Policies

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.

Subject Policy Number
340B Drug Pricing Program PRO 13-002 PDF icon to symbol the link is a pdf
Actuarial Soundness of TennCare Rates PAY 08-001 PDF icon to 

symbol the link is a pdf
Cash Receipts ORG 09-002 PDF icon to 

symbol the link is a pdf
Claims Processing, Timely Filing and Prior Authorizations PAY 06-002 PDF icon to 

symbol the link is a pdf
Contractor and Provider Screening of Employees and Contractors PI 11-002 PDF icon to symbol 

the link is a pdf
Cost Effective Alternatives BEN 08-001 PDF icon to 

symbol the link is a pdf
Coverage Review of Newly Released or Approved Pharmaceuticals BEN 15-001 PDF icon to 

symbol the link is a pdf
Credible Allegation of Fraud PI 12-001 PDF icon to symbol 

the link is a pdf
Dental, Coverage of Adult Services in a Hospital Emergency Room BEN 06-002 PDF icon to 

symbol the link is a pdf
Disclosure of Ownership or Control; Changes in Ownership; and Program Integrity Reporting Responsibilities PI 10-001 PDF icon to symbol 

the link is a pdf
Enhanced Rate for Primary Care PRO 13-003 PDF icon to 

symbol the link is a pdf
Erectile Dysfunction Medications BEN 06-001 PDF icon to 

symbol the link is a pdf
False Claims Act Policy PI 08-001 PDF icon to symbol 

the link is a pdf
Federal Provider Terminations and Exclusions PI 11-003 PDF icon to symbol 

the link is a pdf
Hospice BEN 07-001 PDF icon to 

symbol the link is a pdf
Investigative Monitoring & Examination of HCFA Employees’ Computer, Email, and Internet Usage ORG 09-003 PDF icon to 

symbol the link is a pdf
MCCs' Responsibilities to Provide Services to TennCare Children Receiving Special Education Services CON 07-003 PDF icon to 

symbol the link is a pdf
Medicaid State Plan ORG 06-003 PDF icon to 

symbol the link is a pdf
Minimum Requirements for Provider Directories CON 06-001 PDF icon to 

symbol the link is a pdf
National Provider Identifier (NPI) PRO 07-001 PDF icon to 

symbol the link is a pdf
Newborns, Coverage and Billing, Assignment of CON 08-002 PDF icon to 

symbol the link is a pdf
Official TennCare Addresses CON 09-002 PDF icon to 

symbol the link is a pdf
Operational Protocol ORG 09-001 PDF icon to 

symbol the link is a pdf
Ordering, Referring, or Prescribing Providers PRO 13-001 PDF icon to 

symbol the link is a pdf
Orthodontia Providers PRO 05-001 PDF icon to 

symbol the link is a pdf
Overpayments and Section 6402 of the Affordable Care Act PI 11-001 PDF icon to symbol 

the link is a pdf
Paper Checks and Direct Deposits PAY 14-001 PDF icon to 

symbol the link is a pdf
Peer Recovery Services BEN 11-002 PDF icon to 

symbol the link is a pdf
Policy Manual ORG 06-002 PDF icon to 

symbol the link is a pdf
Prohibitions of Payments to Institutions or Entities Outside the United States PI 11-004 PDF icon to symbol 

the link is a pdf
Provider Application Fees PRO 11-001 PDF icon to 

symbol the link is a pdf
Provider Assignment or Reassignment of Payments PI 11-005 PDF icon to symbol 

the link is a pdf
Provider Terminations for Inactivity PI 13-001 PDF icon to symbol 

the link is a pdf
TennCare Coverage of Buprenorphine for Opioid Addiction BEN 11-001 PDF icon to 

symbol the link is a pdf
TennCare Rules ORG 06-004 PDF icon to 

symbol the link is a pdf
TennCare/Medicaid for Qualified Aliens, Including Lawfully Admitted Aliens, Refugees, and Asylees EED 06-002 PDF icon to 

symbol the link is a pdf
Third party Copays and Deductibles, MCCs' and Providers' Responsibilities CON 05-001 PDF icon to 

symbol the link is a pdf
Timely Filing PAY 13-001 PDF icon to 

symbol the link is a pdf
Transition of Enrollees Between MCOs CON 11-001 PDF icon to 

symbol the link is a pdf
When a Provider May Bill a TennCare Enrollee PRO 08-001 PDF icon to 

symbol the link is a pdf
Withholds for MCC Non-Compliance PAY 06-001 PDF icon to 

symbol the link is a pdf

 

Medical Necessity Guidelines