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What's the difference between TRICARE-certified and TRICARE-contracted?
A TRICARE-certified (authorized) provider is a facility, doctor or other healthcare professional that meets the licensing and certification requirements of TRICARE regulations and practices for that area of healthcare.
TRICARE-certified (authorized) healthcare providers may or may not agree to "accept assignment" — that is, accept the TRICARE maximum allowable charge as payment in full for services. If they don't agree, then they are considered certified (authorized), non-participating providers. They may elect to accept assignment on a claim-by-claim basis. These are also known as TRICARE-certified (authorized), non-network providers.
In other words, just because a provider is TRICARE-certified (authorized) does not mean that the provider is contracted with TRICARE.
A TRICARE-contracted provider is a TRICARE-certified (authorized) provider who has a contract agreement with a TRICARE Prime Contractor. This provider agrees to accept the TRICARE maximum allowable charge as payment in full and submit claim forms for beneficiaries. A TRICARE-contracted provider is an certified (authorized), participating provider or a network provider.
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