Medication Therapy Management Program

Due to a confirmed data breach TennCare has suspended operation of the Care Coordination Tool (CCT) and all other HEC functions.

  • Medication Therapy Management (MTM)
    • Medication therapy management (MTM) program is defined as distinct service or group of services which optimizes therapeutic outcomes for individual TennCare members. MTM services include medication reviews, pharmacotherapy consult, anticoagulation management, immunizations, health and wellness programs and many other clinical services.
    • Pharmacists provide MTM services to help TennCare members get the best benefits from their medications by managing drug therapy and by identifying, preventing, and resolving medication-related problems.
  • Pharmacist Participation in MTM in Medicaid Program
    • The authorizes qualified Tennessee-licensed pharmacists to provide MTM services to eligible TennCare members under a collaborative practice agreement (CPA) with TennCare Patient Centered Medical Homes (PCMH) and Health Link
  • (THL) organizations.
  • Minimum Requirements:
    • Pharmacist must have a valid Tennessee License
    • Pharmacist must apply to and obtain a Tennessee Medicaid ID
    • A written collaborative practice agreement (CPA) is required between the PCMH/THL and pharmacist.
    • Must have a Managed Care Organizations (MCO) Network and Credentialing agreement
    • Insurance Requirements
      • Pharmacist should contact their malpractice Insurance to see if they have appropriate coverage.
      • Professional Liability
        • At all times during the term of this Agreement, Pharmacist shall maintain professional liability insurance as is necessary to adequately protect TennCare Members and TennCare under this Agreement, including maintaining such tail or prior acts coverage necessary to avoid any gap in coverage for claims arising from incidents occurring during the term of this Agreement. Such insurance shall
        • (i) be obtained from a carrier authorized to conduct business in the jurisdiction in which Pharmacist operates,
        • (ii) maintain minimum policy limits of at least $1,000,000.00 per occurrence and $3,000,000.00 in the aggregate; and
        • (iii) include coverage for the professional acts and omissions of Pharmacist and any employee, agent or other person for whose acts or omissions Pharmacist is responsible.
  • Participating pharmacists must have a TennCare Medicaid ID, have entered into a collaborative practice agreement (CPA) with a TennCare PCMH or THL organization, and have network & credentialing agreements with Managed Care Organizations (MCO).
  • TennCare Provider Registration and Information

The reimbursment information for MTM services is described within each MCO provider manual:

BlueCare (Page 163-164)

United Healthcare

Wellpoint MTM Provider Operations Manual

Wellpoint Network Access

  • Go to "Home | Wellpoint Tennessee, Inc."
  • Select “Our Network”, from the drop down select : Join our Network"
  • On the next page, scroll down to indicate your provider type and select “Continue”
  • On the next page fill out the form and select "submit"

United Healthcare Network Access

  • Provider Help Line (National Credentialing Center): 

BlueCare Network Access

Minimum requirements for CPA