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How to file a medical appeal?

Use this form ONLY to appeal. DO NOT use it to apply for TennCare.

Step 1. Print this TennCare Medical Appeal form .

Step 2. Fill it out.

Step 3. Make a copy of the completed form to keep for your records.

Step 4. Mail to

TennCare Solutions
PO Box 593, Nashville, TN 37202-0593

OR FAX (toll-free) 1-888-345-5575

Keep a copy of the page that shows your fax went through.

Kurdish, Arabic, Somali, Bosnian or Vietnamese

QUESTIONS: Telephone (toll-free) 1-800-878-3192 TTY/TDD: 1-866-771-7043

 

Do you need to know how to file an appeal for medical services?

Have your services been denied, delayed, reduced, suspended, or terminated?

Call your health plan first. Their free phone number is on your TennCare card.

Don’t have your card? OR, still have problems AFTER you call your health plan?
Then, call TennCare Solutions for free at 1-800-878-3192. They can help you with your problem OR help you file an appeal. An appeal is one way to fix problems with TennCare.

You have the right to appeal if:

  • TennCare says NO when you ask for health care.
  • OR, TennCare stops or changes your health care.
  • OR, you have to wait too long to get health care.
  • OR, you have health care bills you think TennCare should have paid for, but didn't.
  • OR, there's some other reason you can't get health care when you need it.

You only have 30 days to appeal after you find out that there is a problem.
You can ask someone to help you file an appeal.

Usually, your appeal is decided within 90 days after you file it. But, if you have an emergency and your health plan agrees that you do, you will get an expedited appeal. An expedited appeal will be decided in 3 business days.

An emergency means if you don’t get a decision within 3 business days, it could seriously jeopardize (put in danger):

  • your life;
  • your physical health;
  • your mental health; or
  • your ability to reach, get back, or keep your mind and body as healthy as possible.

If you think you have an emergency, you can ask TennCare for an expedited appeal. Your doctor can also ask TennCare for an expedited appeal for you.  If your doctor wants to ask for this kind of appeal, your doctor can complete a “Provider’s Expedited Appeal Certificate” and fax it to TennCare.  Your doctor should fax your medical records to us also.  Your doctor can get the page from our website. Go to tn.gov/tenncare. Click “Providers,” and then click “Miscellaneous Provider Forms.” TennCare and your health plan will look at your request and then decide if your appeal should be expedited.  If it should be, you will get a decision on your appeal in 3 business days.

Have questions? Need help? Want to appeal?

Call TennCare Solutions for free at 1-800-878-3192.
They can help solve many problems before you have to appeal.
They can also take your appeal over the phone.

We do not allow unfair treatment in TennCare. No one is treated differently because of race, color, birthplace, religion, language, sex, age, or disability. Do you think you’ve been treated unfairly? Then call the Tennessee Health Connection for free at 1-855-259-0701.