News and Announcements
On July 11, TennCare co-hosted a webinar with the state’s managed care organizations (Amerigroup, BlueCare, and UnitedHealthcare Community Plan) to share details regarding the new lactation consultation benefit. To learn more about the new benefit, you can watch a recording of the webinar or find the slides shared during the webinar below.
Please note: the webinar slides were updated on 09/14/2023. The webinar recording will reflect the content shared on July 11 and will not reflect the updated slides.
Starting June 1, 2023, members with TennCare Medicaid (including TennCareSelect) and CoverKids coverage may receive lactation consultation services from in-network providers as a separate, reimbursable benefit.
In addition to in-network MDs, DOs, Nurse Practitioners, Physician Assistants, and Certified Nurse Midwives for whom lactation services are within their scope of practice, International Board-Certified Lactation Consultants (IBCLCs) with medical licensure can contract with a TennCare Managed Care Organization (BlueCare Tennessee, Amerigroup, and United Healthcare Community Plan) as independent TennCare providers.
When supervised and billed by a registered, in-network provider listed above, International Board-Certified Lactation Consultants (IBCLCs) with no additional medical licensure, Certified Lactation Specialists (CLSs), Certified Breastfeeding Specialists (CBSs), Certified Lactation Counselors (CLCs), and Certified Lactation Educators (CLEs) may provide lactation support to individuals with TennCare.
The following types of in-network providers can provide lactation services to TennCare members if it’s within their scope of practice:
- Nurse Practitioner
- Physician Assistant
- Certified Nurse Midwife
If you are an in-network provider, reimbursement codes for these providers will activate automatically on June 1, 2023.
Are you an in-network provider with a CLC, CLE, or IBCLC certification?
You may add this taxonomy to your Medicaid ID through TennCare’s Provider Registration process. If you are an in-network provider, this is not necessary to start providing and receiving reimbursement for lactation support and services.
The new taxonomy codes are:
- IBCLC: 163WL0100X (Lactation Consultant – IBCLC/RLC)
- CLC/CLE: 174N00000X (Lactation Counselor/Educator – Certified CLC/CLE)
International Board-Certified Lactation Consultants (IBCLCs) with medical licensure can now contract with a TennCare Managed Care Organization (BlueCare Tennessee, Amerigroup, and United Healthcare Community Plan) as independent TennCare providers. The steps to becoming a contracted provider with any of our managed care organizations are outlined below.
If you have any questions regarding the provider registration requirements or steps, please contact TennCare Provider Registration by phone or email.
- Provider Registration assistance by phone: 1-800-852-2683
- Provider Registration assistance by email: Provider.Registration@tn.gov
How to Become a TennCare Provider:
Step 1: Register as a Medicaid Provider
- Register through TennCare’s Provider Registration process.
- Review a Step-by-Step Guide to completing all steps within the TennCare Provider Registration Portal.
You are now eligible to contract with the state’s Health Plans.
Step 2: Credential with the Health Plan(s)
TennCare services are offered through managed care entities.
- After receiving the “Welcome ID” which contains a Medicaid ID and effective date, reach out to the Managed Care Organization(s) (MCOs) for contracting.
Step 3: Contract with the Health Plan(s)
To credential and contract with a managed care organization, reach out to each MCO individually:
UnitedHealthcare Community Plan: 1-800-690-1606
When supervised and billed by a contracted, in-network provider, Certified Lactation Specialists (CLSs), Certified Breastfeeding Specialists (CBSs), Certified Lactation Counselors (CLCs), and Certified Lactation Educators (CLEs) may provide lactation support to individuals with TennCare.
- Authorized supervisors of lactation services include in-network MDs, DOs, NPs, PAs, Certified Nurse Midwives, and IBCLCs with medical licensure.
- Supervision can be off-site or remote. Clinical supervision does not require the continuous and constant presence of the clinical supervisor; however, the clinical supervisor must always be available for consultation or shall arrange for a substitute provider to be available.
- The NPI of the in-network supervising provider must be reported when billing for services by a non-licensed CLS, CBS, CLC, or CLE that is employed by the practice or group.
- CBSs, CLSs, CLCs, and CLEs do not have to have a Medicaid ID in order to provide services to TennCare individuals.
Detailed information about the benefit, including how to register as a TennCare provider can be found in a March 2023 presentation below.
Communication resources to raise awareness about the lactation consultation services benefit are listed below:
Need help? The breastfeeding hotline is available 24hrs a day. Visit the Tennessee Breastfeeding Hotline website for more details.
Designated Breastfeeding Experts are also available through county health departments and clinics. Visit the Tennessee Designated Breastfeeding Experts website to find one if your area.
Comprehensive information on other programs and supports can be found on the Tennessee Department of Health's Breastfeeding in Tennessee website.