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 general questions, eligibility verification or Medicare Cross-Over Claim questions, contact TennCare Provider Services at 1-800-852-2683.
The Centers for Medicare & Medicaid Services (CMS) implemented the Payment Error Rate Measurement (PERM) program to measure improper payments in Medicaid. For more information on PERM please visit CMS PERM website for educational guides and question/answer section Payment Error Rate Measurement (PERM) and view the informational video PERM: Responding to Medical Records/Documentation Requests.
Nursing Facilities and Redetermination
For information regarding redetermination please visit the Long-Term Services & Supports Redetermination page.
Hospital Presumptive Eligibility
TennCare is implementing a Hospital Presumptive (PE) program effective July 1, 2016. Using the Hospital PE process, participating hospitals can screen and provide immediate coverage to qualified individuals -- and help these patients complete the regular TennCare application process. See the following for additional information:
Provider News & Notices
- I/DD Training Offers Free CME Credits for Providers
- If you are a provider of a qualified entity interested in helping someone apply for coverage for Newborn Presumptive Eligibility, please review the following documents:
Update, June 10, 2016: TennCare implemented a Newborn PE program on August 18, 2014. In the interests of expediency, we implemented the Newborn PE program without executing formal agreements with participating hospitals. In the coming months, TennCare will circulate a Newborn PE agreement, which hospitals must execute to continue to perform Newborn PE determinations. Additionally, these hospitals must begin using a new interface at TennCare Online Services later this year. However, hospitals that participate in the Hospital PE program and sign a Hospital PE agreement will not need to sign a second agreement for Newborn PE – and they can use the Hospital PE interface for all PE transactions (including those for newborns).
- Eligibility Assistance for Pregnant Women and Newborns: A Step-by-Step Guide for Hospitals and Birthing Centers
- Newborn Presumptive Eligibility Form (English)
- Newborn Presumptive Eligibility Form (Spanish)
- Newborn Presumptive Eligibility Notice (English)
- Newborn Presumptive Eligibility Notice (Spanish)
- Frequently Asked Questions on Newborn Presumptive Eligibility
- If you are a provider interested in helping someone apply for coverage for emergency medical services, please review the following documents:
- Eligibility Assistance for Reimbursement for Emergency Medical Services: A Step-by-Step Guide for Hospitals
- Emergency Medical Services (EMS) Cover Sheet for Application/Verifications
- Emergency Medical Services Procedures Webinar Slides
- Reimbursement for Emergency Medical Services - Frequently Asked Questions:
- Request for Recommendations and MCO Contracting Information: Behavioral Health Crisis Prevention, Intervention and Stabilization Services for Individuals with Intellectual and Developmental Disabilities
- TennCare Responses to RFR Questions
- Increased Medicaid Payment for Primary Care. In accordance with Section 1202 of the Affordable Care Act, qualified Medicaid primary care providers practicing in family medicine, general internal medicine, pediatric medicine and related subspecialties who meet specified requirements will be eligible to receive enhanced reimbursement rates. This is effective for dates of service on and after January 1, 2013 through December 31, 2014. For information on Primary Care Physician Enhanced Rates
- Provider Contractual Requirement - EQRO Quarterly Survey Participation
- Nondiscrimination Compliance Training
- TennCare Drug Safety Alert to Prescribing Providers
- CMS Accountable Health Communities (AHC) grant
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