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.

SubjectPolicy Number
340B Drug Pricing ProgramPRO 13-002
Actuarial Soundness of TennCare RatesPAY 08-001
Addressing the Care Needs of Members Transitioning Between MCOsCON 19-001
Behavioral Health Services Furnished by Unlicensed Master's Level StaffPRO 22-002
Behavioral Health Services Furnished by Qualified Graduate StudentsPRO 22-001
Claims Processing, Timely Filing and Prior AuthorizationsPAY 06-002
Contractor and Provider Screening of Employees and ContractorsPI 11-002
Coordination of Integrated Appeals for Members in Fully Integrated Dual Eligible Special Needs PlansBEN 23-001
Cost Calculations for Medical Necessity Determination of Private Duty Nursing ServicesBEN 25-001
Cost Effective AlternativesBEN 08-001
Coverage of Dental Services in a Hospital Emergency DepartmentBEN 06-002
Coverage Review of Newly Released or Approved PharmaceuticalsBEN 15-001
Credible Allegation of FraudPI 12-001
Delinquent Balances on Nursing Facility Assessment FeesPRO 16-002
Disclosure of Ownership or Control; Changes in Ownership; and Program Integrity Reporting ResponsibilitiesPI 10-001
Electronic Enrollment of ProvidersPRO 19-001
Enrollment of Providers with Out-of-Country OwnershipPRO 23-001
Erectile Dysfunction MedicationsBEN 06-001
Exception Policy/Process for Primary Service Location Indicator Limit – Provider Enrollment FilePRO 26-001
False Claims Act PolicyPI 08-001
Federal Provider Terminations and Exclusions This policy is currently being revised.PI 11-003
Handling of Checks Received at TennCareORG 09-002
HospiceBEN 07-001
MCCs' Responsibilities to Provide Services to TennCare Children Receiving Special Education ServicesCON 07-003
Medicaid State PlanORG 06-003
Minimum Requirements for Provider DirectoriesCON 06-001
National Provider Identifier (NPI)PRO 07-001
Newborns, Coverage and Billing, Assignment ofCON 08-002
Official TennCare AddressesCON 09-002
Ordering, Referring, or Prescribing ProvidersPRO 13-001
Orthodontia ProvidersPRO 05-001
Overpayments and Section 6402 of the Affordable Care ActPI 11-001
Paper Checks and Direct DepositsPAY 14-001
Participation in Pharmacy SurveysPRO 23-002
Peer Recovery ServicesBEN 11-002
Policy ManualORG 06-002
Prohibitions of Payments to Institutions or Entities Outside the United StatesPI 11-004
Provider Application FeesPRO 11-001
Provider Assignment or Reassignment of PaymentsPI 11-005
Provider Screening RequirementsPRO 16-001
Provider Terminations for InactivityPI 13-001
TennCare Coverage of Buprenorphine for Opioid AddictionBEN 11-001
TennCare RulesORG 06-004
TennCare/Medicaid for Qualified Aliens, Including Lawfully Admitted Aliens, Refugees, and AsyleesEED 06-002
Third party Copays and Deductibles, MCCs' and Providers' ResponsibilitiesCON 05-001
Third Party Liability, The Role of TennCare MCOsCON 09-001
Timely FilingPAY 13-001
Transportation Network Companies Providing NEMT ServicesPRO 22-003
When a Provider May Bill a TennCare EnrolleePRO 08-001
Withholds for MCC Non-CompliancePAY 06-001