View the TRICARE Provider Profile

Use the TRICARE Provider Profile page to view TRICARE provider profile information for your facility.

  1. To access the TRICARE Provider Profile page, select Go To > Government Payor Research > TRICARE > Provider Profile.

    Note: If your facility shares its database with other facilities, the Provider Type(s) field appears as a drop-down list that lets the you select the correct provider type. The options in the drop-down list display the provider type, facility type, and facility description.

  2. Select an effective date and click Display Profile.
    • The default is today’s date and will display all of the current information.
    • The categories that display are determined by your facility, but can include the following:
      • Acute, Inpatient
      • Acute, Outpatient
      • Psych
      • Skilled Nursing Facility (SNF)
      • Hospice
      • Critical Access Hospital (CAH)
      • Inpatient Rehab
      • Sole Community Hospital (SCH)

      Note: Some categories are mutually exclusive.

  3. View the TRICARE Provider Profile information.
  4. To view the RUG table, click Show RUG Table. The RUG Table displays.
  5. To view the revenue code rates for Hospice, click Show REV CODE Table. The Hospice Revenue Code Rates table displays.
  6. If your facility is set up for Rehab and LTCH, use the Click here to see Medicare Rehab Factorslink to view the rehab factors and Click here to see Medicare LTCH Factors link to view the LTCH factors.

The following table describes each of the fields on the TRICARE Provider Profile page. 

Field

Description

Inpatient Acute (IPPS - DRGs)

Urban / Rural

Indicates if it an urban facility or a rural facility

Metropolitan Statistical Area (MSA)

The Metropolitan Statistical Area (MSA) rate.

Area Wage Index (W. I.)

Wage Index

IDME Factor

Indirect Medical Education factor

ASA Labor

Labor related portion of Adjusted Standardized Amounts (ASA)

ASA Non-Labor

Non-labor related portion of Adjusted Standardized Amounts

Cost to Charge Ratio

The ratio for determining hospital cost based on charges

Children’s Hospital Differential

The differential for Children’s Hospitals.

ASA Amount

Adjusted Standardized Amounts

Fixed Loss Threshold

The fixed-loss amount used to determine the threshold set by the state Medicaid.

NOSCASTC

National Operating Standard Cost as a Share of Total Costs

Value Based Purchasing (VBP) Factor

Displays the facility's Medicare Value Based Purchasing factor.

TRICARE Inpatient pricing uses the published Medicare VBP factor when calculating reimbursement. While Medicare updates its VBP factors on October 1st of each year, TRICARE delays implementation of that new rate until the following January 1st, in line with TRICARE Calendar-Year pricing.

  • The FY23 Medicare VBP factors (published October 1, 2022) are used for TRICARE pricing from January 1, 2023 - December 31, 2023.

  • The FY24 Medicare VBP factors (published October 1, 2023) take effect for TRICARE effective January 1, 2024.

Outpatient Acute

Zip Code

The facility’s zip code.

CMAC Locality

DHA assigned geographical location

Metropolitan Statistical Area (MSA)

The Metropolitan Statistical Area (MSA) rate.

Area Wage Index (W. I.)

Wage Index

Cost to Charge Ratio

The ratio for determining hospital cost based on charges

Acute Psych (PPS - Per Diem)

Full-Day Partial Hospitalization Rate

The reimbursement rate for an outpatient service that is longer than four hours.

Note: This defaults at the regional rate, but it can be contract specific.

Half-Day Partial Hospitalization Rate

The reimbursement rate for an outpatient service that is less than four hours.

Note: This defaults at the regional rate, but it can be contract specific.

Full-Day Hospitalization Rate

The daily reimbursement rate for psychiatric services.

SCH Psych (Cost To Charge)

ChampVA CTC

The ratio for determining Sole Community Hospital (SCH) psychiatric cost based on charges.

SNF (PPS - Per Diem)

Urban / Rural

Indicates if it an urban facility or a rural facility

Metropolitan Statistical Area (MSA)

The Metropolitan Statistical Area (MSA) rate.

Area Wage Index (W. I.)

Wage Index

Resource Utilization Group (RUG) Table

Click Show RUG Table to view the SNF RUG rates.

Hospice (PPS - Per Diem)

Urban / Rural

Indicates if it an urban facility or a rural facility

Core Based Statistical Area (CBSA)

The Core Based Statistical Area.

Area Wage Index (W. I.)

Wage Index

Revenue Code Rate

Click Show REV CODE Table to view the Hospice revenue code rates.

CAH (PPS - Per Diam)

 

Outpatient CCR

Facility specific CCR.

Inpatient CCR

Facility specific CCR.

Statewide IP CCR

Published CCR for state.

Statewide OP CCR

Published CCR for state.

Inpatient Rehab

Indicates the reimbursement rate for IP Rehab as a percentage of billed charges.