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Legal Updates

Beware of TennCare Reimbursement and Prescribing Issues

TennCare Completes Implementation of the ACA's Medicaid Registration Requirement

Beware of TennCare Reimbursement and Prescribing Issues: 
TennCare Completes Implementation of the ACA's Medicaid Registration Requirement

Due to recent TennCare changes, health care providers not registered with TennCare should consider registering to avoid issues in prescribing for TennCare patients and to preserve TennCare revenue. 

In 2011, following the passage of the Affordable Care Act, the Centers for Medicare and Medicaid Services promulgated screening and enrollment regulations designed to combat Medicaid fraud and abuse. Among other things, the regulations required that all referring physicians or other professionals providing services under a state Medicaid plan be enrolled with Medicaid as participating providers. 

In implementing this requirement, TennCare now requires that all providers, including mid-levels, register with TennCare in order for TennCare to pay for items or services, including prescriptions, ordered or referred by such providers. Formerly, TennCare managed care organizations ("MCOs") paid for prescriptions regardless of whether providers were registered with TennCare. Earlier in the year, TennCare MCOs issued new policies concerning this requirement. Furthermore, on July 29, 2017, the Bureau of TennCare mailed letters to certain recent TennCare prescribers flagged as non-registered to make them aware of this requirement and explain that the providers must register with TennCare within 30 days of the date of the letter (August 28, 2017) to avoid any lapse in TennCare payment for items or services, including prescriptions. 

TennCare's letter states that providers may register with TennCare online via and that providers entering data on the website should also complete their profile at CAQH, verify that no documents are missing and authorize TennCare to receive their CAQH data. The letter indicates that providers with questions should call TennCare's Provider Services Call Center (1-800-852-2683). 

For more information, contact Cal Marshall or any member of the Chambliss Health Care Section.