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Upcoming Opportunity to Comment on the TennCare Demonstration
OPPORTUNITY TO COMMENT ON PROPOSED CHANGES TO THE TENNCARE PROGRAM (CHOICES GROUP 3)
OPPORTUNITY TO COMMENT ON PROPOSED CHANGES TO THE TENNCARE DEMONSTRATION (AMENDMENT 3)
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
  • Operational Protocol
  • Other Eligibility Information
  • Policies
  • Privacy Policies
  • Quick Guide to TennCare Services
  • State Plan
  • TennCare 1115 Demonstration
  • TennCare 1915(c) HCBS Waivers
  • TennCare Evaluation Design
  • TennCare Rules
  • Waiver and State Plan Public Notices
  • TennCare Information About Coronavirus

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

Stay Informed

  • Notice of Change in TennCare III Demonstration: Amendment 3 (Public comment period is open)
  • Notice of Change to TennCare III Program: CHOICES Group 3 (Public comment period is open)
  • Notice of Public Forum on Progress of the TennCare Demonstration
  • Katie Beckett Program
  • Redetermination
  • Need Language help?
  • TennCare's Opioid Strategy
  • Moratorium on Rural Health Centers and Final Rate Setting
  • Upcoming Procurements
  • 1095-B Health Coverage Tax Document

Legal

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

Fraud and Abuse

  • Program Integrity
  • Report TennCare Fraud

Quick Links

  • Deputy Commissioner
  • Eligibility Reference Guide
  • Enrollment Data
  • kidcentral tn
  • TennCare Enrollment and Eligibility Facts
  • TennCare 2021 Agency Priorities
  • FY23 Recommended Budget
TennCare
Stephen Smith

310 Great Circle Rd.
Nashville, TN 37243
1-800-342-3145
Tenn.Care@tn.gov
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