TennCare is the State of Tennessee's Medicaid program and is directed by the Division of TennCare. Services are offered through managed care organizations like BlueCare Tennessee. In addition to BlueCare Tennessee, there is a Pharmacy Benefits Manager and a Dental Benefits Manager for dental services to members under age 21. Click here for more information.
The Contractor Risk Agreement (CRA) details the terms BlueCare Tennessee must follow to operate a provider network and provide covered health services to TennCare enrollees.
Medicare crossover payments are normally made by the Division of TennCare separately from the Managed Care Contractors. Rules 1200-13-13-.08(12)(b) and 1200-13-14-.08(12)(b) set forth the guidelines for timely filing for Medicare crossover claims. If you have questions or would like more information, please contact TennCare Provider Services at 1-800-852-2683.
The Improper Payments Information Act (IPIA) of 2002 (amended in 2010 by the Improper Payments Elimination and Recovery Act or IPERA) requires the heads of Federal agencies to annually review programs they administer and identify those that may be susceptible to significant improper payments, to estimate the amount of improper payments, to submit those estimates to Congress, and to submit a report on actions the agency is taking to reduce the improper payments. The Office of Management and Budget (OMB) has identified Medicaid and the Children's Health Insurance Program (CHIP) as programs at risk for significant improper payments. As a result, CMS developed the Payment Error Rate Measurement (PERM) program to comply with the IPIA and related guidance issued by OMB. Learn more about the PERM Program at the CMS website.