How to file a medical appeal?
Use this form ONLY to appeal. DO NOT use it to apply for TennCare.
Step 1. Print this TennCare Medical Appeal form .
Step 2. Fill it out.
Step 3. Make a copy of the completed form to keep for your records.
Step 4. Mail to
PO Box 593, Nashville, TN 37202-0593
OR FAX (toll-free) 1-888-345-5575
Keep a copy of the page that shows your fax went through.
QUESTIONS: Telephone (toll-free) 1-800-878-3192 TTY/TDD: 1-866-771-7043
Do you need to know how to file an appeal for medical services?
Have your services been denied, delayed, reduced, suspended, or terminated?
Call your health plan first. Their free phone number is on your TennCare card.
Don’t have your card? OR, still have problems AFTER you call your health plan?
Then, call TennCare Solutions for free at 1-800-878-3192. They can help you with your problem OR help you file an appeal. An appeal is one way to fix problems with TennCare.
You have the right to appeal if:
- TennCare says NO when you ask for health care.
- OR, TennCare stops or changes your health care.
- OR, you have to wait too long to get health care.
- OR, you have health care bills you think TennCare should have paid for, but didn't.
- OR, there's some other reason you can't get health care when you need it.
You only have 60 days to appeal after you find out that there is a problem.
You can ask someone to help you file an appeal.
Usually, your appeal is decided within 90 days after you file it. But, if you have an emergency and your health plan agrees that you do, you will get an expedited appeal. An expedited appeal will be decided in about one week. It could take longer if your health plan needs more time to get your medical records.
An emergency means that waiting 90 days for a “yes” or “no” decision could put your life or physical or mental health in real danger.
If you think you have an emergency, you can ask TennCare for an expedited appeal by calling 1-800-878-3192. Your doctor can also ask for this kind of appeal for you. But the law requires your doctor to have your permission (OK) in writing. Write your name, your date of birth, your doctor’s name, and your permission for them to appeal for you on a piece of paper. Then fax or mail it to TennCare. (See the fax number and the address above.)
After you give your OK in writing, your doctor can help by completing a “Provider’s Expedited Appeal Certificate”. They can print a copy of that certificate at this link: https://www.tn.gov/content/dam/tn/tenncare/documents/ExpeditedAppealProvidersCertificate.pdf . Your doctor can fill out and fax this certificate and your medical records to TennCare.
TennCare and your health plan will then look at your appeal and decide if it should be expedited. If it should be, you will get a decision on your appeal in about one week. Remember, it could take longer if your health plan needs more time to get your medical records.
Have questions? Need help? Want to appeal?
Call TennCare Solutions for free at 1-800-878-3192.
They can help solve many problems before you have to appeal.
They can also take your appeal over the phone.
We do not allow unfair treatment in TennCare. No one is treated differently because of race, color, birthplace, religion, language, sex, age, or disability. Do you think you’ve been treated unfairly? Then call the Tennessee Health Connection for free at 1-855-259-0701.