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Policies

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.

Subject Policy Number
340B Drug Pricing Program PRO 13-002
Actuarial Soundness of TennCare Rates PAY 08-001
Cash Receipts ORG 09-002
Claims Processing, Timely Filing and Prior Authorizations PAY 06-002
Contractor and Provider Screening of Employees and Contractors PI 11-002
Cost Effective Alternatives BEN 08-001
Credible Allegation of Fraud PI 12-001
Dental, Coverage of Adult Services in a Hospital Emergency Room BEN 06-002
Disclosure of Ownership or Control; Changes in Ownership; and Program Integrity Reporting Responsibilities PI 10-001
Enhanced Rate for Primary Care PRO 13-003
Erectile Dysfunction Medications BEN 06-001
False Claims Act Policy PI 08-001
Federal Provider Terminations and Exclusions PI 11-003
Hospice BEN 07-001
Investigative Monitoring & Examination of TennCare Employees’ Computer, Email, and Internet Usage ORG 09-003
MCCs' Responsibilities to Provide Services to TennCare Children Receiving Special Education Services CON 07-003
Medicaid State Plan ORG 06-003
Minimum Requirements for Provider Directories CON 06-001
National Provider Identifier (NPI) PRO 07-001
Newborns, Coverage and Billing, Assignment of CON 08-002
Official TennCare Addresses CON 09-002
Operational Protocol ORG 09-001
Ordering, Referring, or Prescribing Providers PRO 13-001
Orthodontia Providers PRO 05-001
Overpayments and Section 6402 of the Affordable Care Act PI 11-001
Paper Checks and Direct Deposits PAY 14-001
Peer Recovery Services BEN 11-002
Policy Manual ORG 06-002
Prohibitions of Payments to Institutions or Entities Outside the United States PI 11-004
Provider Application Fees PRO 11-001
Provider Assignment or Reassignment of Payments PI 11-005
Provider Terminations for Inactivity PI 13-001
TennCare Coverage of Buprenorphine for Opioid Addiction BEN 11-001
TennCare Rules ORG 06-004
TennCare/Medicaid for Qualified Aliens, Including Lawfully Admitted Aliens, Refugees, and Asylees EED 06-002
Eligibility of Inmates of a Public Institution EED 06-001
Third party Copays and Deductibles, MCCs' and Providers' Responsibilities CON 05-001
Timely Filing PAY 13-001
When a Provider May Bill a TennCare Enrollee PRO 08-001
Withholds for MCC Non-Compliance PAY 06-001
Provider Screening Requirements PRO 16-001
Third Party Liability, The Role of TennCare MCOs CON 09-001
Delinquent Balances on Nursing Facility Assessment Fees PRO 16-002
Coverage Review of Newly Released or Approved Pharmaceuticals BEN 15-001

 

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