What Are the Requirements to Become a Tricare Provider?


Quick Answer

To begin the process of gaining Tricare credentials, the health-care provider must submit an application to Health Net Federal Services. The health-care provider must have all licences up to date, provide a covered benefit and have malpractice insurance.

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Full Answer

Obvious qualifications required of Tricare providers include no recent disciplinary actions, no felony convictions and no excessive malpractice claim history. In addition, the provider must not have any excessive gaps in employments in the past five years or current Medicare or Medicaid sanctions. The provider must have all continuing education completed as appropriate to his specialty, and all active licences must be current and unrestricted. Another requirement is good standing and active hospital privileges at an accredited hospital, and a valid Drug Enforcement Administration certificate is required in some cases.

The provider must also supply a Social Security number, or an employer identification number can be used when the provider is a group of individuals. A National Provider Identifier is required of all individuals who work in the group. The applicant must also have a signed Medicare CMS-460 agreement to become a Tricare member or provide proof of participation in Medicare on a case-by-case basis. If the individual applying is a primary-care manager, he must provide 24-hour medical coverage and agree to refer all patients to specialists if necessary.

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