TennCare Requires More Providers to Register

Aug. 4, 2017

Due to a provision of the Affordable Care Act, TennCare now requires all ordering, referring and prescribing providers to be registered with the TennCare program in order to pay claims. In the past, the TennCare MCOs have paid for prescriptions written for TennCare patients regardless of the enrollment status of the prescribing provider. However, TennCare and the three MCOs will now start denying payment for prescriptions and any claims submitted by a non-registered provider based on the provider’s NPI.

The Bureau of TennCare is mailing letters to more than 6,000 non-registered providers who have written prescriptions to TennCare patients over the past six months. These prescribers were considered “high-volume” prescribers and are only a portion of the total number of non-registered prescribers that TennCare has identified. The letter urges these providers to register with the TennCare program within 30 days. TennCare will not pay for any prescriptions written by non-registered providers after that time.

This move is due to a recent CMS regulation mandated by the ACA requiring all providers who order or refer services for Medicaid patients to be enrolled in the Medicaid program. Earlier this year, BCBST, Amerigroup and UHC Community Plan issued new policies mandating that all secondary providers, including mid-levels, who provide care to TennCare patients register with the TennCare program and credential with the health plans. Any claims submitted by these mid-levels must include the mid-level’s own NPI number, regardless of whether the mid-level has historically billed claims under the supervising physician’s NPI. Any claims submitted without the ordering, referring or prescribing TennCare-registered provider’s NPI will be rejected.

If you have any questions about the new TennCare registration requirement, please contact the TMA Legal Department at legal@tnmed.org.