How to Complete the Ownership section of your Enrollment

• The Ownership Information section of the portal must be completed to prevent enrollment delays.
• If the entity is enrolled with PECOS (Medicare) the information must MATCH or be updated prior to submitting the TennCare enrollment for approval.
• Any Change of Ownership or Change of Ownership Interest must be reported to TennCare within 35 days of the change if you are currently enrolled. Reach out to provider.registration@tn.gov to obtain direction from TennCare on the next steps in reporting a CHOW / CHOI.

Instructions:

1. Enter the Identifying information and if the organization entity is “For Profit” or “Non-Profit” (must match the IRS filing status)

2. If the entity is “For Profit”, the following MUST be entered, Including the (%) percentage held.

• Managing employee (Handles Day to day business operations)
• Control Interest (Board of Directors, etc.)
• Ownership

3. If the entity is “Non-Profit”, the following MUST be entered.

• Managing employee (Handles Day to day business operations)
• Control Interest (Board of Directors, etc.)

4. To add the list of Owner(s), Board of Director(s) and/or Managing Employee(s), click the “+” sign until you have added all owner(s) for the organization/entity. For information and definition of the categories, click on the “+” sign next to definitions.

All entities are required to answer the 11 disclosure questions.

If “yes” is answered to any of the questions, further information will be asked. If the ownership section is not correct, the enrollment will be returned and could delay assignment of the Medicaid ID. Once all questions have been reviewed, click “Save” and then “Next”.

For questions or further guidance please contact the Provider Enrollment team at Provider.Registraion@tn.gov