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Home > Providers > Provider Education Manual > Section 3: TRICARE Preferred Provider Network & Provider Credentialing
Section 3: TRICARE Preferred Provider Network & Provider Credentialing
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What is a Preferred Provider?
TRICARE Preferred Providers enter into a formal agreement with
International SOS to provide medical care or services to
members of the U.S. military. Preferred Providers may be
individuals, group practices, hospitals, pharmacies, durable
medical equipment providers or other facilities.
Benefits of Joining the Preferred Provider Network
The Preferred Provider Network benefits both host nation
providers and the U.S. military. When U.S. military members need
host nation care, they are referred to preferred providers
whenever possible.
International SOS' Global Assistance Network Management team is available 24/7 to provide information, support and assistance to preferred providers.
In turn, preferred providers offer a number of benefits to U.S. patients:
International SOS' Global Assistance Network Management team is available 24/7 to provide information, support and assistance to preferred providers.
In turn, preferred providers offer a number of benefits to U.S. patients:
- Patients feel confident that are receiving quality care, because preferred providers' credentials have been reviewed.
- Beneficiaries are more comfortable, because their provider can directly or indirectly communicate with them in English.
- TOP Prime and TOP Prime Remote beneficiaries can receive assistance in filing claims.
How to Become a Preferred Provider
We encourage you to contact your International SOS Regional
Global Assistance Network Coordinator to find out more about
joining the Preferred Provider Network. For a full list of phone
numbers click here.
Your Network Coordinator will provide you with all the information you need, along with a Mutual Cooperation Protocol between you and International SOS. Once you have reviewed the document, provided the required information (including your credentials), and both parties have signed the Mutual Cooperation Protocol, you may become part of the network.
Examples of credentials include a copy of professional license, proof of malpractice insurance (where applicable), fee schedules and other information.
Your Network Coordinator will provide you with all the information you need, along with a Mutual Cooperation Protocol between you and International SOS. Once you have reviewed the document, provided the required information (including your credentials), and both parties have signed the Mutual Cooperation Protocol, you may become part of the network.
Examples of credentials include a copy of professional license, proof of malpractice insurance (where applicable), fee schedules and other information.
Preferred Provider Responsibilities
A detailed list of preferred provider responsibilities can be found
in the International SOS Mutual Cooperation Protocol.
Preferred providers are expected to follow the guidelines below:
Preferred providers are expected to follow the guidelines below:
- Do not discriminate based on sex, race, color, creed or religion.
- Communicate directly or indirectly with patients in English.
- Identify and assist TRICARE patients who seek emergency care and properly authorized routine and specialty care.
- Maintain health records for TRICARE beneficiaries and, whenever possible, make English-language summaries of these records available for inclusion in the beneficiaries' U.S. military medical records.
- Promptly return consultation results to the referring Military Treatment Facility (Note: Routine consultation reports should be returned within 10 working days, emergency consultation reports should be returned within 24 hours).
Keeping Your Provider File Current
International SOS Global Assistance Network Coordinators are
committed to keeping preferred provider files current and
accurate. Reviewing this information on an annual basis helps
prevent confusion and avoid problems.
Listed below are events that will require a yearly update to your preferred provider file:
Europe, Middle East & Africa:
providerseurasiaafrica@internationalsos.com
Asia Pacific:
providersasiapacific@internationalsos.com
Latin America and Canada:
providerslatinamerica@internationalsos.com
Puerto Rico:
provider.inquiries.PR@internationalsos.com
Listed below are events that will require a yearly update to your preferred provider file:
- The address from which you provide care changes.
- Your billing address or other billing information changes.
- Your phone, fax, email or other contact information changes.
- Your office hours change.
- Your credentials change or are renewed.
Europe, Middle East & Africa:
providerseurasiaafrica@internationalsos.com
Asia Pacific:
providersasiapacific@internationalsos.com
Latin America and Canada:
providerslatinamerica@internationalsos.com
Puerto Rico:
provider.inquiries.PR@internationalsos.com
Preferred Provider Quality Mission
International SOS is committed to delivering quality medical care
to all beneficiaries living overseas. By joining the Preferred
Provider Network, you can be proud to know that you are part of
this mission.
International SOS works with you to understand how problems can be corrected or improved. We also work with you to develop a plan for avoiding quality- or service-related problems in the future.
The Mutual Cooperation Protocol, together with our ongoing development and maintenance of the Preferred Provider Network, helps International SOS ensure our quality performance.
From time to time, you may be contacted by International SOS or TRICARE directly, to assess and monitor your overall satisfaction with TOP, including service, accessibility, provider education and other areas.
International SOS works with you to understand how problems can be corrected or improved. We also work with you to develop a plan for avoiding quality- or service-related problems in the future.
The Mutual Cooperation Protocol, together with our ongoing development and maintenance of the Preferred Provider Network, helps International SOS ensure our quality performance.
From time to time, you may be contacted by International SOS or TRICARE directly, to assess and monitor your overall satisfaction with TOP, including service, accessibility, provider education and other areas.
TOP Regional Network Managers
A dedicated TOP Regional Global Assistance Network Manager
and their respective team of dedicated network specialists is
available to assist you. The TOP Network team includes nurses,
administrators and quality staff dedicated to TOP. This team is
responsible for working with Host Nation Providers in their
respective countries, building and maintaining relationships, and
answering questions about TOP covered services, authorizations
and submitting your claims for payment.
Access to Care
International SOS is committed to ensuring that TOP beneficiaries
have access to quality care with suitable wait times and other
standards of service delivery. Below is an overview of these
standards and guidelines, as established by TRICARE Policy.
Note: If you have any questions or concerns about your ability to meet these standards and guidelines, please contact International SOS.
| TOP Access to Care Standards | ||
|---|---|---|
| Element | Definition | Service Standard |
| Wait Time for an Appointment | When a TRICARE Prime beneficiary contacts you to make an appointment, you will are expected to follow the guidelines below for seeing the patient: • Well-patient visit or Specialty Care Referral: 4 weeks • Routine Visit: 1 week • Urgent Care: 24 hours |
Well-patient: 4 weeks Routine: 1 week Urgent: 24 hours |
| Office Waiting Times | When a TRICARE beneficiary comes in for their appointment, the office waiting time to see their clinician can be no more than 30 minutes – unless the clinician’s schedule is disrupted because of a medical emergency. | No more than 30 minutes |
| Availability of Emergency Services | Providers of emergency care services are expected to be available 24 hours a day, 7 days a week. Emergency care providers are selected on this basis. If your availability changes, you must notify us immediately. | 24 hours a day / 7 days a week |
Note: If you have any questions or concerns about your ability to meet these standards and guidelines, please contact International SOS.
Provider Credentialing Process
With 25 years of experience in international health care and
medical assistance services, and operations in 70+ countries,
International SOS understands that health care delivery differs
significantly from country to country.
Factors such as local country legislation and regulations are considered, as well as existing health care infrastructure and any unique challenges that may impact the delivery of care in a specific region.
International SOS takes these differences into account, when reviewing provider capabilities and determining eligibility to participate in TOP. Local Global Assistance Network managers use country-specific credentialing guidelines and we work with host nation licensing agencies, to maintain accurate and up-todate information about local standards.
Provider performance is monitored on an ongoing basis so that potential problems can be addressed before they impact beneficiary satisfaction and quality of care. Provider satisfaction surveys are also used to monitor your overall satisfaction with International SOS, including how accessible or helpful our call center and TOP Network staff is in assisting with claims processing, provider education, and other areas.
The following credentialing items are required to become part of the TRICARE Preferred Provider Network:
Factors such as local country legislation and regulations are considered, as well as existing health care infrastructure and any unique challenges that may impact the delivery of care in a specific region.
International SOS takes these differences into account, when reviewing provider capabilities and determining eligibility to participate in TOP. Local Global Assistance Network managers use country-specific credentialing guidelines and we work with host nation licensing agencies, to maintain accurate and up-todate information about local standards.
Provider performance is monitored on an ongoing basis so that potential problems can be addressed before they impact beneficiary satisfaction and quality of care. Provider satisfaction surveys are also used to monitor your overall satisfaction with International SOS, including how accessible or helpful our call center and TOP Network staff is in assisting with claims processing, provider education, and other areas.
The following credentialing items are required to become part of the TRICARE Preferred Provider Network:
| Criteria | Standards |
|---|---|
| Signed Provider Agreement | An International SOS Provider Agreement (Mutual Cooperation Protocol) must be signed, in order to be part of the TOP Preferred Provider Network. |
| Meet the Standards for Authorization | All health care services for TOP Prime and TOP Prime Remote beneficiaries are provided on an authorized basis. You will be expected to accept International SOS’ authorization for services, and agree to submit Claims and itemized invoices for payment to International SOS, through our subcontractor Wisconsin Physicians Service (WPS). You agree not to balance bill a Prime beneficiary for uncovered services. |
| Valid Malpractice Insurance (If Applicable) | You must have professional liability insurance, if this is required by the laws of your respective host nation. If you are a country, state, province, etc., entity provider, and you are self-insured, then you are not required to have malpractice insurance. |
| Licensure / Registration | You must meet the requirements for licensure / registration as specified by your local Governmental authority or licensing board. This includes having a valid license or registration in the host nation where you practice. |
| Evidence of Professional Qualifications and Experience | You must be a graduate of an accredited program in health care sciences. This includes completing a certificate (residency) program, leading to certification in general medicine, family practice, gynecology, pediatrics, dentistry or other disciplines/specialties recognized by the applicable certifying agency in your country. |
| English Language Proficiency | You must be able to proficiently communicate in English (both verbally and in writing), or to provide English translation and interpretation services at the time of service. |
Beneficiary Access to TOP Preferred Providers
All Host Nation Providers with a signed Mutual Cooperation
Protocol and approved credentials on file with International SOS
will be published on this website and displayed
for beneficiaries.
The published list of providers is matched with International SOS' internal database of TOP preferred network providers, so it is important that you keep all of your information up-to-date.
TOP beneficiaries using the www.tricare-overseas.com website have the comfort of knowing that listed providers are "quality assured" and recommended for care locally. Detailed information about referrals and authorizations is also included on this website, making provider selection easier and more convenient for beneficiaries.
Note: If you would not like your provider information published, please let your TOP Regional Network Contact know.
The published list of providers is matched with International SOS' internal database of TOP preferred network providers, so it is important that you keep all of your information up-to-date.
TOP beneficiaries using the www.tricare-overseas.com website have the comfort of knowing that listed providers are "quality assured" and recommended for care locally. Detailed information about referrals and authorizations is also included on this website, making provider selection easier and more convenient for beneficiaries.
Note: If you would not like your provider information published, please let your TOP Regional Network Contact know.