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.
| 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 |
TIP! Sort multiple columns simultaneously by holding down the shift key and clicking a second or even third column header!
| 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 |
Medical Necessity Guidelines