How to File a Medical Appeal

Use this form ONLY to appeal. 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 to:

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

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.

Do you have questions? Call TennCare Medical Appeals for free at 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 Member Medical Appeals 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. 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.

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 and can also take your appeal over the phone.

Do you have a disability that impacts how you communicate with TennCare, and need free help communicating with TennCare? This would be for things like you have a TennCare meeting, training, or hearing, and need help to communicate with TennCare at that event. Or you 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.