TennCare Provider Resource Board

Changes Effective January 2027:

By January 2027, full benefit dual eligible individuals who want to be in a Dual Special Needs Plan (D-SNP) must get Medicaid and Medicare benefits from the same health plan. Full benefit dual eligible individuals are eligible for both Medicare and Medicaid.

If your Medicare D-SNP plan is with BlueCare, UnitedHealthCare, or Wellpoint and your TennCare Medicaid plan does not match, beginning January 1, 2027, your D-SNP plan and TennCare health plan must be with the same company.

If your D-SNP plan with BlueCare, UnitedHealthCare, or Wellpoint and your TennCare health plan do not match by December 31, 2026, you will be disenrolled from your Medicare D-SNP plan and be moved to Original Medicare and will need to select a Part D prescription drug plan.

How can you avoid being disenrolled from your Medicare D-SNP plan?

You must make your Medicare D-SNP plan and TennCare Medicaid plan match. There are two ways to make this change, update your Medicare D-SNP plan to match your TennCare Medicaid plan OR update your TennCare Medicaid plan to match your Medicare D-SNP plan.

Please refer to our Dual Eligible Special Needs Plan (D-SNP) webpage for additional details and resources.

REMINDER FOR ALL PROVIDERS WHO BILL CROSSOVERS, ICF/IID, 1915c, and DCS CLAIMS:

As of 9/1/2025 the Division of TennCare no longer accepts paper claims, as the responsibility of adjudicating claims have been turned over to the MCOs, for dates of service on and after 1/1/2024. All paper claims that are mailed to the Division of TennCare will be returned to sender.

If you have questions regarding your claims, please reach out to the members assigned MCO:

UHC:

Chat with a live advocate 7 a.m.–7 p.m. CT from the UnitedHealthcare Provider Portal or call Provider Services at 800-690-1606

Wellpoint:

Provider Services 833-731-2154 or visit the Contact Us section at the bottom of WLP’s provider website provider.wellpoint.com/tn for up-to-date contact information.

BCBS:

Please call the Provider Service line for your patient’s plan:

BlueCare – 1-800-468-9736

TennCareSelect – 1-800-276-1978 *DCS and QMB claims

CoverKids – 1-800-924-7141

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.

TennCare requires all providers to maintain an active license on any registration that includes a license upload. If you received an email or phone call requesting a license update, please log in to the TennCare Provider Registration Portal to upload your current license and resubmit your application. Individual providers should update their license information and complete re-attestation in Data Spring (Formerly CAQH) to ensure their enrollment remains active. A good rule of thumb is to update your license information in the TennCare Provider Registration Portal—or in Data Spring (Formerly CAQH) for individual providers—immediately after your license is renewed. If your license expires and is not updated in a timely manner, your application could be terminated. 

Effective July 1, 2027, TennCare's timely filing limit for 1915(c) and ICF/IID claims will be reduced from one (1) year to one hundred twenty (120) days from the date of service.

Providers should ensure their billing processes and internal workflows are updated to meet this new requirement which will be effective for services provided on and after July 1, 2027. Claims submitted more than 120 days after the date of service will be denied for untimely filing.

TennCare will share additional guidance, including the link to the proposed rule change and updated policy language as soon as it is available. TennCare is working on finalizing updates to the current timely filing policy, which can be found in the TennCare Policy Manual. Please note this still reflects a one-year timeline, but it may help answer any questions that arise related to dates of service.

TennCare will be reaching out individually to providers who regularly file claims 180+ days from the date of service to ensure they are aware of this change and working towards compliance effective July 1, 2027. In the meantime, providers can reach out if they have questions or need assistance preparing for this change.

Thank you for your continued partnership and commitment to serving TennCare members.