Policies
TennCare policies are listed below in alphabetical order. Policies are categorized according to their functional area, and each policy is identified by a number consisting of the year it was finalized and its category (e.g., policy BEN 05-001 was the first Benefits policy finalized in 2005). These are the categories, or functional areas in which policies are placed.
| Subject | Policy Number |
|---|---|
| 340B Drug Pricing Program | PRO 13-002 |
| Actuarial Soundness of TennCare Rates | PAY 08-001 |
| Addressing the Care Needs of Enrollees Transitioning from One MCO to Another MCO | CON 19-001 |
| Behavioral Health Services Furnished by Candidates for Licensure | PRO 22-002 |
| Behavioral Health Services Furnished by Qualified Graduate Students | PRO 22-001 |
| Claims Processing, Timely Filing and Prior Authorizations | PAY 06-002 |
| Contractor and Provider Screening of Employees and Contractors | PI 11-002 |
| Coordination of Integrated Appeals for Members in Fully Integrated Dual Eligible Special Needs Plans | BEN 23-001 |
| Cost Effective Alternatives | BEN 08-001 |
| Coverage of Dental Services in a Hospital Emergency Department | BEN 06-002 |
| Coverage Review of Newly Released or Approved Pharmaceuticals | BEN 15-001 |
| Credible Allegation of Fraud | PI 12-001 |
| Delinquent Balances on Nursing Facility Assessment Fees | PRO 16-002 |
| Disclosure of Ownership or Control; Changes in Ownership; and Program Integrity Reporting Responsibilities | PI 10-001 |
| Electronic Registration of Providers | PRO 19-001 |
| Eligibility of Inmates of a Public Institution | EED 06-001 |
| Enrollment of Providers with Out-of-Country Ownership | PRO 23-001 |
| Erectile Dysfunction Medications | BEN 06-001 |
| False Claims Act Policy | PI 08-001 |
| Federal Provider Terminations and Exclusions This policy is currently being revised. | PI 11-003 |
| Handling of Checks Received at TennCare | ORG 09-002 |
| Hospice | BEN 07-001 |
| Investigative Monitoring & Examination of TennCare Employees’ Computer, Email, and Internet Usage | ORG 09-003 |
| MCCs' Responsibilities to Provide Services to TennCare Children Receiving Special Education Services | CON 07-003 |
| Medicaid State Plan | ORG 06-003 |
| Minimum Requirements for Provider Directories | CON 06-001 |
| National Provider Identifier (NPI) | PRO 07-001 |
| Newborns, Coverage and Billing, Assignment of | CON 08-002 |
| Official TennCare Addresses | CON 09-002 |
| Operational Protocol | ORG 09-001 |
| Ordering, Referring, or Prescribing Providers | PRO 13-001 |
| Orthodontia Providers | PRO 05-001 |
| Overpayments and Section 6402 of the Affordable Care Act | PI 11-001 |
| Paper Checks and Direct Deposits | PAY 14-001 |
| Participation in Pharmacy Surveys | PRO 23-002 |
| Peer Recovery Services | BEN 11-002 |
| Policy Manual | ORG 06-002 |
| Prohibitions of Payments to Institutions or Entities Outside the United States | PI 11-004 |
| Provider Application Fees | PRO 11-001 |
| Provider Assignment or Reassignment of Payments | PI 11-005 |
| Provider Screening Requirements | PRO 16-001 |
| Provider Terminations for Inactivity | PI 13-001 |
| TennCare Coverage of Buprenorphine for Opioid Addiction | BEN 11-001 |
| TennCare Rules | ORG 06-004 |
| TennCare/Medicaid for Qualified Aliens, Including Lawfully Admitted Aliens, Refugees, and Asylees | EED 06-002 |
| Third party Copays and Deductibles, MCCs' and Providers' Responsibilities | CON 05-001 |
| Third Party Liability, The Role of TennCare MCOs | CON 09-001 |
| Timely Filing | PAY 13-001 |
| Transportation Network Companies Providing NEMT Services | PRO 22-003 |
| When a Provider May Bill a TennCare Enrollee | PRO 08-001 |
| Withholds for MCC Non-Compliance | PAY 06-001 |