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TENNCARE ONLINE SERVICES

Welcome to TennCare Online Services.
Here TennCare providers and trading partners can:

  • Verify TennCare eligibility
  • Enter, review, and submit or adjudicate claims*

Learn how to subscribe.

If you cannot verify an enrollee's eligibility via this online system, you should contact the enrollee's TennCare MCO.

You may also contact
TennCare Provider Services at 1-800-852-2683 (toll free) or
(615) 741-6669 (Nashville, TN local)

Doctor and Patient

IMPORTANT MESSAGES:


Important Claims Processing Information:

Beginning on 7/1/2024, the Division of TennCare will transition the adjudication of all private Intermediate Care Facility (ICF)/Individuals with Intellectual Disabilities (IID) facility provider claims to TennCare's existing Managed Care Organizations (MCOs): Blue Cross Blue Shield of Tennessee, UnitedHealthcare, and Wellpoint.

PLEASE NOTE: There will be no changes taking place with the current process for any private ICF/IID provider facilities. All private facility claims processing that is done today by providers submitting private facility claims to TennCare will continue for claims with dates of service through 6/30/2024. After the 7/1/2024 go-live date, private ICF/IID facility providers will submit claims to the member's assigned MCO for processing and adjudication.

Additional communication details regarding the transition will be provided in the upcoming months. In the meantime, for any questions, feel free to reach out to Nathan Stremming at Nathan.J.Stremming2@tn.gov.

Information Technology Modernization Project - Private Intermediate Care Facility (ICF)/Individuals with Intellectual Disabilities (IID) Facility Provider Claims Processing Transition.

The Division of TennCare is pleased to announce the final step in our Information Technology Modernization Project.  Starting July 1, 2024, claims for Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) and 1915(c) claims will be transitioned to TennCareís existing Managed Care Organizations (MCO); Wellpoint (formerly known as Amerigroup), BlueCare, and UnitedHealthcare for adjudication.  TennCare will no longer process these claims with dates of services on or after the transition go-live date of July 1, 2024.

What does this mean for me?
  • Nothing is changing with the current process.  Everything that is done today by providers on submitting claims to TennCare/DIDD will continue for claims with dates of service up to June 30, 2024.
  • After the July 1, 2024, go-live date, private ICF/IIDs will submit claims to the memberís assigned MCO for processing and adjudication.
  • At this time, we anticipate 1915(c) providers will submit claims through Therap effective July 1, 2024.
  • TennCare will continue to accept claims with dates of service through June 30, 2024, as well as handling adjustments and voids with dates of service prior to June 30, 2024.
  • Providers will not need to contract directly with the MCOs to receive payment for claims at this time.
  • MCOs will be reaching out to ICF/IID providers with specific information and guidance on claims submission processes in the next several months.
  • The MCOs, DIDD, and TennCare IT will communicate additional details on the transition in the upcoming months.
Please note this is NOT related to IDD Integration and the waiver amendments related to integration are still pending with CMS.  Transitioning claims processing to the MCOs supports TennCare systems enterprise modernization strategies to shift the adjudication and payment of all claims for TennCare members out of the current system and to the MCOs.  TennCare and DIDD will continue to review service requests and service plans.  We look forward to the completion of this final step in our operating model that will increase claims processing operational efficiency.

We will communicate additional details regarding the transition in the upcoming months.  In the meantime, for any questions, feel free to reach out to Nathan Stremming at Nathan.J.Stremming2@tn.gov.

1.  If you received a $20.00 payment from the state of TN that is not listed on your Tennessee Medical Assistance Program Remittance Advice, it is likely that the payment is from Disability Determination for medical records.  Please contact Disability Determination at 615-743-7300 for further information.

2.  Beginning on 7/12/2021, TennCare is implementing updated procedures for requests to reprocess crossover claims.  After a claim adjudicates and the RA is received, if you find that the claim paid amount is incorrect or the denial reason was due to a TennCare keying error or TennCare system issue, you can submit a request for reprocessing by secured email or mail to: Crossover.Reprocess.Request@tn.gov

Please Note: Provider billing errors do not qualify for a reprocess.  Also, a delay in the providerís registration/recertification process due to invalid and/or incomplete information required from the registering provider/group/facility, is not a TennCare system issue and does not qualify for the reprocessing of claims.  It is the sender's responsibility to transmit any PHI/PII securely.  If you are not able to send your request via secured email, please mail in your request to the address provided below:

Claims Unit Manager
Division of TennCare
310 Great Circle Road
Nashville, TN 37243

The reprocessing request must be in writing and contain the reasons you believe the payment amount or reason for denial was incorrect.  The request must be filed within 35 days from the RA date and must include any documentation the provider deems relevant to this request.  TennCare will make its decision within 60 days from the receipt of the reprocess request.  Notification of the reprocess decision will be mailed to Provider in the manner it was received.  For additional information on the acceptable documentation needed to prove that the timely filing guidelines were met, refer to the crossover claims FAQ's @ https://www.tn.gov/content/dam/tn/tenncare/documents/FAQCrossoverClaimsRequirements.pdf

3.  TennCare will deny claims that contain secondary providers (rendering, attending, referring, ordering, operating, etc.) who are not enrolled in the TennCare program as valid and active providers, pursuant to Federal Regulation, 42 CFR Subpart E 455.410(b), the State Medicaid agency must require all ordering or referring physicians or other professionals providing services under the State plan or under a waiver of the plan to be enrolled as participating providers.  The claims must also contain the secondary providers NPI, unless the provider has an atypical provider status.

4.  Corrections or modifications to claims that have been previously paid must be performed by submitting an adjustment/void form found at:
https://www.tn.gov/tenncare/providers/medicare-medicaid-crossover-claims.html Corrections or modifications to previously denied claims can be performed by submitting a new day claim.

Crossover Claim Pricing Methodology: For Part A, rates obtained from the Medicaid State Plan less Medicare paid amount and TPL.  For Part B, rates obtained from applying the logic outlined in Rule 1200-13-17.

All claims must be submitted on a CMS approved claim form.

The Division of TennCare previously announced that all institutional and professional Fee-For-Service Medicare crossover claims transitioned to TennCareís existing Managed Care Organizations (MCO); Wellpoint, BlueCross BlueShield of Tennessee, and UnitedHealthcare for adjudication.  TennCare will no longer process Medicare crossover claims with dates of service on or after 1/1/2024.

How does this transition impact the Qualified Medicare Beneficiary (QMB) only members?
  • QMB-only members will be assigned to the TennCareSelect plan, and the claims will crossover from Medicare or the Dual Special Needs Plan (DSNP) to TennCareSelect for copay, coinsurance, and deductible payment.
Please contact TennCareSelect for information or questions on QMB-only members claims with dates of service on or after 1/1/2024.


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