Are you a provider who needs assistance with TennCare related matters?
If so, please contact Provider Services at the member's Managed Care Organization for MCO claims.
For general questions, eligibility verification or Medicare Cross-Over Claim questions, contact TennCare Provider Services at 1-800-852-2683.
The Centers for Medicare & Medicaid Services (CMS) implemented the Payment Error Rate Measurement (PERM) program to measure improper payments in Medicaid. For more information on PERM please visit CMS PERM website for educational guides and question/answer section Payment Error Rate Measurement (PERM) and view the informational video PERM: Responding to Medical Records/Documentation Requests.
Nursing Facilities and Redetermination
Hospital Presumptive Eligibility
TennCare is implementing a Hospital Presumptive (PE) program effective July 1, 2016. Using the Hospital PE process, participating hospitals can screen and provide immediate coverage to qualified individuals -- and help these patients complete the regular TennCare application process. See the following for additional information:
Provider News & Notices
- Alzheimer’s/Dementia Training offers Free CME Credits for Providers
- I/DD Training Offers Free CME Credits for Providers
- Request for Recommendations and MCO Contracting Information: Behavioral Health Crisis Prevention, Intervention and Stabilization Services for Individuals with Intellectual and Developmental Disabilities
- TennCare Responses to RFR Questions
- Increased Medicaid Payment for Primary Care. In accordance with Section 1202 of the Affordable Care Act, qualified Medicaid primary care providers practicing in family medicine, general internal medicine, pediatric medicine and related subspecialties who meet specified requirements will be eligible to receive enhanced reimbursement rates. This is effective for dates of service on and after January 1, 2013 through December 31, 2014. For information on Primary Care Physician Enhanced Rates
- Provider Contractual Requirement - EQRO Quarterly Survey Participation
- TennCare Drug Safety Alert to Prescribing Providers
- CMS Accountable Health Communities (AHC) grant
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340B Covered Entities Carved-In for TennCare
Two Webinars were hosted by Myers and Stauffer on TennCare’s behalf on Thursday, March 18, 2021 announcing new claims submission rules for medical and pharmacy covered entities.