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TennCare Oversight Division

Provider Complaint Process

 

This process is a courtesy provided to medical and transportation providers who have a complaint against a TennCare managed care company ("MCC") or a Medicare Advantage Special Needs Plan

(“MA-SNP”).  Complaints may involve claims payment accuracy and timeliness, credentialing procedures, inability to contact or obtain assistance from the MCC/MA-SNP, miscommunication or confusion around MCC/MA-SNP policy and procedures, etc.  This process is free.

 

When a provider complaint is received, the TennCare Oversight Division will forward the complaint to the MCC or MA-SNP for investigation.  The MCC or MA-SNP is required to respond in writing to both the provider and the TennCare Oversight Division by a set deadline to avoid assessment of liquidated damages or other appropriate sanction.

 

If the provider is not satisfied with a Tenncare MCC's response to the complaint, the provider may seek other remedies to resolve the complaint, including but not limited to, requesting a claims payment dispute be sent to an Independent Reviewer for resolution or pursuing other available legal or contractual remedies.

 

If the provider is not satisfied with a MA-SNP’s response to the complaint, the provider may seek other remedies to resolve the complaint, including pursuing other available legal or contractual remedies. However, the Independent Review process is not available for MA-SNP provider disputes.

 

Provider complaints can be submitted by completing the electronic form for TennCare Provider Complaints HERE and submitting it by fax or mail to the fax or mail address listed below.

 

An MA-SNP provider complaint can be submitted by completing the electronic form for MA-SNP Provider Complaints HERE and submitting it to the fax or mail address listed below.

 

Fax Number: (615) 401-6834

Mailing Address:

Tennessee Department of Commerce & Insurance

TennCare Oversight Division

500 James Robertson Parkway, 11th Floor

Nashville, TN 37243-1169

 

In you need to speak with us; we can be reached by Telephone at: (615) 741-2677

 

Please provide as much information as possible, including copies of claims and remittance advices and/or other denial correspondence from the MCC, if applicable.

 

Always include with your provider complaint:

Full name of provider contact person

Mailing address

Phone #

Fax number #

Email address

 

To learn more about the PROVIDER COMPLAINT process, click here for the Information Packet for PROVIDER COMPLAINTS.

 

To review the Quarterly Summary of Provider Complaints, Click here.