Provider Forms
- Applied Behavioral Analyst (pdf, 445kb)
- Home Health Providers (pdf, 982kb)
- Home Health Recertification (pdf, 1,179kb)
- In-state & Out-Of-State Group Providers (pdf, 570kb)
- In-State & Out-Of-State Hospital Providers (pdf, 1,306kb)
- In-State & Out-Of-state Individual Provider Joining a Group (pdf, 796kb)
- In-state & Out-Of-State Provider In Private Practice (pdf, 820kb)
- MCC Instate and Out of State Individual Provider Joining a Group (pdf, 659kb)
- MCC Instate and Out of State Provider In Private Practice (pdf, 732kb)
- MCC Instate and Out of state Group Provider (pdf, 348kb)
- Non-Emergency Transportation Providers (pdf, 383kb)
- Miscellaneous Provider Forms
- Address Change (pdf, 27kb)
- Provider Termination Form (pdf, 64kb)
- Certification of Medical Necessity for Abortion (English) (pdf, 100kb)
- Certification of Medical Necessity for Abortion (Spanish) (pdf, 425kb)
- Hysterectomy Acknowledgment Form (pdf, 105kb)
- National Provider Identification (NPI)
- Sterilization Consent Form (pdf, 115kb)
- TennCare Medicaid Benefits Limited Reassigment Authorization (pdf, 680kb)
- Adjustment/Void Form (pdf, 2,157kb)
- Disclosure of Ownership Form (pdf, 78kb)
