TennCare Bureau - TennCare Solutions Unit - Medical Appeals/Complaints for TennCare Customers

AKA:

TennCare Complaints

Description:

Provides program to file an appeal about medical or prescription problems concerning TennCare.

Administrative appeals are filed through TN Health Connections for those terminated from TennCare or denied TennCare who have applied.

Medical appeals may be filed for services or medicines not covered by TennCare. File this appeal if MCO cannot help find a doctor, if prescribed medicine or medical equipment cannot be obtained, to change MCO, or to request reimbursement for services that should have been covered by TennCare. If currently receiving service or medicine in question, TennCare can be asked to continue paying for it during appeal. File appeal for medicine within 10 days of notice that coverage will end or within 30 days of notice that a service will end. Must show proof of having paid for a medicine or service to qualify for possible reimbursement.

File expedited or fast appeal if in need of medical care AND health will worsen if not obtained. Mail expedited appeal to TennCare Solutions Unit, PO Box 593, Nashville, TN 37202-0593; or call (800) 878-3192; or Fax (888) 345-5575. TTY for the hearing impaired is (866) 771-7043.

Can also assist in helping to change health plans for those already on TennCare.

Hours:

Mon - Fri 8:00 am - 4:30 pm Central Time

Intake Process:

Call 1-800-878-3192 for more information on how to appeal; Can download forms to appeal from website (make sure you keep copy of form for your records); Call (866) 311-4287 for eligibility appeals; mail appeals to Div of Appeals and Hearings, PO Box 198996, Nashville, TN 37219-8986. Call (800) 878-3192 for medical or expedited appeals; call TTY for the hearing impaired at (866) 771-7043; Fax to (800) 778-4234; or mail to TennCare Solutions Unit, PO Box 593, Nashville, TN 37202-0593.

Program Fees:

No fee, unless appeal is lost and services were received after cutoff date. TennCare may request repayment for services received during appeal.

Eligibility:

Anyone denied TennCare coverage or if coverage is terminated or denied with a first application, prescribed services/medicines are not covered, MCO needs to change, or prescribed medicine or service was paid out of pocket and should have been covered.

Is Shelter?

No

Date of Official Change:

March 7, 2024

Address Listings

Contacts

Phone Numbers

Legal Status:

State