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Policy Index

TennCare policies are listed below in alphabetical order. Policies are categorized according to their functional area, and each policy is identified by a number consisting of the year it was finalized and its category (e.g., policy BEN 05-001 was the first Benefits policy finalized in 2005). These are the categories, or functional areas in which policies are placed.

 

Note: TSOPs are now included in the Policy Index.

 

Category Key

Benefits BEN
Contractors CON
Eligibility, Enrollment & Disenrollment EED
Organization ORG
Payment Issues PAY
Program Integrity PI
Providers PRO

 

 

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Subject Policy Number Category Key
Actuarial Soundness of TennCare Rates PAY 08-001 PAY
Cash Receipts ORG 09-002 ORG
Claims processing, timely filing and prior authorizations PAY 06-002 PAY
Contractor and Provider Screening of Employees and Contractors PI 11-002 PI
Cost effective alternatives BEN 08-001 BEN
Credible Allegation of Fraud PI 12-001 PI
Dental, coverage of adult services in a hospital emergency room BEN 06-002 BEN
Disclosure of Ownership or Control; Changes in Ownership; and Program Integrity Reporting Responsibilities PI 10-001 PI
Emergency Medical Services for Illegal and Ineligible Aliens EED 05-001 EED
Enrollment & Disenrollment of Providers in TennCare Managed Care PRO 09-001
Policy Under Revision		 PRO
EPSDT = Overview TSOP 036 TSOP
EPSDT = Outreach and informing requirements TSOP-036 Addendum 1 TSOP
EPSDT = Coordination of EPSDT services TSOP-036 Addendum 2 TSOP
EPSDT = screening requirements TSOP-036 Addendum 3 TSOP
EPSDT = Interperiodic screening requirements TSOP-036 Addendum 4 TSOP
Erectile dysfunction medications BEN 06-001 BEN
False Claims Act Policy PI 08-001 PI
Federal Provider Terminations and Exclusions PI 11-003 PI
Hospice BEN 07-001 BEN
Hospice and Patient Liability PAY 07-001
Policy Under Revision		 PAY
Incarcerated people, eligibility of EED 06-001 EED
Investigative Monitoring & Examination of TennCare Employees' Computer, Email, and Internet Usage ORG 09-003 ORG
MCCs' Responsibilities to Provide Services to TennCare Children Receiving Special Education Services CON 07-003 CON
Medicaid State Plan ORG 06-003 ORG
National Provider Identifier (NPI) PRO 07-001 PRO
Newborns, Coverage and Billing, Assignment of CON 08-002 CON
Official TennCare Addresses CON 09-002 CON
Operational Protocol ORG 09-001 ORG
Orthodontia providers PRO 05-001 PRO
Overpayments and Section 6402 of the Affordable Care Act PI 11-001 PI
Peer Support Services BEN 11-002 BEN
Policy manual ORG 06-002 ORG
Prohibitions of Payments to Institutions or Entities Outside the United States PI 11-004 PI
Provider Application Fees PRO 11-001 PRO
Provider Assignment or Reassignment of Payments PI 11-005 PI
Minimum Requirements for Provider Directories CON 06-001 CON
TennCare Coverage of Buprenorphine (Suboxone and Subutex) for Opiate Addiction BEN 11-001 BEN
TennCare Provider Audit and Recoupment Policy PI 12-002 PI
TennCare Rules ORG 06-004 ORG
TennCare/Medicaid for Qualified Aliens, including Lawfully Admitted Aliens, Refugees, and Asylees EED 06-002 EED
Third party copays and deductibles, MCCs' and providers' responsibilities CON 05-001 CON
Third Party Liability CON 09-001 CON
Transition of Enrollees Between MCOs CON 11-001 CON
When a Provider May Bill a TennCare Enrollee PRO 08-001 PRO
Withholds for MCC non-compliance PAY 06-001 PAY

 

Medical Necessity Guidelines