Policies

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 Members Transitioning Between MCOs	CON 19-001
Behavioral Health Services Furnished by Candidates for Licensure	PRO 22-002
Behavioral Health Services Furnished by Qualified Graduate Students	PRO 22-001
Claims Processing, Timely Filing and Prior Authorizations	PAY 06-002
Contractor and Provider Screening of Employees and Contractors	PI 11-002
Coordination of Integrated Appeals for Members in Fully Integrated Dual Eligible Special Needs Plans	BEN 23-001
Cost Effective Alternatives	BEN 08-001
Coverage of Dental Services in a Hospital Emergency Department	BEN 06-002
Coverage Review of Newly Released or Approved Pharmaceuticals	BEN 15-001
Credible Allegation of Fraud	PI 12-001
Delinquent Balances on Nursing Facility Assessment Fees	PRO 16-002
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
Enrollment of Providers with Out-of-Country Ownership	PRO 23-001
Erectile Dysfunction Medications	BEN 06-001
False Claims Act Policy	PI 08-001
Federal Provider Terminations and Exclusions This policy is currently being revised.	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
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
Participation in Pharmacy Surveys	PRO 23-002
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
Transportation Network Companies Providing NEMT Services	PRO 22-003
When a Provider May Bill a TennCare Enrollee	PRO 08-001
Withholds for MCC Non-Compliance	PAY 06-001