TennCare
Darin Gordon, Deputy Commissioner

Are you a provider who needs assistance with TennCare related matters?

If so, please contact Provider Services at the member's Managed Care Organization for MCO claims.

For Medicare Cross-Over Claim questions, contact TennCare Provider Services at 1-800-852-2683.

Provider Links

The Centers for Medicare & Medicaid Services (CMS) implemented the Payment Error Rate Measurement (PERM) program to measure improper payments in the Medicaid program and the Children's Health Insurance Program (CHIP). For more information on PERM please visit CMS website by clicking on the link Payment Error Rate Measurement (PERM) for educational guides and question/answer section.

Information regarding language assistance for TennCare enrollees, cultural competency in health care and health care disparities is available.

• Interpretation and Translation Services - Assistance for enrollees with Limited English Proficiency may be obtained by contacting the Provider Services division of an enrollee's managed care organization. Also, the following link will provide I Speak Cards which can assist you with identifying an enrollees primary language - http://www.justice.gov/crt/about/cor/Pubs/ISpeakCards.pdf

 

• Health Care Communication in Plain Language – Providing medical information to enrollees can often be unsuccessful. Assistance with medical communication in plain language is available from the Centers for Disease Control at: CDC Plain Language Thesaurus for Health Communications (doc)

 

• Working with Medical Interpreters - Guidelines for working with medical interpreters.

 

• Cultural Competency and Literacy in Health Care

 

• Multicultural Health Care: A Quality Improvement Guide for planning, implementing and evaluating the provision of multicultural health care.

 

• Resources for understanding disparities in health care:

   

  1. Racial Disparities in Health Care

   

  2. An Approach to Studying Social Disparities in Health and Health Care

   

  3. Socioeconomic Disparities In Health

   

  4. Kaiser's Disparity Update

• Provider Contractual Requirement - EQRO Quarterly Survey Participation (pdf, 29kb)

 

• TennCare Providers now have an RSS feed

 

• Provider Bulletin 2009 Attention: Physicians and Pharmacy Professional Medicare/Medicaid Crossover Providers (pdf, 51kb)

 

• Provider Bulletin 2008 (pdf, 35kb)

 

• Prescriber Notifications (After October 1, 2008)

 

• Notices prior to October 1, 2008 can be found here.

 

• Important Information for Physicians Concerning TennCare Changes in Coverage of Private Duty Nursing and Home Health (pdf, 34kb)

 

• Provider RA Message: Changes have been made to TennCare's payment methodology (pdf, 29kb) for professional Part B crossover claims. This change is effective with dates of service beginning July 1, 2008.

   

  In addition, on July 1, 2008 a member must be QMB, SSI, or under age 21 for TennCare to pay the copays after Medicare for non-covered TennCare services. View the list of Medicare Services Not Covered by TennCare (pdf, 53kb) or TennCare Services Not Covered by Medicare (pdf 67kb) for Adults age 21 and over, pursuant to TennCare Rule 1200-13-13-.10 (pdf, 283kb) and 1200-13-14-.10 (pdf, 310kb).

   

  The non-covered services list for other claims is much more extensive and can be found in TennCare rules at 1200-13-13-.10 (pdf, 283kb).

 

• Tamper-Resistant Prescription Pads Notification (pdf, 53kb)
• Provider Quick Reference Sheet (pdf, 73kb)
• TN.Gov Step-By-Step Online TennCare Eligibility Verification (pdf, 21kb)
• How to Report Third Party Liability (TPL) Insurance Updates (pdf, 52kb)

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Provider Training (pdf, 139kb)