Skip to Main Content

Home
Go to TN.gov
  State of Tennessee
Go to TN.gov
Section
  • Go to TennCare
  • Members & Applicants
    • Learn More & Apply
    • Benefits & Services
    • Need Help?
  • Providers
    • Provider Registration
    • Verify Eligibility
    • Dental Providers
    • Managed Care Contractors (MCCs)
    • Programs and Facilities
    • Report Provider Fraud
    • TennCare Provider News, Notices & Forms
    • Training and Education
    • Provider Resources
    • Contact Us
  • Policy & Guidelines
    • Cost-Effective Alternative Prior Authorization Form
    • Eligibility Policy
    • Information Systems Policies
    • Mental Health Parity
    • Other Eligibility Information
    • Policies
    • Privacy Policies
    • State Plan
    • TennCare 1115 Demonstration
    • TennCare 1915(c) HCBS Waivers
    • TennCare Rules
    • Waiver and State Plan Public Notices
    • Renewal Flexibilities
  • Long-Term Services & Supports
    • CHOICES
    • How to Apply?
    • Employment and Community First CHOICES
    • 1915(c) HCBS Waivers
    • Member Resources
    • LTSS Contact Information
    • PACE
    • Katie Beckett Waiver
    • Involuntary Discharge and Transfer Appeals
    • Beneficiary Support System
    • Enhanced HCBS FMAP
    • LTSS Documents- Memos, Forms, Protocols, Trainings, Historical
    • Dual Eligible Special Needs Plan (D-SNP)
  • Media
  • Contact Us
Print This Page
Print This Page
Go to Search
Policy & Guidelines
  • Cost-Effective Alternative Prior Authorization Form
  • Eligibility Policy
    • Administrative Manual
    • Aged, Blind and Disabled Manual
    • Families and Children Manual
  • Information Systems Policies
  • Mental Health Parity
  • Other Eligibility Information
  • Policies
  • Privacy Policies
  • State Plan
  • TennCare 1115 Demonstration
  • TennCare 1915(c) HCBS Waivers
  • TennCare Rules
  • Waiver and State Plan Public Notices
  • Renewal Flexibilities

Information Systems Policies

  • CHOICES Patient Liability Rounding
  • CHOICES Types of Bill This policy was created to assist with the implementation of the CHOICES program. It should only be used with the understanding that it includes a snap shot of services at the time of implementation and is not current.
  • Claim and Encounters File Naming Standard
  • Claims Paid With Zero Paid Amount
  • Claim Rejection Versus Denial by MCCs
  • Definition of TennCare Duplicate Encounters
  • Edifecs Rejected Encounter Removals and 45 Day Report
  • Encounter Line Items Spanning More Than One Date of Service
  • Encounter Sequencing Within Managed Care Contractor Transaction Files
  • Header versus Detail as a Data Source
  • MCC/DSNP Payments Made Directly to Members
  • MCC Provider Enrollment Files
  • NDC Submission for HCPCS
  • Proper Reporting of Covered and Non-Covered Days
  • Provider Identification Usage on Submitted Transactions
  • Receipt of Submitter Transaction Files
  • Referring Provider Usage
  • Reporting Non-Compliant Drug Claims
  • Required Encounter Information Submitted to TennCare
  • Requirement of NPI
  • Reuse of Internal Control Numbers
  • Revenue Codes Requiring Surgical Code
  • School Based Dental Encounter File
  • Services Paid For More Than Billed Amount
  • TennCare Recovery Initiative
  • TPL Carrier Code
  • Void and Replacement Encounter Submission
  • Social Media

  • facebook
  • twitter
  • youtube
  • instagram
  • linkedin

Stay Informed

  • Katie Beckett Program
  • Preparing for Renewals
  • Need Language help?
  • Upcoming Procurements
  • 1095-B Health Coverage Tax Document
  • Reimbursement Information for RHC and FQHC Providers

Legal

  • Estate Recovery
  • TennCare Forms and Agreements
  • Privacy Policies
  • HIPAA Privacy Information
  • TennCare Public Records
  • Subrogation
  • Civil Rights Notice

Fraud and Abuse

  • Program Integrity

Quick Links

  • Deputy Commissioner
  • Eligibility Reference Guide
  • Enrollment Data
  • kidcentral tn
  • TennCare Enrollment and Eligibility Facts
TennCare
Stephen Smith

310 Great Circle Rd.
Nashville, TN 37243
1-800-342-3145
Tenn.Care@tn.gov
Tennessee State Seal
  • Help
  • Translate
  • Font Size
    • a-
    • Normal
    • A+
Tristar
  • TN.gov Services TN.gov Directory Web Policies
  • About Tennessee Title VI Accessibility Help & Contact Survey
Close