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Network Applied Behavior Analysis (ABA) Provider Participation Packet

ABA group and sole providers interested in joining the Health Net Federal Services, LLC (HNFS) network for the TRICARE West Region contract must complete this packet and submit it to HNFS. Please also include a completed TRICARE Provider Roster

Indivdiual providers joining a group already contracted with HNFS are only required to submit our TRICARE Provider Roster.

Do not submit individual Provider Information Forms (PIFs) for ABA providers.  

Fax: 1-844-836-5818

Mailing Address:
Health Net Federal Services, LLC/TRICARE
Attn: Provider Network Management
PO Box 9410
Virginia Beach, VA 23450-9410

  • Created: Feb 18, 2021
  • Modified: Feb 18, 2021
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Network Provider Information Form

Note: Existing network providers must use our Provider Demographics Update Tool to request demographic changes. 

In addition to the CAQH credentialing application, TRICARE network provider applicants (excluding ABA providers) must also submit a supplemental Provider Information Form or PIF. This supplemental application requests information unique to TRICARE that is not addressed within the CAQH application.

  • Please allow 21 days for processing. Keep in mind, the full credentialing process takes, on average, 90 days from the date we receive a completed application. 
  • You can check status using our Check Credentialing Status tool.
  • Provider groups with 20 or more individual providers can complete the TRICARE Provider Roster rather than a PIF for each provider. 
  • ABA providers must complete the TRICARE Provider Roster, regardless of group size.

You may mail or fax your completed PIF.

If faxing, use the fax cover sheet included in the form as the first page of your fax. Applications that do not have this cover sheet as the first page of the fax will not be processed.

Mailing Address:
Health Net Federal Services, LLC/TRICARE
Attn: Provider Network Management
PO Box 9410
Virginia Beach, VA 23450-9410

Fax:
1-844-224-0381

  • Created: May 3, 2021
  • Modified: Apr 28, 2021
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TRICARE Provider Roster

Health Net Federal Services, LLC (HNFS) offers a TRICARE Provider Roster* for:

  • Provider groups joining the HNFS network who have 20 or more individual providers they wish to credential.
  • Existing network providers who would like to make changes to demographic or credentialing information.
  • Groups who have a delegated credentialing agreement with HNFS. 
  • ABA providers (including behavior technicians) who need to submit provider roster information to HNFS.

Complete all columns in the spreadsheet and submit to HNFS via email to PDMRoster@hnfs.com.

  • Delegated providers: Visit our Delegated Provider page for details on how to submit rosters.

See our Roster Help page for additional details. Please allow up to 90 days for processing new provider groups joining the network and 45 days for loading certified BTs and demographic updates.  

HNFS will issue a determination letter to the credentialing point of contact for each practitioner once the credentialing process has completed.

*In order to access the roster, click the link above and save the Excel file locally on your computer. After completing all of the fields, save the file again and submit a copy to the email address above. 

  • Created: Feb 18, 2021
  • Modified: Feb 18, 2021
  • View »