Tricare Provider Credentialing Services

A Tricare-authorized provider must complete the credentialing procedure and sign a contract to join the Tricare network. The credentialing procedure at Military necessitates primary/acceptable-source verification of the provider’s education/training, board certification, license, professional and criminal record, malpractice history, and other relevant data. To provide high-quality healthcare services, Tricare brings together military and civilians healthcare personnel and resources. Tricare is divided into two regions on the ground in the United States: Tricare East and Tricare West.

Our Specialist Will Help You Get Credentialed

Our objective is to improve the healthcare environment and ensure the safety of our patients by adhering to medical standards and regulations while also committing to ongoing professional growth. During the credentialing and privileging process, our staff is committed to provide excellent professionalism, careful quality assurance, and exceptional customer service and support. Our objective is to improve the healthcare environment and ensure the safety of our patients by adhering to medical standards and regulations while also committing to ongoing professional growth.

How Does Tricare Credentialing Work?  

During the credentialing and privileging process, our staff is committed to providing

  1. Excellent professionalism
  2. Careful quality assurance
  3. Exceptional customer service
  4. Support service

We aim to have all credentialing and privileging acts approved within 90 days. However, each timetable will differ depending on the date of receipt of the application, the Primary Source Verification of documents, the reception of references, and other factors

Tricare Credentialing Requirements

This is whole file of credentials and privileges.  It is the obligation of the provider to keep the file up to date. It will assist in keeping track of files and will answer any questions anyone may have.

  1. Qualifying Degree, Postgraduate Training, and Professional Licenses, Certification
  2. Primary Source Verification is required for all professional licenses
  3. Healthcare providers who fail to meet with the manual’s license, certification, or registration standards will be withdrawn from patient care immediately
  4. All job history extending back ten years or to a qualifying degree
  5. Proof of DOD Opioid Prescriber Safety Training and current DEA registration:
  6. A DEA application can be submitted by any provider who does not have a registration
  7. Registration for NPIs and the Provider Enrollment, Chain, and Ownership System (PECOS)
  8. Providers who must participate in PECOS for the purpose of ordering and referring
  9. Professional Competence Proof
  10. To testify to competency, new accession providers have supervisor and peer reference
  11. Any provider with a Postgraduate Medical Education or Civilian Internship will require a Program Director letter, an End of Training Evaluation, and a peer reference

Practitioner Rights Pertaining to Credentialing

The Credentialing department performs practitioner credentialing at the start of a practitioner’s contract and every three years after that. The following rights are available to practitioners who are undergoing credentialing.

  • You have the right to see a summary of outside data gathered by the Credentialing Department in order to evaluate your application.
  • The Credentialing Manager must be contacted if you want to review a file.
  • Providers will not have accessibility to references from other practitioners or health-care facilities.
  • Providers will only be able to get a copy of papers that are submitted by the provider or addressed to the provider personally.
  • If information differs considerably from what you gave, you will be told as soon as possible and given the option to report it to the Credentialing Department.
  • Incorrect information must be corrected in writing within ten (10) days after notification.
  • You have the right to be updated on the status of your application at any moment if you make a request.

Within 60 calendar days of the committee’s credentialing or re-credentialing decision, you will be advised of the Credentials Committee’s decision about your application via written letter.

Tricare Credentialing Phone Number

To verify employment and the progress of your application, please call our third-party supplier, The Call Number, at 1-844-866-9378.

Tricare Enrollment Application

Please complete the form and submit it. Within 60-90 days of receiving your completed request form, you should receive correspondence. Only a valid credentialing application or a Preferred Provider Agreement will be used with the information given. The completion of this document does not imply that you will be a part of the Network. This form is solely for Tricare Provider Network members. Please contact the proper entity if you require assistance with Medicare or TRICARE.

Tricare Enrollment Email

This address can also be used to send email. Please send an email to www.tricare-west.com to acquire information and contact directly with our officers.

Tricare Credentialing Status

After member finished and validated application, it’ll go through seven levels of review. You will receive an email or communication of approval once the Privileging Authority, or designated official, has granted your request. This notice will also be sent to the Department Head and the Information Management Department (IMD) in order to allow you access.