Military - Colroado Springs

**We are Non-network Providers for TRICARE**

What is the difference between a network and non-network provider?

A network provider is a civilian provider who has completed the credentialing process and signed a contracted agreement to be part of the network of providers who participate in the TRICARE program. A network provider accepts the negotiated rate as payment in full for services rendered.

A non-network provider is a civilian provider who is authorized to provide care to TRICARE beneficiaries, but has not signed a network agreement. Non-network providers meet TRICARE licensing and certification requirements, and are certified by TRICARE to provide care to TRICARE beneficiaries.

Particpating and Nonparticipating - TRICARE

We are Nonparticpating Providers at this point in our programming. This means that we are an authorized behavioral health provider that furnishes substance use disorder and trauma based services to TRICARE beneficiaries, but we have not signed an agreement and does not agree to accept assignment. A nonparticipating provider may balance bill up to 115 percent of the TRICARE allowable charge.

For example, if the TRICARE allowable rate on a service is $100, you could potentially be charged $115 for that service or an additional $15.

Out-of-Network Requests for TRICARE Prime Benefciaries - Colorado Springs

TRICARE Prime, TRICARE Prime Remote active duty family members and TRICARE Young Adult Prime beneficiaries must see network providers to avoid additional out-of-pocket costs. TRICARE Prime beneficiaries who receive care from a non-network provider without a prior authorization or referral from Health Net Federal Services, LLC (HNFS) will be subject to paying Point of Service charges. To avoid unnecessary use of non-network providers, HNFS assists both providers and beneficiaries in finding network providers. If a non-network provider is requested for a TRICARE Prime beneficiary and there are network providers available within access standards, then care may automatically be redirected to a network provider.

In the rare case that network providers are not available or there is a clinically significant reason care must be provided by a non-network provider, clear and detailed documentation must be provided for consideration of this request.

Contact Peaks Services Today

To learn more about how we can help beyond current network providers in your area, please call 719-422-6423 to learn more.