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TennCare Oversight Division

Our Mission

 

The TennCare Oversight Division protects the public health and the integrity of the TennCare Program by overseeing, examining and monitoring Health Maintenance Organizations and Behavioral Health Organizations participating in the program. The division ensures that the HMOs and BHOs under contract with the state are in compliance with statutory and contractual requirements relating to their financial responsibility, stability and integrity.

 

To ensure that health care services are not interrupted, all HMOs and BHOs must provide adequate provider networks, remain financially sound and reimburse providers fairly and timely. according to established guidelines. The TennCare Oversight Division is responsible for enforcing the state’s health maintenance organization laws and prepaid limited health services organization law relating to the TennCare Program.

 

The responsibilities of this division include reviewing and analyzing financial status, market conduct activities (claims processing operations, prompt pay requirements) and compliance with federal and state laws, rules and regulations as they apply to the TennCare Program MCO operations. The division also supports the Selection Panel for TennCare Reviewers, overseeing the independent review of provider claims denial program and administering that program for the Panel.

 

TennCare provides health coverage to about 1.3 million Tennesseans.