Bureau of TennCare

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	Introduction
Chapter 1	Overview
Chapter 2	Eligibility and Enrollment
Chapter 3	Benefits and Cost-Sharing
Chapter 4	Service Delivery
Chapter 5	Quality of Care
Chapter 6	Administration
Attachment A	Bureau of TennCare Organization Chart
Attachment B	Definitions of “Insurance” under TennCare
Attachment C	Qualifying Diagnoses for Medical Eligibility
Attachment D	List of Current Managed Care Contractors (MCCs)
Attachment E	Hardship Criteria for MCO Changes
Attachment F	Helpful Telephone Numbers
Attachment G	Terms and Conditions for Access