INFORMATION FOR WORKING WITH US
Provider Administration Manual (PAM)
As discussed in our provider contracts, these manuals are your source for important information about our policies and procedures.
PROMOTING MEDICATION ADHERENCE
Medication Therapy Management Program
The Medication Therapy Management (MTM) Program helps eligible members with medication management, including identifying, preventing and resolving medication interactions and other treatment-related problems. Review information from the Division of TennCare about the MTM Program and Care Coordination. We’ve also created a Medication Therapy Management Provider Operations Manual.
MEDICAL POLICIES & MORE
See our coverage policies & guidelines
Find more information about our medical policies, utilization management guidelines and administrative services policies. You can also see newly approved policies and guidelines, and offer feedback on developing policies and updates.
We review requests based on medical necessity, and the guidelines used for reviews are applied in the following order:
Utilization Management Guidelines
Utilization Management GuidelinesUpcoming Utilization Management GuidelinesAdministrative Services Policies
Administrative Services PoliciesDraft Administrative Services PoliciesUpcoming Administrative Services Policies
