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Policy Index

TennCare policies are listed below in alphabetical order. Policies are categorized according to their functional area, and each policy is identified by a number consisting of the year it was finalized and its category (e.g., policy BEN 05-001 was the first Benefits policy finalized in 2005). These are the categories, or functional areas in which policies are placed.

 

Note: TSOPs are now included in the Policy Index.

 

Category Key

Appeals Processes APP Long Term Care LTC
Benefits BEN Organization ORG
Contractors CON Payment Issues PAY
Cost Sharing COS Providers PRO
Eligibility, Enrollment & Disenrollment EED Quality of Care QC
Fraud and Abuse F&A Reporting REP
HIPAA Policies HIP    

 

 

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Subject Policy Number Category Key
Addressing Issues Affecting the Actuarial Soundness of TennCare Rates PAY 08-001 PAY
Capitation, payment and methodology for withhold and non-compliance PAY 06-001 PAY
Cash Receipts ORG 09-002 ORG
Claims processing, timely filing and prior authorizations PAY 06-002 PAY
Cost effective alternatives BEN 08-001 BEN
Dental, coverage of adult services in a hospital emergency Room BEN 06-002 BEN
Emergency Medical Services for Illegal and Ineligible Aliens EED 05-001 EED
Encounter Data & Direct Fee-for-Service Claims Reporting CON 08-001 CON
Enrollment & Disenrollment of Providers in TennCare Managed Care PRO 09-001 PRO
EPSDT = Overview TSOP 036 TSOP
EPSDT = Outreach and informing requirements TSOP-036 Addendum 1 TSOP
EPSDT = Coordination of EPSDT services TSOP-036 Addendum 2 TSOP
EPSDT = screening requirements TSOP-036 Addendum 3 TSOP
EPSDT = Interperiodic screening requirements TSOP-036 Addendum 4 TSOP
Erectile dysfunction medications BEN 06-001 BEN
False Claims Act Policy F&A 08-001 F&A
Hospice BEN 07-001 BEN
Hospice and Patient Liability PAY 07-001 PAY
Incarcerated people, eligibility of EED 06-001 EED
MCCs' Responsibilities to Provide Services to TennCare Children Receiving Special Education Services CON 07-003 CON
Medicaid State Plan ORG 06-003 ORG
National Provider Identifier (NPI) PRO 07-001 PRO
Newborns, Coverage and Billing, Assignment of CON 08-002 CON
Operational Protocol ORG 09-001 ORG
Orthodontia providers PRO 05-001 PRO
Policy manual ORG 06-002 ORG
Minimum Requirements for Provider Directories CON 06-001 CON
Rules ORG 06-004 ORG
Seeking Payment from a TennCare Enrollee PRO 08-001 PRO
Surveys, responses to ORG 06-001 ORG
TennCare/Medicaid for Qualified Aliens, including Lawfully Admitted Aliens, Refugees, and Asylees EED 06-002 EED
Third party copays and deductibles, MCCs’ and providers’ responsibilities CON 05-001 CON
Third Party Liability CON 09-001 CON
Use of Official TennCare Addresses CON 09-002 CON

 

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