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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 |
AAP |
| Benefits |
BEN |
| Contractors |
CON |
| Cost Sharing |
COS |
| Eligibility, Enrollment & Disenrollment |
EED |
| Fraud and Abuse |
F&A |
| HIPAA Policies |
HIP |
| Long Term Care |
LTC |
| Organization |
ORG |
| Payment Issues |
PAY |
| Providers |
PRO |
| Quality of Care |
QC |
| Reporting |
REP |
Click on the policy number of the policy statement desired.
| Subject |
Policy Number |
| Addressing Issues Affecting the Actuarial Soundness of TennCare Rates |
PAY 08-001 (pdf) |
| Aliens, qualified, and refugees |
EED 06-002 (pdf) |
| Aliens, undocumented |
EED 05-001 (pdf) |
| Capitation, payment and methodology for withhold and non-compliance |
PAY 06-001 (pdf) |
| Claims processing, timely filing and prior authorizations |
PAY 06-002 (pdf) |
| Confidentiality of enrollee information |
HIP 06-001 (pdf) |
| Cost effective alternatives |
BEN 08-001 (pdf) |
| Dental, coverage of adult services in a hospital emergency Room |
BEN 06-002 (pdf) |
| Encounter Data & Direct Fee-for-Service Claims Reporting |
CON 08-001 (pdf) |
| EPSDT |
|
|
TSOP 036 |
- Outreach and informing requirements
|
TSOP-036
Addendum 1 |
- Coordination of EPSDT services
|
TSOP-036
Addendum 2 |
- EPSDT screening requirements
|
TSOP-036
Addendum 3 (pdf) |
- Interperiodic screening requirements
|
TSOP-036
Addendum 4 |
| Erectile dysfunction medications |
BEN 06-001 (pdf) |
| False Claims Act Policy |
F&A 08-001 (pdf) |
| Hospice |
BEN 07-001 (pdf) |
| Hospice and Patient Liability |
PAY 07-001 (pdf) |
| Incarcerated people, eligibility of |
EED 06-001 (pdf) |
| MCCs' Responsibilities to Provide Services to TennCare Children
Receiving Special Education Services |
CON 07-003 (pdf) |
| Medicaid State Plan |
ORG 06-003 (pdf) |
| National Provider Identifier (NPI) |
PRO 07-001 (pdf) |
| Newborns, Coverage and Billing, Assignment of |
CON 08-002 (pdf) |
| Orthodontia providers |
QC 05-001 (pdf) |
| Policy manual |
ORG 06-002 (pdf) |
| Minimum Requirements for Provider Directories |
CON 06-001 (pdf) |
| Refugees |
EED 06-002 (pdf) |
| Rules |
ORG 06-004 (pdf) |
| Seeking Payment from a TennCare Enrollee |
PRO 08-01 |
| Services Paid For More Than Allowed Amount |
CON 07-001 |
| Services Paid For More Than Billed Amount |
CON 07-002 |
| Surveys, responses to |
ORG 06-001 (pdf) |
| Third party copays and deductibles, MCCs’ and providers’ responsibilities |
CON 05-001 (pdf) |
Medical Necessity Guidelines
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