This process is a courtesy provided to medical and transportation providers who have a complaint against a TennCare managed care company ("MCC").  Complaints may involve claims payment accuracy and timeliness, credentialing procedures, inability to contact or obtain assistance from the MCC, miscommunication or confusion around MCC policy and procedures, etc.  This process is free.

 

When a provider complaint is received, the TennCare Oversight Division will forward the complaint to the MCC for investigation.  The MCC is required to respond in writing to both the provider and the TennCare Oversight Division by a set deadline to avoid assessment of liquidated damages.

 

If the provider is not satisfied with the MCC's response to the complaint, the provider may seek other remedies to resolve the complaint, including but not limited to, requesting a claims payment dispute be sent to an independent reviewer for resolution or pursuing other available legal or contractual remedies.

 

A provider complaint can be submitted in writing to:

 

Mailing Address:

Tennessee Department of Commerce & Insurance

TennCare Oversight Division

500 James Robertson Parkway, 11th Floor

Nashville, TN 37243-1169

 

Telephone:

Phone: (615) 741-2677

Fax: 615-532-8872

 

Please provide as much information as possible, including copies of claims and remittance advices and/or other denial correspondence from the MCC, if applicable.

 

To learn more about the PROVIDER COMPLAINT process, click here for the Information Packet for PROVIDER COMPLAINTS.

 

To review the Quarterly Summary of Provider Complaints, Click here.