certification through Tricare, but you then have to become certified first and then request your application from Tricare South, which must be done through Humana Military, a Value Options Company. Even if you are credentialed with Value Options, that does not mean you are credentialed with Tricare South.
Tricare can be tricky, but we have perfected it so that we know what we are doing.
In TriWest, it is pretty much locked down. Blue Shield throughout Colorado and West mandates TriWest. You are going to run into an issue with TriWest. It is a panel that has been closed down for almost two years, and they are only letting in those that can prescribe medication.
We recently did get someone on TriWest. After applying multiple times, he was let in. TriWest has traditionally been run by a company called TriWest Alliance, but it will now be taken over by UBH.
If you’ve had enough of fighting with insurance companies and filling out provider applications, just to have those applications lost or rejected, give us a call at 1-855-4-THRIVE (847-483).
Or, to learn more, we have posted a handful of helpful videos on our FAQ Credentialing Page.
Dr. Anthony Centore
and your Friends at Thriveworks Medical Credentialing