Tennessee Medicaid — TennCare (Tennessee Medicaid)
| Program name | TennCare (Tennessee Medicaid) |
|---|---|
| Provider portal | https://www.tn.gov/tenncare |
| FFS claims payer ID | No single canonical ID — routing is fiscal-intermediary-specific. Verify per clearinghouse. |
| Medicaid timely filing | 120 days from date of service |
The federal ceiling for Medicaid timely filing is 12 months under 42 CFR §447.45; most states set a shorter window. Always verify the current policy on the Tennessee Medicaid provider portal before filing a late-billing appeal.
BCBS licensee in Tennessee
The Blue Cross Blue Shield Association licensee in Tennessee is BlueCross BlueShield of Tennessee. See the BCBS Tennessee payer guide for payer ID, timely filing, prior auth, and appeal procedures.
Top commercial payers in Tennessee
The dominant commercial insurers operating in Tennessee, in approximate order of lives covered. Click through for per-payer claims payer IDs, timely filing windows, prior-authorization rules, and appeal procedures.
Medicaid MCOs in Tennessee
TennCare (Tennessee Medicaid) contracts with the following managed-care organizations to administer Medicaid benefits in Tennessee. MCO contracts dictate claims routing, prior-auth workflows, and appeal deadlines — route each claim by the member's MCO assignment, not the state FFS payer ID.
Medicare contractor and active LCDs in Tennessee
Palmetto GBA is the Medicare A/B MAC for Tennessee: Part A and Part B fee-for-service claims from Tennessee go to it, and its Local Coverage Determinations decide local medical necessity. Durable medical equipment and supply claims go to CGS Administrators, LLC as the DME MAC. Home health and hospice claims are processed by Palmetto GBA. In the current Medicare Coverage Database export, 247 active LCDs from these contractors apply to Tennessee claims.
- Palmetto GBA
A/B MAC (Part A and Part B claims); Home health and hospice MAC
- CGS Administrators, LLC
DME MAC (durable medical equipment and supplies)
Selected active Palmetto GBA policies for Tennessee
A selection, not the full list: policies with measured search demand come first, then those on topics that more contractors publish LCDs for.
- L35025 MolDX: Molecular Diagnostic Tests (MDT)
- L37379 Echocardiography
- L39671 Trigger Point Injections (TPI)
- L34415 CT of the Abdomen and Pelvis
- L39853 Outpatient Psychotherapy
- L35724 Urine Drug Testing
- L38779 MolDX: Minimal Residual Disease Testing for Cancer
- L39237 Erythropoiesis Stimulating Agents
- L33445 Removal of Benign and Malignant Skin Lesions
- L33459 Computerized Axial Tomography (CT), Thorax
- L38765 Facet Joint Interventions for Pain Management
- L37794 MolDX: Breast Cancer Index® (BCI) Gene Expression Test
Equipment, home health and hospice policies that apply in Tennessee
- L33822 Glucose Monitors
- L33789 Power Mobility Devices
- L33318 Knee Orthoses
- L33686 Ankle-Foot/Knee-Ankle-Foot Orthosis
- L33718 Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea
- L34544 Hospice - Liver Disease
- L34547 Hospice - Neurological Conditions
- L34548 Hospice Cardiopulmonary Conditions
Steps to confirm which LCD governs a claim · Every active LCD by contractor
State-specific regulations affecting Tennessee billing
- TCA §56-7-1009 (TN Health Care Consumer Right to Shop Act — balance billing protections)
- TCA §56-32-226 (TN prompt pay — 30 days clean electronic claim)
- TennCare Rule 1200-13-13 (TennCare provider billing and appeals)
Provider licensing & enrollment in Tennessee
Providers enroll via TennCare Provider Data Management System (PDMS) / Medicaid Management Information System. All TennCare MCOs require PDMS enrollment.
Major health systems headquartered in Tennessee
| Health system | Headquarters |
|---|---|
| Vanderbilt University Medical Center | Nashville, TN |
| HCA Healthcare (TriStar Health) | Nashville, TN |
| Ballad Health | Johnson City, TN |
| Methodist Le Bonheur Healthcare | Memphis, TN |
| Erlanger Health System | Chattanooga, TN |
Frequently asked questions — Tennessee billing
What is the Tennessee Medicaid program called?
Tennessee's Medicaid program is known as TennCare (Tennessee Medicaid). Providers enroll and manage claims through the provider portal at https://www.tn.gov/tenncare.
What is the Tennessee Medicaid timely filing limit?
TennCare (Tennessee Medicaid) requires initial claims to be filed within 120 days from the date of service. The federal ceiling is 12 months under 42 CFR §447.45; Tennessee's 120-day window is set by the state provider manual. Late-billing exceptions may be allowed with good-cause documentation — verify on the state portal before filing an appeal.
Does Tennessee Medicaid publish a single claims payer ID?
No single canonical claims payer ID is published for TennCare (Tennessee Medicaid). Claims route through the state's fiscal intermediary; look up the correct submitter ID in your clearinghouse directory (Availity, Change Healthcare/Optum, Waystar) and route managed-care claims by the member's MCO assignment.
Who are the largest commercial insurers in Tennessee?
The dominant commercial payers in Tennessee include BCBS Tennessee, UnitedHealthcare, Aetna, Cigna, Humana, along with the BCBS licensee BlueCross BlueShield of Tennessee. Each payer's claims routing, timely filing, and prior-auth rules differ — see the per-payer guides linked above.
What Medicaid managed-care organizations operate in Tennessee?
TennCare (Tennessee Medicaid) contracts with 3 Medicaid MCOs tracked in the QuickIntell registry, including BCBS Tennessee, UnitedHealthcare, Anthem (Elevance Health). MCO contracts determine claims routing and appeal deadlines — route each claim by the member's MCO assignment, not by the FFS payer ID.
What state-specific billing regulations apply in Tennessee?
Tennessee has 3 tracked state-level statutes that affect medical billing and RCM: TCA §56-7-1009 (TN Health Care Consumer Right to Shop Act — balance billing protections); TCA §56-32-226 (TN prompt pay — 30 days clean electronic claim); TennCare Rule 1200-13-13 (TennCare provider billing and appeals). These sit on top of federal protections such as the No Surprises Act, HIPAA, and 42 CFR §447.45.
Run cleaner claims in Tennessee with QuickIntell
QuickRCM, QuickAuth, and QuickERA are tuned to TennCare (Tennessee Medicaid) and the commercial payers on this page — eligibility, prior auth, claim scrubbing, and ERA posting all run on real payer rules, not generic adapters.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. State Medicaid policies, MCO contracts, and payer rules change without notice — always verify against the current provider manual from Tennessee Medicaid and the member ID card before submission.