TennCare
Darin Gordon, Deputy Commissioner

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 Medicare Cross-Over Claim questions, contact TennCare Provider Services at 1-800-852-2683.

Provider Links

Dental Services	Pharmacy
Electronic Data Interchange	Provider Miscellaneous Forms
HEDIS Reports	Provider Registration
Managed Care Organizations	Provider Resources
Medicare/Medicaid Crossover Claims	TennCare/Medicaid EHR Incentive Program
Medicare/Medicaid Current P.O. Box List	Verify Eligibility
National Provider Identification	Web Functionality & Access

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.

• Do your patients understand their treatment plans? Help with achieving that goal may be found by viewing:
• The North Carolina Health Literacy - “Teach Back Method" at: http://nchealthliteracy.org/teachingaids.html.
• The National Patient Safety Foundation- "Ask Me 3" video at: http://www.npsf.org/for-healthcare-professionals/programs/ask-me-3/
• The American Medical Association- "Health Literacy and Patient Safety http://www.youtube.com/watch?v=cGtTZ_vxjyA

• Information to assist providers with communicating with Limited English Proficient (LEP) enrollees or those classified as having a low level of health care literacy is available at:
• Interpretation and Translation Services - Assistance for enrollees with Limited English Proficiency may be obtained by contacting the Provider Services division of an enrollee's managed care organization. Also, the following link will provide I Speak Cards which can assist you with identifying an enrollees primary language - http://www.justice.gov/crt/about/cor/Pubs/ISpeakCards.pdf
• Working with Medical Interpreters - Guidelines for working with medical interpreters.
• Health Care Communication in Plain Language - Assistance with medical communication in plain language is available from the Centers for Disease Control at: CDC Plain Language Thesaurus for Health Communications (doc)


• Do you need basic information related to Cultural Competency and Literacy in Health Care?


• Do you need basic information related to disparities in health care? Information may be found at:
  1. http://www.ahrq.gov/research/findings/nhqrdr/nhqrdr10/minority.html
  2. http://www.healthypeople.gov/2020/about/disparitiesAbout.aspx
  3. Socioeconomic Disparities In Health
  4. Kaiser's Disparity Update

• 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. more...


• Payment Error Rate Measurement (PERM) Provider Audits Webinars
• Provider Contractual Requirement - EQRO Quarterly Survey Participation (pdf, 29kb)
• TennCare Providers now have an RSS feed
• Provider Bulletin 2009 Attention: Physicians and Pharmacy Professional Medicare/Medicaid Crossover Providers (pdf, 51kb)
• Provider Bulletin 2008 (pdf, 35kb)
• Prescriber Notifications (After October 1, 2008)
  • Notices prior to October 1, 2008 can be found here.
• Important Information for Physicians Concerning TennCare Changes in Coverage of Private Duty Nursing and Home Health (pdf, 34kb)
• Provider RA Message: Changes have been made to TennCare's payment methodology (pdf, 29kb) for professional Part B crossover claims. This change is effective with dates of service beginning July 1, 2008. In addition, on July 1, 2008 a member must be QMB, SSI, or under age 21 for TennCare to pay the copays after Medicare for non-covered TennCare services. View the list of Medicare Services Not Covered by TennCare (pdf, 53kb) or TennCare Services Not Covered by Medicare (pdf 67kb) for Adults age 21 and over, pursuant to TennCare Rule 1200-13-13-.10 (pdf, 283kb) and 1200-13-14-.10 (pdf, 310kb). The non-covered services list for other claims is much more extensive and can be found in TennCare rules at 1200-13-13-.10 (pdf, 283kb).

• Tamper-Resistant Prescription Pads Notification (pdf, 53kb)
• Provider Quick Reference Sheet (pdf, 73kb)
• TN.Gov Step-By-Step Online TennCare Eligibility Verification (pdf, 21kb)
• How to Report Third Party Liability (TPL) Insurance Updates (pdf, 52kb)
• Individual Provider Registration Process (pdf, 28kb)

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Provider Training (pdf, 139kb)