Network Provider Information Form (PIF) for Individual Providers

The Network PIF for Individual Providers is a supplemental form that must be completed in addition to the CAQH Provider Data Portal (formerly CAQH ProView) credentialing application when joining HNFS’ TRICARE West Region network. The PIF captures information unique to TRICARE that is not addressed within the CAQH application. The PIF may NOT be used for demographic updates.

• Are you in a provider group and need to add more than five (5) providers? STOP. Do not submit a PIF. Instead, we strongly encourage you to submit a TRICARE Provider Roster to expedite the process. (We will accept rosters for less than five providers as well.) 
• Are you an applied behavior analysis (ABA) provider (individual or group)? STOP. Due to specific requirements for the Autism Care Demonstration, we can only accept a TRICARE Provider Roster when adding ABA providers.

Please allow HNFS up to 21 days after receipt of a completed PIF to load providers into our systems, and up to 90 days to complete the credentialing process. You can check credentialing status using our Check Credentialing Status tool.

Return your completed PIF via fax to HNFS at 1-844-224-0381.

Be sure to use the fax cover sheet included in the form as the first page of your fax. Applications that do not have this cover sheet as the first page of the fax will not be processed.

• Created: Jan 9, 2024
• Modified: Jan 9, 2024
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