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TennCare Information About Coronavirus

Notice Templates

  • MCC 1 Denial of New Non-Covered Service before appeal
  • MCC 2 Initial Denial of New Non-Covered Service upon reconsideration
  • MCC 3 Termination of Non-Covered Service
  • MN - Denial Medical Necessity Denial of New Service before appeal
  • MN - Reconsideration Reconsideration of an appealed adverse benefit determination
  • MN - Reduction Reduction of Service based on Medical Necessity
  • MN - Termination Termination of Service based on Medical Necessity
  • MCC 10-11w Waiver of Right to Stay 2-Bs.Days after notice of Provider-Initiated Termination
  • MCC 10 2 business day advance notice of MCC-Initiated Hospital Discharge doc
  • MCC 11pr Post Reduction Notice of Provider-Initiated Reduction of BHO service for SPMI/SED, I/P psych, residential, or home health service, or service to treat a chronic condition across a continuum when next appropriate level of service not available
  • MCC 11pt Post Termination Notice of Provider-Initiated Termination of BHO service for SPMI/SED, I/P psych, residential, or home health service, or service to treat a chronic condition across a continuum when next appropriate level of service not available
  • MCC 11r 2-Bs Day Notice of Provider-Initiated Reduction of BHO service for SPMI/SED, I/P psych, residential, or home health service, or service to treat a chronic condition across a continuum when next appropriate level of service not available
  • MCC 11rf 2-Bs Day Notice of Provider-Initiated Reduction of BHO service for SPMI/SED, I/P psych, residential, or home health service, or service to treat a chronic condition across a continuum when next appropriate level of service not available
  • MCC 11t 2-Bs Day Notice of Provider-Initiated Termination of BHO service for SPMI/SED, I/P psych, residential, or home health service, or service to treat a chronic condition across a continuum when next appropriate level of service not available
  • MCC 11tf 2-Bs Day Notice of Provider-Initiated Termination of BHO service for SPMI/SED, I/P psych, residential, or home health service, or service to treat a chronic condition across a continuum when next appropriate level of service not available
  • MCC 12 General Delay
  • MCC 12.net Network Shortage Delay
  • MCC 12.N-PCPterm Non-PCP Termination Delay
  • MCC 12.PCP PCP Change Delay