Skip to Main Content

Opportunity to Comment on Proposed Changes to the TennCare Program


TennCare policies are listed below in alphabetical order. Policies are categorized according to their functional area, and each policy is identified by a number consisting of the year it was finalized and its category (e.g., policy BEN 05-001 was the first Benefits policy finalized in 2005). These are the categories, or functional areas in which policies are placed.

Subject Policy Number
340B Drug Pricing Program PRO 13-002
Actuarial Soundness of TennCare Rates PAY 08-001
Addressing the Care Needs of Enrollees Transitioning from One MCO to Another MCO CON 19-001
Claims Processing, Timely Filing and Prior Authorizations PAY 06-002
Contractor and Provider Screening of Employees and Contractors PI 11-002
Cost Effective Alternatives BEN 08-001
Coverage Review of Newly Released or Approved Pharmaceuticals BEN 15-001
Credible Allegation of Fraud PI 12-001
Delinquent Balances on Ambulance Service Provider Assessment Fees PRO 18-001
Delinquent Balances on Nursing Facility Assessment Fees PRO 16-002
Dental, Coverage of Adult Services in a Hospital Emergency Room BEN 06-002
Disclosure of Ownership or Control; Changes in Ownership; and Program Integrity Reporting Responsibilities PI 10-001
Electronic Registration of Providers PRO 19-001
Eligibility of Inmates of a Public Institution EED 06-001
Enhanced Rate for Primary Care PRO 13-003
Erectile Dysfunction Medications BEN 06-001
False Claims Act Policy PI 08-001
Federal Provider Terminations and Exclusions PI 11-003
Handling of Checks Received at TennCare ORG 09-002
Hospice BEN 07-001
Investigative Monitoring & Examination of TennCare Employees’ Computer, Email, and Internet Usage ORG 09-003
MCCs' Responsibilities to Provide Services to TennCare Children Receiving Special Education Services CON 07-003
Medicaid State Plan ORG 06-003
Minimum Requirements for Provider Directories CON 06-001
National Provider Identifier (NPI) PRO 07-001
Newborns, Coverage and Billing, Assignment of CON 08-002
Official TennCare Addresses CON 09-002
Operational Protocol ORG 09-001
Ordering, Referring, or Prescribing Providers PRO 13-001
Orthodontia Providers PRO 05-001
Overpayments and Section 6402 of the Affordable Care Act PI 11-001
Paper Checks and Direct Deposits PAY 14-001
Peer Recovery Services BEN 11-002
Policy Manual ORG 06-002
Prohibitions of Payments to Institutions or Entities Outside the United States PI 11-004
Provider Application Fees PRO 11-001
Provider Assignment or Reassignment of Payments PI 11-005
Provider Screening Requirements PRO 16-001
Provider Terminations for Inactivity PI 13-001
TennCare Coverage of Buprenorphine for Opioid Addiction BEN 11-001
TennCare Rules ORG 06-004
TennCare/Medicaid for Qualified Aliens, Including Lawfully Admitted Aliens, Refugees, and Asylees EED 06-002
Third party Copays and Deductibles, MCCs' and Providers' Responsibilities CON 05-001
Third Party Liability, The Role of TennCare MCOs CON 09-001
Timely Filing PAY 13-001
When a Provider May Bill a TennCare Enrollee PRO 08-001
Withholds for MCC Non-Compliance PAY 06-001