Operational Protocol
The Operational Protocol is a document that summarizes how the TennCare demonstration waiver works. It provides an overview of various program elements such as eligibility and enrollment, benefits, quality of care, utilization review, appeals, payments, and financial reporting.
Section |
Subject |
Introduction (pdf, 204kb) |
Introduction |
Chapter 1 (pdf, 61kb) |
Overview |
Chapter 2 (pdf, 169kb) |
Eligibility and Enrollment |
Chapter 3 (pdf, 63kb) |
Benefits and Cost-Sharing |
Chapter 4 (pdf, 121kb) |
Service Delivery |
Chapter 5 (pdf, 47kb) |
Quality of Care |
Chapter 6 (pdf, 71kb) |
Administration |
Attachment A (pdf, 18kb) |
Bureau of TennCare Organization Chart |
Attachment B (pdf, 17kb) |
Definitions of “Insurance” under TennCare |
Attachment C (pdf, 31kb) |
Qualifying Diagnoses for Medical Eligibility |
Attachment D (pdf, 17kb) |
List of Current Managed Care Contractors (MCCs) |
Attachment E (pdf, 14kb) |
Hardship Criteria for MCO Changes |
Attachment F (pdf, 15kb) |
Helpful Telephone Numbers |
Attachment G (pdf, 38kb) |
Terms and Conditions for Access |
Attachment H (pdf, 38kb) |
Waiver Special Terms and Conditions |
Index (pdf, 65kb) |
Index to the Operational Protocol |
