Get the free TRICARE INSTITUTIONAL PROVIDER APPLICATION

TRI CARE West Region Provider Data Management P.O. Box 7066 Camden, SC 29021-7066 1-877-988-9378 Fax 1-855-831-7044 www.myTRICARE.com TRI CARE INSTITUTIONAL PROVIDER APPLICATION FACILITY NAME: FEDERAL

How to fill out tricare institutional provider application

Who needs tricare institutional provider application?

Healthcare organizations that wish to become an approved provider under the Tricare program, which provides military health benefits for eligible individuals, including active duty service members, retirees, and their families.

How to fill out tricare institutional provider application:

1. Gather the necessary information: Before starting the application, make sure to have all the required documentation and information on hand. This may include the organization's tax identification number, National Provider Identifier (NPI), proof of accreditation, licenses, and any relevant certifications.
2. Access the application form: Visit the Tricare website or contact the Tricare Management Activity (TMA) to obtain the institutional provider application form. This form will contain sections that require detailed information about the organization.
3. Complete the organizational information section: Provide accurate details about the healthcare organization, including its legal name, address, contact information, and ownership structure. It may be necessary to include information about any affiliated clinics or facilities.
4. Provide credentialing and accreditation information: Tricare requires healthcare organizations to meet specific credentialing and accreditation standards. In this section of the application, include supporting documentation to demonstrate compliance with these requirements. This may include copies of accreditation certificates, state licenses, or any other relevant certifications.
5. Add information about services offered: Describe the types of services the healthcare organization provides and specify which Tricare programs and regions these services are intended to cover. This section may also require information on provider specialties, the availability of specific medical equipment or facilities, and any unique qualifications or expertise offered.
6. Complete the financial disclosure section: Tricare requires organizations to disclose financial information to ensure transparency and prevent conflicts of interest. Provide accurate details about the organization's ownership, including any affiliations or financial relationships with other healthcare entities.
7. Submit the application: Once all sections of the application are complete and all necessary supporting documents are attached, submit the application to Tricare for review. Be sure to double-check that everything is accurate, complete, and legible before submitting.
8. Follow up and review: After submitting the application, it is essential to follow up with Tricare to ensure it has been received and to inquire about any additional steps or documentation required. Allow sufficient time for the application to be reviewed and processed, as the timeline may vary.
9. Await approval: Tricare will review the application and assess the organization's eligibility to become an institutional provider. If approved, the organization will be issued a Tricare provider number and can begin providing services to Tricare beneficiaries.
10. Maintain compliance: Once approved, it is crucial for the organization to maintain compliance with all Tricare requirements and standards. Regularly review and update the information provided in the application, notify Tricare of any changes, and participate in any required reporting or audits to ensure continuing eligibility as a Tricare institutional provider.

For pdfFiller’s FAQs

What is tricare institutional provider application?

Tricare institutional provider application is a form that healthcare providers must submit to become approved to provide services to Tricare beneficiaries.

Who is required to file tricare institutional provider application?

Healthcare providers who wish to provide services to Tricare beneficiaries are required to file the tricare institutional provider application.

How to fill out tricare institutional provider application?

Tricare institutional provider application can typically be filled out online through the Tricare website or by contacting the Tricare provider services department.

What is the purpose of tricare institutional provider application?

The purpose of tricare institutional provider application is to ensure that healthcare providers meet the necessary requirements to provide services to Tricare beneficiaries.

What information must be reported on tricare institutional provider application?

Tricare institutional provider application typically requires information about the provider's credentials, services offered, billing practices, and compliance with Tricare regulations.

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