Subrogation

Subrogation is TennCare's right to be reimbursed any funds it has spent for medical care for a TennCare enrollee when an insurance company or another person owes money to the TennCare enrollee because of the injury or illness.

The State of Tennessee is required by federal and State law to seek reimbursement of medical assistance funds it has paid on behalf of TennCare enrollees from responsible or liable third parties. 42 USC §§ 1396a(25) and 1396k, and Tenn. Code Ann. § 71-5-117. Tennessee law creates an automatic assignment of third party benefits from each TennCare enrollee to the State of Tennessee. The law provides that the State, through the Division of TennCare or its MCOs, is "...subrogated to all rights of recovery, for the cost of care or treatment for the injury or illness for which medical assistance is provided..." Even though TennCare and its MCOs are responsible for recovering subrogation interests, each attorney representing a personal injury plaintiff is required to contact TennCare and the appropriate managed care organization(s) to determine the existence of subrogation interests prior to entry of judgment or settlement. The law also clarifies that the "made whole doctrine" does not apply to recoveries made on behalf of TennCare enrollees and describes the factors to be considered in calculating the subrogation interest due the State.

Tenn. Code Ann. § 71-5-117 requires the Division of TennCare to provide the appropriate manner, method and form by which managed care organizations, TennCare or its contractors may be contacted to obtain information regarding subrogation interests of TennCare enrollees.

Simply follow the INSTRUCTIONS FOR FILING (see below) the TennCare Subrogation Interest Identification Inquiry form . A HIPAA-compliant Release form must be filed with an inquiry. Any HIPAA-compliant Release form is acceptable.

Tenn. Code Ann. § 71-5-117(f) gives the Division of TennCare and its MCOs 60 days to provide a written response to an inquiry. If additional time is needed to determine the amount of the subrogation interest, a response containing the total subrogation amount may be provided within 120 days.