Tricare is the federal program that covers the medical costs for military personnel, their dependents, and as of October 2000, retired active duty and reserve personnel. Many medical practices could see increased patient census numbers if they were to enroll in the Tricare program.

Why is there a shortage of authorized Tricare providers? Many times it is because of incorrect information or fear of a government program. (Yet most practices rely heavily upon the fair Medicare reimbursement policies for dependable income).

Let's take a look at some frequent questions:

Q: When a medical provider becomes an authorized Tricare Provider, are they then obligated to treat Tricare patients?
A: No. In fact, the authorization incurs no legal obligation to Tricare (until a Tricare beneficiary is actually seen).

Q: Is it hard to enroll in Tricare?
A: No, it is actually no harder than enrolling in Medicare. First the provider requests a certification packet from the claims-processing contractor. He returns the enclosed form, which gives information about their professional credentials. When approved, Tricare issues a Tricare provider number.

Q: Does a medical provider have to enroll in Tricare to see Tricare beneficiaries?
A: No, only if the provider wishes to receive payment for services from Tricare. Like Medicare, Tricare can only pay for the medical services of authorized providers (except in certain emergencies). However, federal law places the same restrictions on providers who choose not to participate in Tricare as for Medicare patients: A Tricare beneficiary may not be charged more than 15 percent above the Tricare approved amount for that level of service.

Q: Does Tricare require medical providers to file the claim for services they provide?
A: No, only if they wish to receive reimbursement directly from Tricare. The patient may file a claim for services by an authorized Tricare provider and be reimbursed Tricare's share directly. (In some regions, reimbursement is much faster to the patient than to the authorized providers who bill directly.)

Q: Since both Tricare and Medicare are federal programs with either the same or similar rules, are providers that see Medicare patients required to see Tricare patients?
A: No, except for hospital services.

Q: Regarding referrals, what if there are no specialists in my area that accept Tricare?
A: You or the patient should write to Beneficiary and Provider Relations Division, Tricare Management Activity, 16401 E. Centretech Parkway, Aurora, CO 80011-9043. Include the geographical area, zip code, and if any providers have been contacted.

For further information, see TRICARE General Information, Tricare for Life Tips, or Tricare Q & A from TRADOC.

This article represents the author's understanding of Tricare regulations. Also referenced for this article was "How to get your doctor into Tricare", Newslines Pay and Benefits, Army Times, March 18, 2002. Readers should contact Tricare itself for current information and interpretations.