Electronic Data Interchange
The Companion Document (linked below) provides information related to the HIPAA Transactions, as well as the other ways in which health plans and program contractors will receive information from the TennCare administration via various supplemental files.
TennCare HIPAA Companion Guide Front Matter (pdf, 138kb)
The following Companion Documents are available:
- 270 Eligibility Verification Transaction (pdf, 26kb)
- 270 TennCare Outbound Eligibility Verification Transaction (pdf, 28kb)
- 271 Eligibility Response Transaction (pdf, 63kb)
- 271 TennCare Inbound Eligibility Response Transaction (pdf, 118kb)
- 271 Unsolicited Transaction (MCC 834 limitations file) (pdf, 68kb)
- 271U Service Limits Overview Document (pdf, 18kb)
- 271U Service Limits BHO (pdf, 15kb)
- 271U Unsolicited Companion Guide BHO (pdf, 36kb)
- 276 Claims Status Request Transaction (pdf, 80kb)
- 277 Claims Status Response Transaction (pdf, 46kb)
- 278 Prior Authorization (Services Review) Request Transaction (pdf, 115kb)
- 278 Prior Authorization (Services Review) Response Transaction (pdf, 115kb)
- 820 Capitation (Premium Payment) Transaction (pdf, 78kb)
- 834 Enrollment and Audit Transaction (pdf, 67kb)
- 834 2300 Loop Definitions (pdf, 16kb)
- 835 Electronic FFS Claims Remittance Advice Transaction (pdf, 63kb)
- 837D Dental Claims/Encounter Transaction (pdf, 98kb)
- 837I Institutional Claims/Encounter Transaction (pdf, 162kb)
- 837P Professional Claims/Encounter Transaction (pdf, 208kb)
- NCPDP Batch 1.1 Encounter Transaction (pdf, 19kb)
- Taxonomy Crosswalk (pdf, 232kb)
- TennCare Trading Partner Agreement (Legal terms, EDI Form, Security Form) (pdf, 138kb) Agreements are subject to change and users should contact TennCare for questions regarding revised versions.
- TennCare Acceptable Use Policy (pdf, 44kb)
- TennCare TCMIS Security/Information Request Form (pdf, 38kb)
- TPL Coverage Codes Crosswalk (pdf, 17kb)
