Providers
Are you a provider who needs assistance with TennCare related matters?
If so, please contact Provider Services at the member's Managed Care Organization for MCO claims.
For Medicare Cross-Over Claim questions, contact TennCare Provider Services at 1-800-852-2683.
Provider Links
The Centers for Medicare & Medicaid Services (CMS) implemented the Payment Error Rate Measurement (PERM) program to measure improper payments in the Medicaid program and the Children's Health Insurance Program (CHIP). For more information on PERM please visit CMS website by clicking on the link Payment Error Rate Measurement (PERM) for educational guides and question/answer section.
Language Assistance and Cultural Competency
Information regarding language assistance for TennCare enrollees and cultural competency in health care is available.
- Language Assistance – For TennCare enrollees with Limited English Proficiency, providers may obtain assistance with translation and interpretation services by contacting Provider Services at the enrollees' managed care organization.
- Cultural Competency and Literacy in Health Care (pdf, 38kb)
- Multicultural Health Care: A Quality Improvement Guide
- Cultural Proficiency Resources
- Working with Medical Interpreters
Provider News & Notices
- Important Information For TennCare Providers - Please be advised that effective immediately, TennCare has temporarily removed the prior authorization requirement for Tamiflu. Given the large amount of influenza-like illness that is circulating in the State and little indication at this time that illness levels are subsiding, we are taking this step to ease the administrative burden on health care professionals. I would ask all of you to join the TennCare Bureau in reminding the providers with whom you interact that adherence to the CDC guidelines regarding appropriate prescribing of influenza antiviral medication is critical to minimizing further exacerbation of the Tamiflu shortages that already exist and to preventing the development of Tamiful resistance.
- TennCare Providers now have an RSS feed
- Attention: Physicians and Pharmacy Professional Medicare/Medicaid Crossover Providers (pdf, 51kb)
- Prescriber Notifications (Prior to October 1, 2008)
- Notices after October 1, 2008 can be found on the SXC/TennCare website
- Important Information for Physicians Concerning TennCare Changes in Coverage of Private Duty Nursing and Home Health (pdf, 34kb)
- Provider RA Message: Changes have been made to TennCare’s payment methodology (pdf, 29kb) for professional Part B crossover claims. This change is effective with dates of service beginning July 1, 2008.
In addition, on July 1, 2008 a member must be QMB, SSI, or under age 21 for TennCare to pay the copays after Medicare for non-covered TennCare services. View the list of Medicare Services Not Covered by TennCare (pdf, 53kb) or TennCare Services Not Covered by Medicare (pdf 67kb) for Adults age 21 and over, pursuant to TennCare Rule 1200-13-13-.10 (pdf, 283kb) and 1200-13-14-.10 (pdf, 310kb).
The non-covered services list for other claims is much more extensive and can be found in TennCare rules at 1200-13-13-.10 (pdf, 283kb). - Provider Bulletin (pdf, 35kb)
- External Quality Review Organization to Validate Provider Data 08/17/09 (pdf, 29kb)
- Tamper-Resistant Prescription Pads Notification (pdf, 53kb)
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Provider Training (pdf, 139kb)
