Credentialing and Updating Demographics

How do I check my network credentialing status?

To check your credentialing status or last credentialing effective date, call Health Net Federal Services, LLC (Health Net) at 1-877-TRICARE (1-877-874-2273) to speak with a Provider Services customer service representative. If you provided an email address in your provider agreement package, you will receive credentialing status updates by email.

Once Health Net receives your completed provider agreement package it can take 60 to 180 days to credential a provider based upon the accuracy of the information provided. If you are currently undergoing initial credentialing or re-credentialing, please make sure your CAQH profile is current and you have authorized Health Net to access your profile. Credentialing and re-credentialing are valid for three years.

For more information on credentialing, visit our Credentialing for TRICARE Network Providers page.

How do I update my demographics? (network provider)

You can update your demographics using the Provider Demographics Update form, which can be either faxed or emailed.

You also can follow the steps below to make changes to your demographics using the Network Provider Directory.

Please note: Changes to your Tax Identification Number or group name require submission of an updated W-9 to 1-888-244-4025.

Network Provider Directory steps:
1) Click on Search Provider Directory Now.
2) Enter Your Location Details.
3) Enter provider name (last, first).
4) Click on provider name.
5) Click on Suggest Changes to This Provider.
6) Check the small white box to the left of the provider information you would like to change.
7) Click on Continue.
8) Click what type of change you would like to make to your listing, including: No Change, Add New Listing (Add Office/Specialty), Change Existing Listing, Delete This Listing
9) Enter corrected or new information.
10) Click on Continue.
11) Review your changes and then click on Confirm and Submit.

Note: Do not use the Provider Information Form (PIF) to update demographics. The PIF should only be used when applying for TRICARE network status.

How do I add a provider to my network practice?

To add a provider to your network practice who has been credentialed by Health Net Federal Services, LLC (Health Net) within the last three years, send the provider's information by filling out a Provider Information Form (PIF) and either mailing it or faxing it. Network providers must be re-credentialed by Health Net every three years.

To add a provider to your network practice who has not been credentialed by Health Net, he or she must send in a Provider Information Form to ensure he or she gets credentialed by Health Net. The provider must have all information current with the Council for Affordable Quality Healthcare (CAQH®), as well. It can take Health Net 60 to 180 days to credential your new provider based upon the accuracy of the information provided.

  • Mailing Address:   
    Health Net Federal Services, LLC / TRICARE
    Attn: Provider Network Management
    P.O. Box 105422
    Atlanta, GA 30348-5422

  • Fax:
    1-888-428-8710

 

What are the new requirements for a TRICARE Certified Mental Health Counselor?

Effective January 1, 2015, provider requirements are changing. For more information visit our Mental Health Counselor Provider Requirements page.

How do I certify as a network Corporate Services Provider?

Network Corporate Services Providers are certified during the credentialing process.

How do I become a TRICARE network provider?

As part of the provider agreement process, medical or surgical providers must complete the credentialing process and participate in a stringent review of qualifications, education, licensure, malpractice coverage, and other criteria in accordance with URAC standards to ensure quality of health care services.

Visit our Credentialing for Network Providers page for more information.

What is a network provider?

A TRICARE network provider is a civilian provider who has signed an agreement with Health Net Federal Services, LLC (Health Net) or MHN – Health Net's behavioral health subsidiary – to be part of the network of providers who participate in the TRICARE program.

What is the role of a network provider?

Network providers serve an important role in TRICARE by complementing the services offered by military treatment facilities (MTFs). Network providers are civilian providers of choice for most TRICARE beneficiaries, and as a result, will typically receive higher TRICARE patient volume than non-network providers. A network provider agrees to a negotiated rate as payment in full for services rendered.

What are the requirements for behavioral health network providers?

While medical/surgical network providers are contracted through Health Net Federal Services, LLC, behavioral health network providers are contracted through MHN. Behavioral health providers should visit the MHN website and click on Join Our Network for more information about behavioral health network provider contracting.

What are the requirements for freestanding partial hospital programs and behavioral health facilities?

Behavioral health freestanding partial hospital programs (PHPs), residential treatment centers (RTCs) and substance use disorder rehabilitation facilities (SUDRFs) must first become certified by Keystone Peer Review Organization, Inc. (KePRO), the quality monitoring contactor for TRICARE.

To become certified, these facilities should contact KePRO at 1-800-222-0771 and speak with a TRICARE certification representative to request a certification packet. You can also visit the KePRO website at www.kepro.com for more information.

Once the behavioral health facility is approved by KePRO, the facility will need to complete the network provider contracting process with MHN by visiting the MHN website and click on Join Our Network.