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Network Providers

(Network) How do I check my credentialing status?

HNFS will notify you once credentialing is completed. You can also check your credentialing status or last credentialing effective date using our Check Credentialing Status tool

Once HNFS receives your completed provider agreement package, it can take 60 to 90 calendar days to credential a provider based upon the accuracy of the information provided. If you are currently undergoing initial credentialing or re-credentialing, please make sure your CAQH profile is current and you have authorized HNFS to access your profile. Credentialing and re-credentialing are valid for three years.

Note: Credentialing status is different than network status. Please refer to your Provider Participation Agreement for network status and effective date. (If your group has a delegated credentialing agreement, contact your group’s credentialing department for your contract execution date. Otherwise, contact HNFS should you have questions.

 

(Network) How do I update the following demographics: address, phone number or fax number? 

You can update your address, phone number or fax number by using the Provider Demographics Update tool. If you have more than 20 providers and/or locations that require an update, please use our TRICARE Provider Group Roster.

It can take HNFS 21 days to review and publish updates based upon the accuracy of the information provided. 

 

(Network) How do I update my specialty information?

In order to update your specialty information, first make sure your information is listed correctly in the National Plan & Provider Enumeration System (NPPES). If correct, use our Update Specialty Tool to request specialty changes. 

Behavior technicians updating their specialty to BCBA, BCaBA, BCBA-D or QASP must submit a Provider Information Form and go through the credentialing process to request changes. 

 

(Network) How do I change my Tax ID or Social Security number? 

You can update your Tax ID or Social Security number (SSN) by faxing in a completed W-9 with a letter on company letterhead to HNFS. Network provider updates can take up to 21 days and non-network provider updates can take up to 30 days.  

 

(Network) How do I add a provider to my network practice?

To add a provider to your network practice who has been credentialed by Health Net Federal Services, LLC (HNFS) within the last three years:

To add a provider to your network practice who has not been credentialed by HNFS:

To add behavior technicians (BTs) who are currently certified or need to be certified:

It can take HNFS 60 to 90 days to credential a new provider once all completed information is received and up to 21 days for loading certified BTs based upon the accuracy of the information provided.  

If your group has a delegated credentialing agreement, see our Delegated Provider page.

 

(Network) How do I add a location to a group?

You can add a location using the Provider Demographics Update tool. If you have more than 20 locations that require an update, please use our TRICARE Provider Group Roster.

(Network) How do I remove a provider from my group practice?

You can remove a provider using our Provider Demographic Update Tool.

If your group has a delegated credentialing agreement, see our Delegated Provider page. 

 

(Network) What are the requirements for a TRICARE Certified Mental Health Counselor?

Visit our Mental Health Counselor Provider Requirements page to learn about the requirements.

 

(Network) What is the role of a network provider?

Network providers serve an important role in TRICARE by complementing the services offered by military hospital and clinics. Network providers are civilian providers of choice for most TRICARE beneficiaries, and as a result, will typically receive higher TRICARE patient volume than non-network providers. A network provider agrees to a negotiated rate as payment in full for services rendered.

 

(Network) What states are in the TRICARE West Region?

The TRICARE West Region is comprised of 21 states: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa (except the Rock Island Arsenal area), Kansas, Minnesota, Missouri, (except the St. Louis area), Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Texas (areas of Western Texas only, including Amarillo, Lubbock and El Paso), Utah, Washington, and Wyoming. 

 

(Network) What is CAQH® and am I required to update my information with them?

HNFS uses CAQH for its provider network application and credentialing process. CAQH is a not-for-profit alliance of the nation’s leading health plans, including HNFS. All providers are required to complete a CAQH online application (and keep their information current), except those located in Idaho, Hawaii, Minnesota, and Washington, as an alternate to CAQH is available. (These states have special circumstances and the credentialing process can be completed with another entity.) 

 

(Network) What is a delegated group?

HNFS recognizes that many provider groups have their own credentialing department to verify individual provider requirements such as licensure, education, professional liability insurance, adverse sanctions, etc. If you are a provider group with its own credentialing department, consider expediting the TRICARE West Region network credentialing process by allowing HNFS to delegate credentialing to you. This will allow HNFS to use the credentialing data you have already collected, which can be submitted to HNFS in an electronic format. 

By delegating the majority of the credentialing process to the provider group, rather than HNFS, the credentialing process is streamlined. Groups are able to submit practitioners on a TRICARE Provider Group Roster (rather than individual Provider Information Forms), which allows for a quicker turnaround time to get practitioners through the network approval process and loaded into HNFS’ systems.

See also our Delegated Credentialing fact sheet.

 

(Network) What happens after a group is approved for delegated credentialing?

Once approved by HNFS’ Credentialing Committee, HNFS will request a full and up-to-date provider roster from the group. Visit our Delegated Provider page for more information.