Provider Contractual Requirements

Attention TennCare Providers Participation in the EQRO Quarterly Survey is a Contractual Requirement

All TennCare Managed Care Organizations (MCOs) are required to submit updated provider information to the Division of TennCare each month. On a quarterly basis, TennCare conducts a telephonic survey of providers to validate certain data elements contained within the monthly MCO provider file submissions.

QSource performs this function as the TennCare External Quality Review Organization (EQRO).

As the EQRO for TennCare, QSource is required to conduct a provider data validation survey each quarter. A statistically valid random sample of providers from each MCOs provider file is pulled and each provider is contacted telephonically to verify the accuracy of the provider’s information:

• Contract Status with the MCO
• Provider Address
• Provider Telephone Number to schedule appointments
• Provider Credentialed Specialty
• Panel Status (Open/Closed to New Patients)
• Age Range of patients seen
• Availability of services to Children less than 21 years of age
• Availability of services to Adults age 21 and greater
• Primary Care services offered
• Prenatal services offered
• Appointment availability for Routine Care and Urgent Care services

IMPORTANT: If your office is included in the quarterly random sample, please promptly provide answers to the very brief survey when your office is contacted by a QSource Representative.

** Your participation ensures the information supplied to TennCare members is accurate and up-to-date. Please contact your Provider Relations Representative at your contracted MCO(s) if your provider profile/demographics requires updating.**