TennCare Provider Resource Board

Timely and accurate reporting of newborn hearing screening results and audiological referrals is essential to ensuring that infants with hearing loss receive early intervention services. The Newborn Hearing Follow-Up Program is committed to reducing the number of infants lost to follow-up or lost to documentation. Your partnership is vital in helping us achieve this goal. We kindly ask for your continued support in reporting newborn hearing screening results and diagnostic referral information.

Please visit the Newborn Hearing Follow-Up dashboard to access the most up-to-date statewide statistics for hearing screening, diagnosis, and early intervention enrollment.

SafeGuard Services (SGS), working on behalf of the Centers for Medicare & Medicaid Services (CMS) as the Southeastern Unified Program Integrity Contractor (SE UPIC), will soon begin Medicaid audits of TennCare's Managed Care Plans (MCPs), BlueCare, United Health and Wellpoint. These audits align with federal recommendations to enhance oversight, strengthen program integrity, and ensure the appropriate use of Medicaid funds.

During the audit, SGS will request medical records from network providers for a group of recipients selected through a statistically valid random sampling methodology. Providers are expected to submit all requested documentation promptly, accurately, and in full to support the review process.

Any questions should be directed to the contact information provided in the medical records request you receive from SGS.

Changes Effective January 2026

Tennessee will start moving FBDEs (full benefit dual eligible) persons into a FIDE D-SNP. This is only for people who are now getting Medicare and Medicaid benefits from the same health plan. Any newly eligible FBDE person who enrolls in a D-SNP must enroll in a FIDE D-SNP. This is called an “exclusive aligned enrollment.”

By 2030, all FBDE persons must get Medicaid and Medicare benefits from the same health plan.

If you are a FBDE enrolled in a CO D-SNP that is not the same as your MCO, you can keep this plan until January 1, 2030. At that time, you will automatically be disenrolled from the CO D-SNP and enrolled in Fee for Service (original) Medicare.

To avoid this, you can change your Medicaid MCO to align with your D-SNP MCO during the Medicaid open enrollment period:

• For West TN: Open Enrollment is March with changes effective May 1st
• For Middle TN: Open Enrollment is May with changes effective July 1st
• For East TN: Open Enrollment is July with changes effective September 1st

Please reach out to your revenue cycle management vendor and remind them that the 888-345-5575 fax number for TennCare Member Medical Appeals should not be used for provider payment reviews and disputes but only for prior authorization reviews for active episodes of care. If the service has already been provided, providers must appeals those decisions directly to the health plan or dental benefit manager, not to TennCare Member Medical Appeals.