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Network Providers

How do I check my network credentialing status?

Health Net Federal Services 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.

 

How do I update my demographics? (network provider)

You can update your demographics using the Provider Demographics Update tool

If your group has a delegated credentialing agreement, see our delegated provider FAQ

You can also follow the steps below to make changes to your demographics using the Network Provider Directory.

Network Provider Directory steps:

1) Click on Search Provider Directory Now.
2) Enter Your Location Details.
3) Enter provider name (last, first).
4) Click on provider name.
5) Click on Suggest Changes to This Provider.
6) Check the small white box to the left of the provider information you would like to change.
7) Click on Continue.
8) Click what type of change you would like to make to your listing, including: No Change, Add New Listing (Add Office/Specialty), Change Existing Listing, Delete This Listing
9) Enter corrected or new information.
10) Click on Continue.
11) Review your changes and then click on Confirm and Submit.

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

For non-network provider demographic updates, see our non-network provider FAQ.

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, update your demographics using the network provider directory. Network providers must be re-credentialed by HNFS every three years.

To add a provider to your network practice who has not been credentialed by HNFS, he or she must send in a Provider Information Form to ensure he or she gets credentialed by HNFS. The provider must have all information current with the Council for Affordable Quality Healthcare (CAQH®), as well. Provider groups with 20 or more individual providers can complete the TRICARE Provider Group Roster rather than a PIF for each provider.

Note: It can take HNFS 60 to 90 days to credential your new provider based upon the accuracy of the information provided.  

If your group has a delegated credentialing agreement, see our delegated provider FAQ

What are the new requirements for a TRICARE Certified Mental Health Counselor?

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

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.

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 FAQ

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. 

What is CAQH and am I required to update my information with them?

CAQH stands for Council for Affordable Quality Healthcare. Health Net Federal Services, LLC (HNFS) uses CAQH Universal Credentialing DataSource for the 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 Minnesota and Washington who have an alternate to CAQH available. These states have special circumstances and the credentialing process can be completed with another entity. 

What is a delegated group?

Health Net Federal Services, LLC (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.

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. Email complete rosters to: HNFS_delegated@HNFS.com. We recommend you use our TRICARE Provider Group Roster template, as it includes all required data elements. 

How often are delegated groups required to send HNFS a full roster?

HNFS requires delegated groups submit a full TRICARE Provider Group Roster via email at least quarterly (every 90 days). Per the delegated credentialing agreement, groups should submit full rosters within 10 days of their quarterly credentialing committee meetings. 

When should delegated groups send practitioner additions, demographic updates and/or practitioner terminations?  

HNFS recommends delegated groups send TRICARE Provider Group Roster updates a minimum of once a month; however, we will accept updates weekly or even daily. If there are no changes in a given month, we ask groups still send an email indicating “no updates to report.”

Who do I contact if I have questions specific to HNFS’ delegated credentialing process?

You may email your delegated credentialing questions to HNFS at HNFS_delegated@HNFS.com.