How to File a Medical Appeal

You have the right to appeal if:

  • TennCare says NO when you ask for healthcare.
  • TennCare stops or changes your healthcare.
  • You have to wait too long to get healthcare.
  • You have healthcare bills or have paid out of pocket for healthcare you think TennCare or CoverKids should have paid for, but didn’t.
  • There’s some other reason you can’t get healthcare 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.

Have Questions? Need Help? Want to Appeal?

Call TennCare Member Medical Appeals 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.

There is another option. You can fill out the form below. Use this form only to appeal a healthcare-related request. Do not use this form to apply for TennCare.

Step 1. Print the 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 the completed form to:

TennCare Member Medical Appeals
PO Box 593
Nashville, TN 37202-0593

Or, you can email your form to TMMA.Contact.Center@tn.gov.

Or, you can fax your form to: 1-888-345-5575 (Toll-Free). Be sure to keep a copy of the page that shows your fax went through.

If you speak a language other than English, help in your language is available for free. Download the Foreign Language Assistance page to see how to get help in a language other than English.

Need help communicating due to a disability? TennCare offers free help for those communicating with TennCare at things like TennCare meetings, trainings, or hearings.

Need your letters and notices from TennCare in an alternative/different format like large print, audio, Braille, or other formats? Please complete this Communication Help Form to let us know what type of communication help you need and when you need it.

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 TennCare Connect for free at 855-259-0701.

What happens after you have filed 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. On a piece of paper, write:

  • Your name
  • Your Date of Birth (DOB)
  • Your Doctor’s Name, and
  • Your permission for them to appeal for you.

Then fax or mail it to TennCare. The fax number and mailing address are listed in Step 4 at the top of the page. After you give your OK in writing, your doctor can help by also completing a “Treating Provider’s Certificate: Expedited TennCare Appeal Form.”

Download the Treating Provider’s Certificate: Expedited TennCare Appeal form and print it out for your doctor to fill out. They can fax this form with 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.

Do you need to file an Eligibility Appeal for TennCare or CoverKids? Go to the How to File an Eligibility Appeal webpage.

Are you enrolled in Katie Beckett Part B and have Healthcare Reimbursement Account (HRA) claims to submit for reimbursement? Go to the Katie Beckett HRA Transition FAQs webpage.