Notification of Primary Adjuster Liaison & Bill Review Contact

To ensure timely communication and compliance with the Bureau’s Claims Handling Standards, all workers’ compensation insurance adjusting entities must submit and regularly update contact information using the Notification of Primary Liaisons and Adjusters form.

This form helps the Bureau reach the appropriate contacts to resolve claims, billing issues, and provider concerns efficiently. 
 

Understanding the Role Options on the Notification Form

When completing the notification form, you’ll be asked to select a role for each contact:

• Adjuster. An individual who processes or supervises Tennessee workers’ compensation claims.
• Primary Liaison. The main point of contact between the adjusting entity and the Bureau. Responsible for providing information about claims, payments, and adjusters.
• Bill Review Liaison (New Requirement). The designated contact for resolving billing and payment disputes with medical providers, injured workers, and the Bureau.
• Secondary Liaison. An optional backup contact who can assist with the responsibilities of the Primary Liaison. This helps ensure continuity in communication if the Primary Liaison is unavailable.
• Other. Select this if you would like to provide additional contacts who don't fall into one of the categories above but still play a relevant role in claims handling or communication with the Bureau. 

How to Submit the Form

• Preferred method: Download and complete the Excel template and email it to WC.Forms@tn.gov. This method is preferred if you have more than ten contacts to report. The Excel spreadsheet is for easier bulk entry.
• Alternative: Complete the form online.

Semi-Annual Deadlines

The Bureau requires these contact lists to be re-submitted twice a year: in January and July of each year. If the primary liaison or bill review liaison for your adjusting entity changes, notify the Bureau within fifteen (15) calendar days by resubmitting an updated form. 
 

Why This Information Matters

• Ensures timely communication with the Bureau
• Helps resolve claims and billing issues efficiently
• Keeps your organization in compliance and avoids civil penalties

Frequently Asked Questions (FAQs)

What if I submitted the form but need to make a correction? 
If you need to update or correct submitted information, simply resubmit the form with the corrected details. The new submission will replace the previous submission.

What happens if I don’t submit or update the information on time? 
Failure to comply may result in civil penalties (up to $5000) for each violation. We recommend setting up a reminder to submit this to the bureau to maintain compliance with our rules.

Can one person serve in multiple roles (e.g., Primary Liaison and Bill Review Liaison)? 
Yes. One individual may serve in more than one role, but each role must still be clearly identified on the form.

Is the Bill Review Liaison requirement optional? 
No. As of November 10, 2025, designating a Bill Review Liaison is mandatory for all adjusting entities. Failure to designate and update a Bill Review Liaison may result in civil penalties and could delay resolution of billing disputes or provider communications.

Can I use a general company email or shared inbox for liaison contacts? 
No. To ensure accountability and timely responses, this form requires the name(s), direct phone number(s), email address(es), and mailing address(es) for each individual adjuster that handle workers’ compensation claims in Tennessee.

Who should use the Primary Liaisons and Adjusters form? 
Insurance carriers, self-insured employers, third-party administrators, or any entity processing Tennessee workers’ compensation claims

What if my organization has multiple liaisons or adjusters? 
You can list as many contacts as needed. If the online form becomes too cumbersome, use the Excel template for easier bulk entry and email it to wc.forms@tn.gov.