Revalidation

TennCare Provider Revalidation

TennCare providers must revalidate in the program at least every three (3) years to continue as a provider. TennCare Providers are required to obtain and use a unique National Provider Identifier (NPI) for each service location and provider type enrolled.

Off-cycle revalidation is a revalidation of a provider’s enrollment that occurs outside the standard periodic revalidation cycle (every 3 years for providers.) The new off-cycle revalidation effort is in-place because of orders from the federal Centers for Medicare and Medicaid Services, which instructed the department to revalidate all high-risk and non-NPI providers by June 30, 2027 and all other providers by June 30, 2028.

Attention: Providers and groups will be contacted via email approximately 45 days prior to their revalidation deadline with further instructions.

Providers without an NPI, if you obtain an NPI, please email Provider.Registration@tn.gov to notify TennCare of your new NPI number. Please don’t start a new application with the NPI information, or it could cause a delay in your revalidation.

Risk Levels

Providers are categorized by limited, moderate or high-risk level. This determination is made by CMS, based on an assessment of potential for fraud, waste and abuse for each provider type.

Providers enrolling, revalidating or changing ownership will be screened according to their assigned risk level.

General screening activities required for each risk category:

Applicable Screening Requirements Limited Risk Moderated Risk High Risk
Verification of any provider-specific requirements X X X
Conduct license verifications X X X
Database checks X X X
Unscheduled or unannounced site visits   X X
Fingerprint-based criminal background check     X

Providers are able to update individual affiliations when revalidating enrollment. As a reminder, individual information must be entered or updated any time a change occurs (for example, a new provider joins or leaves the organization or clinic.) Outside of revalidation, this information can be updated using CAQH for individuals. (add link to CAQH)

Tenncare Medicaid ID for providers that have not completed revalidation by their due date will be terminated. 

  • Ensure each National Provider Identifier (NPI) for is also enrolled with Medicare, for providers who bill Medicare.
  • Ensure all data and contact information in CAQH or TennCare Provider Registration Portal profile is correct prior to revalidation. Contact Provider.Registration@tn.gov if TennCare Provider Registration Portal log-in credentials need to be reset or assigned to a new user.
  • Routinely update your information in the TennCare Provider Registration Portal, ie at each license renewal, change of practice address or updated Change of Ownership request. Refer to Revalidations / How to Revalidate / Consequences for Not Revalidating for step-by-step instructions on revalidating.
  • Ensure that employees who have left a provider group no longer have TennCare Provider Registration Portal access for information such as revalidation, claims, and eligibility. Providers must notify TennCare Enrollment staff at Provider.Registration@tn.gov when there are users no longer in the group so that the system can be updated with new staff information.
  • You will be notified by email or phone when you are selected for off cycle revalidation per CMS.
  • When selected for revalidation, emails are sent to the group or facility being revalidated. A phone call will be made as a last attempt to get the provider to revalidate.
  • The revalidation notice will be sent to the primary and the primary correspondence email addresses listed in the TennCare Provider Registration Portal. To ensure the revalidation notification reaches your office, please log into to confirm your primary contact email address is up to date.

You have 45 days from the date at the top of the notice to complete your revalidation before a termination notice will be sent. Once the termination notice is generated, your TennCare Medicaid ID will be terminated. This may also cause your MCO contract to be terminated.  You must contact Provider.Registration@tn.gov to request a reactivation. During the time of your lapsed TennCare Medicaid ID, your claims may not be paid by the MCOs.

  • Review the Revalidation Resources and Revalidation Newsletters section box above for more information on the revalidation process.
  • Providers will be revalidated on a continuous, rolling three (3)-year schedule.
  • Providers with multiple locations will not have to revalidate all sites at once unless all the locations were approved at the same time. Email notices will be sent separately for each location.
  • Each provider will be notified via email forty five (45) days in advance of their revalidation deadline. The deadline is based on the date the enrollment application was approved.

What screening activities occur during revalidation?

Based on risk level, TennCare screening may include:

  • License and certification verification
  • Federal and state exclusion database checks
  • Unannounced Site visits (moderate and high-risk providers)
  • Fingerprinting and criminal background checks (high-risk providers)

How long does the review take?

Processing times vary but generally range take no longer than 30 days for complete revalidation reviews. It could take longer depending on completeness of provider information and screening requirements.

How can I check my application status?

Providers can monitor their revalidation status through the TennCare provider portal.

What if TennCare requests additional information?

Providers must respond promptly to avoid delays, denial, or termination. Requests will be communicated via the portal or email.

What happens after revalidation approval?

Once approved:

  • Your TennCare enrollment remains active
  • You will receive confirmation of revalidation by email
  • You will be assigned to the next applicable revalidation cycle

Can my revalidation be denied?

Yes. Common reasons include:

  • Incomplete or inaccurate application
  • Failure to meet eligibility or disclosure requirements
  • Adverse findings during screening

How can I avoid delays?

  • Submit early within your assigned timeframe
  • Ensure all disclosures are complete and accurate
  • Verify licenses and certifications are current
  • Respond quickly to TennCare requests

What are common mistakes?

  • Missing ownership or managing employee disclosures
  • Expired or incorrect license information
  • Incorrect tax identification numbers
  • Failure to complete required attestations

Providers may contact the Provider Services Call Center by telephone at 800-852-2683 option 5, or by email at Provider.Registration@tn.gov