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Policy Index

TennCare and related HCFA 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.

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
340B Drug Pricing Program PRO 13-002 PRO
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
Enhanced Rate for Primary Care PRO 13-003 PRO
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
Investigative Monitoring & Examination of HCFA 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
Minimum Requirements for Provider Directories CON 06-001 CON
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
Ordering, Referring, or Prescribing Providers PRO 13-001 PRO
Orthodontia Providers PRO 05-001 PRO
Overpayments and Section 6402 of the Affordable Care Act PI 11-001 PI
Paper Checks and Direct Deposits PAY 14-001 PAY
Peer Recovery 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
Provider Terminations for Inactivity PI 13-001 PI
TennCare Coverage of Buprenorphine for Opioid Addiction BEN 11-001 BEN
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
Timely Filing PAY 13-001 PAY
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