- What is it?
Subrogation is TennCare's right to be reimbursed any funds it has spent for medical care for a TennCare enrollee when an insurance company or another person owes money to the TennCare enrollee because of the injury or illness.
The State of Tennessee is required by federal and State law to seek reimbursement of medical assistance funds it has paid on behalf of TennCare enrollees from responsible or liable third parties. 42 USC §§ 1396a(25) and 1396k, and Tenn. Code Ann. § 71-5-117. Tennessee law creates an automatic assignment of third party benefits from each TennCare enrollee to the State of Tennessee. The law provides that the State, through the Bureau of TennCare or its MCOs, is "...subrogated to all rights of recovery, for the cost of care or treatment for the injury or illness for which medical assistance is provided..." Even though the Bureau and its MCOs are responsible for recovering subrogation interests, each attorney representing a personal injury plaintiff is required to contact the Bureau and the appropriate managed care organization(s) to determine the existence of subrogation interests prior to entry of judgment or settlement. The law also clarifies that the "made whole doctrine" does not apply to recoveries made on behalf of TennCare enrollees and describes the factors to be considered in calculating the subrogation interest due the State.
- How do I find out if a TennCare enrollee owes money to the State?
Tenn. Code Ann. § 71-5-117 requires the Bureau of TennCare to provide the appropriate manner, method and form by which managed care organizations, the Bureau or its contractors may be contacted to obtain information regarding subrogation interests of TennCare enrollees.
Simply follow the INSTRUCTIONS FOR FILING (see below) the TennCare Subrogation Interest Identification Inquiry form . A HIPAA-compliant Release form must be filed with an inquiry. Any HIPAA-compliant Release form is acceptable.
- How long does it take to get subrogation information about TennCare enrollees?
Tenn. Code Ann. § 71-5-117(g) gives the Bureau of TennCare and its MCOs 60 days to provide a written response to an inquiry. Upon request, an extension of an additional 60 days (for a total of 120 days) may be obtained if needed to gather all the information.
Instructions for Filing
Complete the TennCare Subrogation Interest Identification Inquiry form and a HIPAA-compliant Release form. Follow the instructions in steps 1 and 2 below:
|FAX both forms to:
TennCare ℅ HMS
1-866-963-6608 or contact 1-866-963-6607
|Send both forms by either FAX or CERTIFIED MAIL RETURN RECEIPT REQUESTED to the PATIENT / enrollee's MCO:|
Amerigroup Community Care Subrogation Specialist Cost Containment Unit
P.O. Box 62509
Virginia Beach, VA 23466
UnitedHealthcare Community Plan ℅ Ingenix Subrogation Services>
12125 Technology Drive
Eden Prairie, MN 55344
(BlueCare or TennCare Select)
1 Cameron Hill Circle
Chattanooga, TN 37402