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 MCC 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