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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^*
Upload or download HIPAA transactions^*
Submit or inquire about pre-admission evaluation status^*
Use TennCare messaging system

^*Long Term Care Providers

Providers and partners who wish to use this online service
must be a TN.gov Subscriber.
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)

IMPORTANT MESSAGES:

The Division of TennCare is pleased to announce that all institutional and professional Fee-For-Service Medicare crossover claims will be transitioned to TennCare’s existing Managed Care Organizations (MCO); Amerigroup, BlueCare, and UnitedHealthcare for adjudication. TennCare will no longer process Medicare crossover claims with dates of service on or after the transition go-live date of 1/1/2024.

What does this mean for me?

Nothing is changing with the current process. Everything that is done today by providers on submitting Medicare crossover claims to TennCare will continue for claims with dates of service up to 12/31/2023.
After the 1/1/2024 go-live date, COBA and the DSNPs will submit Medicare crossover claims to the member’s assigned MCO for processing and adjudication.
TennCare will continue to accept claims with dates of service through 12/31/2023 as well as handling adjustments and voids with dates of service prior to 12/31/2023.
The MCOs will communicate additional details on the transition in the upcoming months.

We look forward to the transition of Medicare crossover claims processing to the MCOs as it will create an operating model that supports TennCare’s managed care approach and increases claims processing operational efficiency.

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 provider’s 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.

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