Welcome Logout

How to Complete the TRICARE Provider Group Roster

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

  • Provider groups joining the HNFS West Region 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 to 20 or more individual providers
  • Groups who have a delegated credentialing agreement with HNFS (regardless of the number of individual providers)
  • ABA provider groups who need to credential providers or submit behavior technician certification information to HNFS, regardless of the number of providers

Use the instructions below to ensure accuracy when completing each of the roster fields.

Column Column Name Instructions
A Add, Update or Terminate Are you adding, updating or terminating a provider? Choose one.
B Update Reason Reason for the update.
C Last Name Last name of the provider.
D First Name First name of the provider.
E Middle Initial Middle initial of the provider
F Degree

Provider's degree or license

Behavior Technicians (BTs) should indicate 'RBT/BCAT/ABAT/CBT'. Assistant Behavior Analyst should indicate 'BCaBA/QASP'. Behavior Analysts should indicate 'BCBA/BCBA-D/LBA'.

G Gender M=Male, F=Female
H Date of Birth Date of birth of the provider
I Social Security Number Social Security number of the provider
J Primary Care Manager or Specialist Primary or specialty provider indicator. Select which one applies.
K Languages Language the provider speaks
L License Number

Provider's license number

ABA providers should indicate their license or certification number. 

M License Issue Date List the issue date for all licenses held.
N License Expiration Date List the expiration date for all licenses held.
O License State List the state for which all licenses are held.
P Drug Enforcement Administration Number (DEA) List the DEA ID number.
Q Medicare Number Medicare number of the provider. This field can be left blank for ABA providers. 
R Provider's National Provider Identifier Provider's NPI
S CAQH ID Provider the CAQH ID if applicable. This field can be left blank for behavior technicians.
T Specialty 1

Provider's main specialty

Behavior Technicians (BTs) should indicate 'RBT/BCAT/ABAT/CBT'. Assistant Behavior Analyst should indicate 'BCaBA/QASP'. Behavior Analysts should indicate 'BCBA/BCBA-D/LBA'.

U Taxonomy Code for Specialty 1

Taxonomy code for the main specialty

Behavior Analyst for master's level and above: 103K00000X
Assistant Behavior Analyst: 106E00000X
Behavior Technician: 106S00000X

V Specialty 2 Provider's secondary specialty, if applicable
W Taxonomy Code for Specialty 2 Taxonomy code for the secondary specialty, if applicable
X Tax Identification Number Tax ID for the provider
Y Location Name Name of the provider location where the provider practices
Z Address Address where the provider practices
AA
Suite The suite, unit or room number where the provider practices
AB City City where the provider practices
AC State State where the provider practices
AD ZIP ZIP code where the provider practices
AE Phone Phone number where the provider practices
AF Fax Fax number where the provider practices
AG Location NPI Location NPI, also known as a Type II NPI
AH Hospital Based? Is the provider hospital based? (Y=Yes, N=No) If yes, list which hospital.
AI Location: Urgent Care Center (UCC)? Is this a UCC only location for this provider? (Y=Yes, N=No)
AJ Location: Convenient Care Clinic (CCC)? Is this a CCC only location for this provider? (Y=Yes, N=No)
AK Location: Outpatient Physical/Occupational/Speech (PT/OT/ST) Therapy? Is this a PT/OT/ST only location for this provider? (Y=Yes, N=No)
AL Remittance Name Name of the location where checks will be sent
AM Remittance Address Address where checks will be sent
AN Remittance Address 2 Suite, unit, room number, if applicable, where checks will be sent
AO Remittance City City where checks will be sent
AP Remittance State State where checks will be sent.
AQ Remittance ZIP ZIP code where checks will be sent
AR Remittance Phone Phone number of the location where checks will be sent
AS Remittance Fax Fax number, if applicable, of the location where checks will be sent
AT Remittance NPI Same as the location NPI
AU Show in Directory? Y=Yes, N=No
AV Practice Restrictions Does the provider have any practice restrictions? (Y=Yes, N=No) If yes, list the restrictions
AW Is Provider Accepting New Patients? Y=Yes, N=No
AX Military Reserve Status Y=Yes, N=No
AY Telemedicine Services Does the provider offer telemedicine services? (Y=Yes, N=No) If yes, the provider must be licensed in the state(s) in which the services are provided and received. 
AZ Initial Effective Date Initial effective date for provider
BA Recredential Date Date of most recent credentialing