TRICARE East Contracting and CAQH

Last verified: July 14, 2026.

A network-interest form is not network participation. This article explains the separate contracting and credentialing work that turns a certified outpatient mental health provider into an active TRICARE East network provider.

Google question answered: What is required for TRICARE East behavioral health credentialing and contracting? Network status requires a Humana Military agreement, applicable credentialing, CAQH information for behavioral health practitioners, final approval, provider loading, and an effective date.

Editorial note: This article assumes the provider's service location belongs to the TRICARE East Region. It is independent administrative education and does not replace current Humana Military instructions, contract terms, TRICARE policy, or beneficiary-specific eligibility and authorization verification.

Certification, Contracting, and Credentialing Are Different

Certification establishes TRICARE-authorized status. Contracting creates the legal network agreement between Humana Military and the participating entity. Credentialing verifies that the practitioner meets the professional and quality requirements for network participation.

These workstreams may overlap, but they are not interchangeable. A signed document alone may not mean the practitioner is credentialed, and completed credentialing alone may not mean the provider has an active contract or effective date.

What Humana Military Says Network Providers Must Complete

Humana Military's new-provider orientation states that network providers have a signed agreement and complete credentialing with Humana Military. It identifies most behavioral health providers as practitioners who require credentialing.

The same orientation states that practitioners who require credentialing must complete it to be in the network, should not provide care before final credentialing approval, and must be recredentialed every three years.

Practice note: Apply the no-care-before-approval instruction to network participation: do not render or represent services as in-network until final credentialing and the network effective date are confirmed.

Behavioral Health Credentialing Centers on CAQH

For behavioral health practitioners, Humana Military's orientation identifies the CAQH number as the accepted credentialing application input and directs practices to add the practitioner CAQH number in provider self-service.

CAQH should be current, complete, and attested. The name, NPI, practice locations, hospital or group affiliations, license, malpractice coverage, education, work history, and disclosure answers should agree with the information supplied to Humana Military. A mismatch can generate outreach or delay primary-source verification.

• Confirm the practitioner has authorized access for organizations that need to view the CAQH profile.

• Reattest the profile before or during credentialing if attestation is approaching expiration.

• Make sure every requested practice location and telehealth state is represented accurately.

• Resolve gaps in work history and incomplete disclosure explanations before they are requested.

What Credentialing Verifies

Humana Military lists acceptable source verification of education and training, board certification or other professional status, licensure, criminal background, and malpractice history among the credentialing requirements.

Credentialing is not merely a document-upload exercise. The information must be verified against authoritative sources, and discrepancies may require written clarification. Respond to every request by the deadline and keep a copy of the response in the provider credentialing file.

Keep the Contract and Provider Roster Synchronized

The contracting entity, tax ID, service locations, and practitioner roster should tell the same story. Before signing, review the agreement and exhibits for the entity name, TIN, locations, specialties, reimbursement terms, administrative obligations, and any delegated or subcontracted relationships.

At the same time, confirm that the credentialing team has the full intended roster and the correct CAQH number for each practitioner. A clinician omitted from the roster or loaded under the wrong location may not be network-active even when the group agreement has been signed.

• Legal entity and DBA name.

• Contracting TIN or EIN.

• Billing and rendering NPIs.

• Every office and telehealth location.

• Practitioner specialty and license state.

• Ages served, accepting-new-patient status, and telehealth capability.

• Credentialing status and requested effective date.

Do Not Confuse Signature Date With Effective Date

The date the agreement is signed may not be the date the provider is loaded and active. Treat the network relationship as live only after Humana Military confirms final credentialing approval and the applicable network effective date for the practitioner, location, and TIN.

Before scheduling a TRICARE Prime patient as in-network, verify the provider record in provider self-service or through the contracting contact. Also confirm that any required referral or authorization identifies the correct provider and location.

How to Keep the Process Moving

1. Assign one contracting contact and one backup contact for the practice.

2. Maintain a tracker for the agreement, roster, CAQH, licenses, malpractice coverage, outreach requests, and effective dates.

3. Answer contracting and credentialing outreach promptly and in one complete response whenever possible.

4. Use provider self-service secure messaging or contact the TRICARE Community Liaison when an item cannot be resolved through the assigned representative.

5. Request written confirmation of final approval and effective dates before go-live.

Credentialing Completion Checklist

• The correct contracting entity and TIN are shown on the agreement.

• The full practitioner and location roster has been submitted.

• Each behavioral health practitioner CAQH number has been supplied and the profile is current.

• All credentialing questions and verification requests have been resolved.

• Final credentialing approval has been documented.

• The network effective date has been confirmed for each provider and location.

• The practice has a three-year recredentialing reminder.

Key takeaway: The safest go-live rule is simple: no in-network representation, scheduling, or billing until the contract, credentialing approval, provider loading, and effective date all align.

Next in the series: Step 7: TRICARE East Go-Live Setup for Portal Access, Claims, EFT/ERA, and Referrals.

Information verified against official Humana Military sources on July 14, 2026.

Sources

• TRICARE 101: New Provider Orientation

• Provider Certification FAQs

• Provider Self-Service Features and Tutorials

Publication disclaimer: Program rules, network availability, forms, and portal workflows can change. Recheck the linked official sources before relying on this article for a live enrollment decision. This independently prepared content is not affiliated with or endorsed by Humana Military, the Defense Health Agency, or TRICARE.