Professional 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. The packet consists of a Provider Participation Agreement, Provider Information Form and IRS Form W-9. All professional providers associated with your agreement must be credentialed by HNFS.
- Applied behavior analysis (ABA) providers: Do not complete this packet. Instead complete the ABA-specific provider participation packet.
- Facilities and ancillary providers: Do not complete this packet. Please send an email to hnfsT2017ProvRel@healthnet.com to request a contract.
Groups of more than 20 providers: Please email a roster to hnfsT2017ProvRel@Healthnet.com rather than completing a Provider Information Form for each provider.
Health Net Federal Services, LLC/TRICARE
Attn: Provider Network Management
PO Box 9410
Virginia Beach, VA 23450-9410
- Created: Aug 19, 2015
- Modified: Jul 24, 2019
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