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Network Provider Information Form

Existing Network Providers 
Network providers (excluding ABA providers) can complete and submit this form to request practice information updates. Follow the instructions on the cover sheet for submission. Please allow 21 days for processing. 

New Providers Interested in Joining the Network
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, 60–90 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 Group Roster rather than a PIF for each provider. 
  • ABA providers must complete the TRICARE Provider Group 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: Mar 9, 2020
  • Modified: Mar 9, 2020
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