Tennessee | Providers – Amerigroup

COVID-19 News and Resources

Medicaid:

CMS Targeted Payments to PCPs (November 13, 2020)
Guidance from HHS on Reporting Requirements for General and Targeted CARES Act Fund Distribution (October 6, 2020)
Post-Payment Notice of Reporting Requirements (October 6, 2020)
Extension of COVID-19 Policies Regarding Hospital Administrative Flexibilities (October 1, 2020)
Payment for COVID-19 testing of Medicaid Enrollees in Nursing Facilities (October 1, 2020)
IMPORTANT! Opportunity to apply for federal COVID relief funding: HHS Extends Application Deadline for CARES Act Provider Relief Funds to September (09/10/2020)
Telehealth guidance for outpatient physical therapy/occupational therapy/speech therapy during COVID 19 public health emergency (Extended through December 31, 2020)
COVID-19 information from Amerigroup Community Care August 28 (Telehealth extensions)
COVID-19 Telehealth Guidance Extension (August 26, 2020)
HHS Extends Deadline for Medicaid, CHIP and Dental Provider Relief Funds (August 10, 2020) )
Episodes of Care 2019 Final Risk-Sharing Payment Waiver (COVID) (August 7, 2020)
Accommodations in Consumer Direction during the Public Health Emergency (7/21/2020)
Federal support for TennCare and CoverKids providers (July 23, 2020)
UPDATE Request to CMS for Targeted Payments to CMHCs/SUDs
COVID-19 information from Amerigroup Community Care (July 9 update) (TeleHealth Extensions)
Telehealth guidance for outpatient physical therapy/occupational therapy/speech therapy during COVID-19 public health emergency (Extended through August 29, 2020)
Update on TennCare MCO Telehealth Coverage Policies July 1, 2020
Implementation of COVID-19 Related Retainer Payments (June 24, 2020)
Health Resources & Services Administration Uninsured Program Frequently Asked Questions
Request to CMS for Targeted Payments to PCPs
TennCare COVID-19 Memo May 8, 2020
Listen now! Webinar recording available from Amerigroup Community Care for network providers on SBA loans and other federal relief programs in response to COVID-19
TennCare COVID-19 Memo April 21, 2020
Federal resources available for health care providers and employers in the federal CARES Act
Civil Rights COVID-19 Guidance
TennCare Guidance on EPSDT/Well Child Visits during COVID-19
TennCare and CoverRx Program Updates Regarding COVID-19
Tennessee Department of Health Recommendations for Long Term Care Facilities (March 28, 2020)
A ‘thank you’ to our providers during the coronavirus (COVID-19) pandemic
REVISED CMS Guidance Re: Prioritization of Survey Activities for COVID-19 Infection Control
COVID-19 Lab Testing Coding and Reimbursement Information from Amerigroup Community Care
Behavioral Health Telehealth Services for TennCare Enrollees -Novel COVID-19 (March 18, 2020)
TennCare And CoverRx Program Updates Regarding COVID-19 Health Concerns (March 19, 2020)
Novel COVID-19 Testing and Telehealth Services for TennCare Enrollees (March 17, 2020)

News & Announcements

Medicaid:

Specialty Pharmacy Prior Authorization Updates
December 2020 Provider NB Announcement
CoverKids transition FAQ (Effective January 1, 2021)
Updates to AIM Clinical Appropriateness Guidelines for Radiation Oncology
New specialty pharmacy medical step therapy requirements effective 1/1/2021
Provider Chat Flier
Providers can now receive and respond to postpay audit record requests via Change Healthcare’s Assurance Attach Assist
Reminder: Providers CARE Survey
Tennessee Healthcare Symposium - Save the Dates with our Early Bird Rates!
Chlamydia Screening in Women (CHL) HEDIS measure
November 2020 Provider NB Announcement
Provider Digital Engagement
Change Healthcare Medical Attachment Functionality FAQ
Racial Trauma Forum Invitation
Medicare Advantage — Provider Notification for UM AROW 1107
Prior authorization requirements for E0482
Inhaled Nitric Oxide Bulletin
October 2020 Provider NB Announcement
May 2020 Medical Policies and Clinical Utilization Management Guidelines update
Prior authorization requirements for 0200T and 0201T
Providers CARE Survey
Clinical Criteria Web Posting June 2020
Clinical Criteria Web Posting May 2020
Resources to Support your Diverse Patient Panel - Flyer
Transition to AIM Specialty Health Rehabilitative Services Clinical Appropriateness Guidelines
New MCG Care Guidelines 24th edition Viral Illness
Provider demographics update
Tennessee Department of Health Summit Bulletin
Tennessee Immunization Summit Agenda Flyer
Diabetes Retinal Camera Bulletin
Updates to AIM Specialty Health advanced imaging Clinical Appropriateness Guidelines
TennCare MCO/ CoverKids Integration FAQ
Medically necessary services obtained from non-contract provider referred by contract provider
February 2020 Medical Policies and Clinical Utilization Management Guidelines update
2020 affirmative statement concerning utilization management decisions
Clinical Criteria Web Posting March 2020
Modifier use reminders
New behavioral health discharge call-in line
Updates to AIM Sleep Disorder Management Clinical Appropriateness Guideline
InterQual 2020 update
November 2019 Medical Policies and Clinical Utilization Management Guidelines Update
Update to Allergen Immunotherapy
MCG care guidelines — 24th edition
Clinical Criteria Web Posting February 2020
MAT Quality Metric Reports
Access to Xolair
Prior authorization requirements: New 2020 codes for coverage and precertification
Early and Periodic Screening, Diagnostic and Treatment — Coding and Billing Facts
Clinical Criteria Web Posting December 2019
Clinical Criteria Web Posting November 2019
Coding tip for psychological and neuropsychological testing
August 2019 Medical Policies and Clinical Utilization Management Guidelines Update
Availity Provider Notification
Availity Provider FAQ
Incorrect Claims Payment Alert
Medical necessity review for appropriate level of care
Memorandum for Coordinating Care for School-Based Health Services
Reminder: HIPAA-compliant claim submission
Clinical Criteria Web Posting September 2019
Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Reimbursement Policy Update
Global 3M19 Medical Policy and Technology Assessment Committee prior authorization requirement updates
Expansion of Specialty Pharmacy Precertification List: Zirabev
Multiple and Bilateral Surgery: Professional and Facility Reimbursement Policy Update
Clinical Criteria Web Posting August 2019
Provider training series
Breast cancer screening FAQ
Assisting your patients in managing the Donut Hole
Lowering health risks with no-cost statins
Introducing a new fall risk program
June 2019 Medical Policies and Clinical Utilization Management Guidelines Update
March 2019 Medical Policies and Clinical Utilization Management Guidelines Update
Providers CARE Survey
Vaccines for pregnant members
InterQual 2019 update
HealthCrowd Flier
Clinical Criteria Web Posting July 2019
Prior authorization requirements for hyperbaric oxygen and supervision of hyperbaric oxygen therapy
March 2019 Clinical Utilization Management Guidelines
Drug Screen Testing Update
MCG Care Guidelines update and customizations
Prior authorization requirements changes effective November 1, 2019
Clinical Criteria Web Posting Q1 2019
Provider CARE Survey Article
Clinical Criteria Web Posting Q2 2019
Clinical Laboratory Improvement Amendments
Semi-Annual Cost of Care Review
AGP Customization for IP Cancer Therapy
January 2019 Medical Policies and Clinical Utilization Management Guidelines Update
Unspecified Diagnosis Code Update
Prepayment clinical validation review process
Reminder to revalidate your TennCare registration information for Medicaid
2019 Utilization Management Affirmative Statement concerning utilization management decisions
November 2018 Medical Policies and Clinical Utilization Management Guidelines Update
Update on nursing facility changes of ownership
Correction: Cervical length measurement by transvaginal ultrasound
Clinical Criteria Updates - Posted 3/8/2019
September 2018 Medical Policies and Clinical Utilization Management Guidelines Update
Update: Amerigroup Community Care expands work with AIM Specialty Health® for outpatient genetic testing services authorizations
Third-party liability
Amerigroup Community Care expands work with AIM Specialty Health for outpatient genetic testing services authorizations
July 2018 Medical Policies and Clinical Utilization Management Guidelines Update
Important changes: Telehealth GT Modifier changes effective 10/01/2018
Introducing the New Amerigroup Professional Provider Market Master Fee Schedule
Frequency and resubmission code requirements
CVS Caremark specialty pharmacy — prior authorization update
Update: noncovered codes
Prior authorization requirements for Subcutaneous Implantable Defibrillator system
Prior authorization requirements for Sublocade
New AGP Community Care Facility Proprietary Reimbursement Method FAQ
May 2018 Medical Policies and Clinical Utilization Management Guidelines Update
Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants
Behavioral health Medical Policies and Clinical Utilization Management Guidelines update
Cervical length measurement by transvaginal ultrasound
Prior authorization requirements for Interferon beta-1a
Prior authorization requirements for Somatrem
Invitation to attend the 2018 Provider Open Forum in Memphis on 10/22
Invitation to attend the 2018 Provider Open Forum in Jackson on 10/15
Providers CARE Survey
Budget Reduction Impacts Effective July 1, 2018
Provider claim payment dispute update
Hospice Tips
Electronic claim payment reconsideration - Effective 09/01/2018
CPT Category II payment opportunity
Availity Claim Payment Disputes Training Webinar
Abortion, Sterilization and Hysterectomy Codes - 08/14/2018
Prior authorization requirements for Cabazitaxel (Jevtana)
Prior authorization requirements for injectable/infusible drugs: mepolizumab and reslizumab
Reimbursement System for Nursing Facilities
Medical Policies and Clinical Utilization Management Guidelines update - March 2018
Medical Policies and Clinical Utilization Management Guidelines update - January 2018
Services requiring prior authorization
Prior authorization requirements for Darzalex (daratumumab) drug
Lower extremity vascular intervention codes require prior authorization
Q4 Medical Policies and Clinical Utilization Management Guidelines Updates
Prior authorization requirement update for Mylotarg
Chimeric antigen receptor T-cell therapy requires prior authorization for all places of service
Electrical stimulation device to require prior authorization
Home health services missed shift notification requirement
AIM Musculoskeletal Guidelines Notice
Spring Provider Information Expo
Update to Policy: Preventive Medicine and Sick Visits
Medical Policy update - Hyaluronan Injections
Eight injectable drugs will require prior authorization
Postpartum outreach initiative
Budget Reduction 1% Payback
Tennessee Health Link Activity Rate with 1% Buyback
MCO Joint Network Notification
Medical Policies Update
Elotuzumab to require prior authorization
PCP panel overview for member assignment
Medication therapy management provider FAQ
Announcing The Amerigroup Community Care Centers of Pain Excellence Network
Levoleucovorin calcium, elosulfase alfa, histrelin acetate, idursulfase and fulvestrant to require prior authorization
Remember to renew your TennCare,CoverKids or Medicare QMB/SLMB
Important Benefit Limit Information Effective January 16, 2018
Effective January 1, 2018, providers will be required to use ProView for credentialing
Important changes: home- and community-based services TennCare CHOICES (CHOICES) Critical Incident Report form
Medicare Advantage – Documented clinical evidence reduces admission denials, peer-to-peer calls
New separate reimbursement for voluntary reversible long-acting contraceptive devices
New review process for not otherwise classified drug codes
Q2 Medical Policies and Clinical Utilization Management Guidelines update
Q3 Medical Policies and Clinical Utilization Management Guidelines update
Hemophilia factor to require prior authorization
Access Patient360 directly through the Availity Web Portal
Q1 Medical Policies and Clinical Utilization Management Guidelines update
Budget reductions/impacts for July 1, 2017
Wheelchair component or accessory, not otherwise specified to require prior authorization
Important - action required for CHOICES and ECF CHOICES providers
Invitation to Attend the Medicaid Perspectives Webinar
Change to prior authorization requests for Makena
Update Provider Profile by March 17 - Link included here
Genetic testing services to require prior authorization
Q4 Medical Policies and Clinical Utilization Management Guidelines update
Hospice Tips Sheet
Continuous interstitial glucose monitoring to require prior authorization
Notification process reminder
Behavioral Health Provider Authorization Bulletin
Amerigroup Community Care sleep medicine authorizations and AIM Specialty Health
Lessons Learned From Employment and Community First CHOICES (ECF CHOICES) Outcome-Based Employment Services
Intracardiac electrophysiological studies and catheter ablation to require prior authorization
Physicians: enrollment deadline for PIPP — updated
Hospitals: enrollment deadline for PIPP — updated
Reimbursement Policy Corrected Claims
Amerigroup Community Care cardiology, radiation oncology and sleep medicine authorizations and AIM Specialty Health® (AIM)
Q3 Medical Policies and Clinical Utilization Management Guidelines update
Prior authorization requirements for new injectable/infusible drugs: Istodax (romidepsin), Ixempra (ixabepilone), Doxil (doxorubicin), Torisel (temsirolimus) and Inflectra (infliximab-dyyb)
Amerigroup Community Care cardiology, radiation oncology and sleep medicine authorizations and AIM Specialty Health® (AIM)
Elective one and two vessel coronary artery bypass graft to require prior authorization
Effective September 15, 2016: Level II Case Management will only require notification
2016 Q2 Medical policies and Clinical Utilization Management (UM) Guidelines
Change to inpatient diagnosis-related group claim submission requirements related to itemized billing
Federal nondiscrimination and accessibility update
Authorizations and medical necessity reminder
ClaimsXten Upgrade
Medical injectable access via ProCare Pharmacy Direct (CVS Specialty subsidiary)
Precertification for knee and spine orthoses effective July 1, 2016
Tennessee Health Link program
Emergency department (ED) diversion case management program
Marshall and Wayne Medical Centers will no longer be in network
Last Chance to Enroll in the TennCare Medicaid EHR Provider Incentive Program
Reimbursement Policy Bulletin - April 2016
Durable medical equipment precertification requirements
ER Services During Inpatient Psychiatric Admission
Revalidate Your Registration
Prior authorization required for drugs Entyvio and Cyramza
Scoliosis and spinal deformity medical necessity reviews
Electronic Registration/Revalidation Required
Tramadol: Drug safety communication
Hemophilia drugs authorization changes effective November 15, 2015
Changes to Level 2 Case Management Guidelines
Retraction of Nonphysician Practitioner Reimbursement Policy
Q3 Medical Policies and Clinical Utilization Management Guidelines Update
Correction to Marshall and Wayne Medical Centers notification
Cervical Length Screening Guidelines
Amerivantage Specialty + Rx Plan now available for eligible members with Medicare and Medicaid coverage​
What is defined as a Critical Incident is changing
ICD-10 Coded Authorizations Accepted Effective June 1.
OrthoNet to conduct professional service coding reviews for musculoskeletal providers
Abortion, Sterilization and Hysterectomy (ASH) Services
Changes to prior authorization for ear, nose and throat codes​
Update to laboratory procedure codes
My PCP Connection Frequently Asked Questions
Recoveries related to retroactive eligibility terminations​
Patient360 Lets You Access Member Records in a Few Clicks
PCP Rate Increase Decommissioning Bulletin
Amerigroup implementation provider transition FAQs
TennCare Drug Safety Alert to Providers
Provider NewsBlast – Sept 2014
Upcoming changes to durable medical equipment precertification requirements
Postponed Upcoming Disbursement Process Changes
Provider News Blast Notice - August 2014
HIPPS Codes Required for All Skilled Nursing and Home Health Providers
Join Us in the Million Hearts Initiative
Reducing the Overuse of Imaging Studies for Lower Back Pain
Availity Announcement and Frequently Asked Questions
Coming Soon! Enhanced Online Precertification Tool
Updated CMS 1500 Form
Annual CPG Notice
School Based Services IEP Reminder
Change in Authorization Process for Short Term Nursing Facility Care - CHOICES Group 2 and 3 Members
Putnam County Provider Town Hall Invitation
New Website Password Requirements
Clarification Regarding Item D Deductions
August 1 Changes to Precertification Guidelines
Medication Precertification Tool Available Now
The New Electronic Health Risk Assessment Form
Consent Form Requirement for Sterilization Services
Univita Update
Important reminder regarding behavioral health CPT codes
CMS fact sheets about the rate increase for primary care providers
Latest updates on the transition to ICD-10
May 1, 2013, Change to UniCare CPBs & Guidelines
CHOICES critical incident reporting and investigation duties
We launched our newly designed online provider directory in September. Try it out here.
Our Medicaid ID cards have gone mobile!
Preventing the flu

Medicare:

Medicare Advantage — Updates to AIM Clinical Appropriateness Guidelines for Radiation Oncology
Essential/Everyday Extras
Updated claims submission requirements for Adult Day Center benefit
Personal Home Helper FAQ
Medicare Advantage — Provider Chat Flier
Medicare Advantage — Providers can now receive and respond to postpay audit record requests via Change Healthcare’s Assurance Attach Assist
Medicare Advantage — 2021 Service Area and Benefit
Medicare Advantage — Expanded Specialty Pharmacy Precertification List - Effective February 1, 2021
Medicare Advantage — Expanded Specialty Pharmacy Precertification List - Effective February 1, 2021
Medicare Advantage — Change Healthcare Medical Attachment Functionality FAQ
Medicare Advantage — Racial Trauma Forum Invitation
Medicare Advantage Policy Update — Emergency Department: Leveling of Evaluation and Management Services
Medicare Advantage — Provider Notification for UM AROW 1125
Procedures for submitting referrals for Medicare Advantage meal benefits requiring precertification
Expanded Specialty Pharmacy Precertification List - Effective January 1, 2021
Medicare Advantage — May 2020 Medical Policies and Clinical Utilization Management Guidelines update
Medicare Advantage — Clinical Criteria Web Posting June 2020
Medicare Advantage — New Specialty Pharmacy Medical Step Therapy Requirements - Effective 1/1/2021
Medicare Advantage — Evaluation and management services correct coding
Medicare Advantage — MCG care guidelines24th edition Viral Illness
Medicare Advantage — Provider demographics update
Medicare Advantage Clinical Criteria Web Posting May 2020
Medicare Advantage — Amerigroup expands specialty pharmacy precertification list
Updates to AIM Specialty Health advanced imaging Clinical Appropriateness Guidelines
Medicare Advantage — AIM Musculoskeletal program expansion
New Specialty Pharmacy Medical Step Therapy Requirements - Effective August 1, 2020
Medicare Advantage — Waived copays, deductibles and coinsurance for CCM, complex CCM and TCM
Medicare Advantage — Submit behavioral health authorizations via our online Interactive Care Reviewer tool
Medicare Advantage — Amerigroup expands specialty pharmacy precertification list (Effective 9/1/2020)
Medicare Advantage Medical Drug Benefits Clinical Criteria Updates (March 2020)
Medicare Advantage MCG care guidelines — 24th edition
Updates to AIM musculoskeletal program clinical appropriateness guidelines
Medicare Advantage — Transition to AIM Rehabilitative Services Clinical Appropriateness Guidelines
Medicare Advantage - Prior authorization requirements
Medicare Advantage - Acquisition of Beacon Health Options
Special Needs Plans (SNPs) and Model of Care (MOC) overview
Medicare Advantage — Resources supporting our providers during COVID-19
Medicare Advantage — Clinical Criteria Web Posting February 2020
Amerigroup expands specialty pharmacy precertification list
Medicare Advantage — Amerigroup working with Optum to collect medical records for risk adjustment
Medicare Advantage — Electronic submission is preferred method for requesting pharmacy prior authorization
Medicare Advantage — Prior authorization requirements: New 2020 codes for coverage and precertification
Medicare Advantage — November 2019 Medical Policies and Clinical Utilization Management Guidelines Update
Availity Provider FAQ & Availity Provider Article
New behavioral health Medicare Advantage provider fax beginning March 30, 2020
Medicare Advantage — Coding tip for psychological and neuropsychological testing
DRG Prepay Update Notification
Medicare Advantage — Clinical Criteria Web Posting December 2019
Medicare Advantage — August 2019 Medical Policies and Clinical UM Guidelines update
New Medicare Advantage — Opioid Treatment Program benefit
Medicare Advantage — Clinical Criteria Web Posting November 2019
Prior authorization requirements for CardioMEMS
Update on Personal Home Helper supplemental benefit for Medicare Advantage Members
Procedures for submitting referrals for Medicare Advantage meal benefits requiring precertification
Benefits update for Special Supplemental Benefits for the Chronically Ill
Everyday Extras — personal home helper
InterQual 2019.1 update
Medicare Advantage — Outpatient Rehabilitation Program transition: new prior authorization requirements
New CMS requirement: Hospitals must use Medicare Outpatient Observation Notice
Prior authorization requirements for E0784, K0553 and K0554
Global 3M19 Medical Policy and Technology Assessment Committee prior authorization requirement updates
Personal Home Helper benefits
New Specialty Part B Preferred Device - Effective January 17, 2020
Medicare New Specialty Pharmacy Medical Step Therapy Requirements - Effective January 17, 2020
Medicare Advantage — Clinical Criteria Web Posting September 2019
Medicare Advantage — Pharmacy Benefit Manager Change to IngenioRx - Effective 1/1/2020
TN 2020 Medicare Advantage plan changes
Hospice Tips
Amerigroup expands specialty pharmacy precertification list
Medicare Advantage — CMS reminder: expedited/urgent requests
Prior authorization requirements for continuous positive airway pressure supplies
Medicare Advantage — Aspire Telehealth Palliative Care Program bulletin
Rehabilitative services prior authorization review update
Medicare Advantage — June 2019 Medical Policies and Clinical UM Guidelines update
Prior Auth Q2 2019 Medicare CoC Rule Changes-AGP
2019 Enhanced Personal Health Care Program releases myFHR
Medicare Advantage — Medicare Preferred Cont Glucose Monitors
Revisions to Floor to SNF program for Amerigroup members
Clinical Criteria Web Posting July 2019
Medicare Advantage — 2019 Risk Adjustment Provider Trainings
Medicare Advantage – January 2019 Medical Policies and Clinical Utilization Management Guidelines update
Medicare Advantage — March 2019 Medical Policies and Clinical Utilization Management Guidelines update
Medicare Advantage — CLIA for Amerigroup
Medicare Advantage — Pharmacy benefit manager change to IngenioRx
Medicare Advantage — Clinical Criteria Web Posting Q2 2019
Prepayment clinical validation review process
Upgrade to 23rd Edition of MCG Care Guidelines
Update to Emergency Department: Level of E&M Services Reimbursement Policy (Medicare-Advantage Only)
Medicare Advantage — Outpatient Rehabilitation Program transitioning to AIM
2019 Utilization Management Affirmative Statement concerning utilization management decisions
Medicare Advantage — Medical records request for risk adjustment
Update: Medicare Advantage — 2019 risk adjustment provider trainings
Update: Medicare Advantage — Submitting corrected claims
Medicare Advantage — Partial hospitalization services
Medicare Advantage — Fall prevention tips
Revision to Facility Emergency Department reimbursement policy postponed
Medicare Advantage — AIM cardiology and radiation oncology guidelines
Medicare Advantage — Prior authorization requirements for DME repair and portable oxygen concentrator
Medicare Advantage — Medical Policies and Clinical Utilization Management Guidelines update
Medicare Advantage — Update: 2019 Risk Adjustment provider trainings
Medicare Advantage — Change to 835 ERA for all D-SNP MA members for 2019
Medicare Advantage — Special Need Plans training required
Medicare Advantage — Clinical criteria updates for specialty pharmacy
Medicare Advantage — Amerigroup eye refraction and routine eye exam billing information
Medicare Advantage — Pharmacy and Therapeutic Committee updates
Update: Amerigroup Community Care expands work with AIM Specialty Health® for outpatient genetic testing services authorizations
Medicare Advantage — Member Explanation of Benefits redesigned
Medicare Advantage — New specialty Part B device Voluntary Steerage program
Medicare Advantage — 2019 Risk Adjustment Training
Medicare Advantage — 2019 Annual Notice of Change
Medicare Advantage — Genetic testing prior authorization by ordering physician helps ensure accurate lab payment
Medicare Advantage — Amerigroup transitions back pain management and cardiology UM programs from OrthoNet to AIM
Medicare Advantage — Please evaluate statin use for MA members with diabetes, cardiovascular disease
Medicare Advantage — Medicare pharmacy and prescriber home starts January 2019
Medicare Advantage — Prior authorization requirements for Part B drugs: Nivestym
Medicare Advantage — Electronic Claim Payment Reconsideration
Medicare Advantage — myNEXUS Home Health Care Program for Utilization Management, Network Contracting and Claims Processing FAQ
Medicare Advantage — Prior authorization requirements for Part B drugs: Moxetumomab Pasudotox, Cemiplimab and Fulphila
Medicare Advantage CMS issues regulatory changes for short- and long-acting narcotics; days’ supply limits effective Jan. 1, 2019
Medicare Advantage — DME providers and physicians: important wheelchair prior authorization information
Medicare Advantage — Submit PA medication requests electronically; new phone number for MA prescription Pas effective Sept. 1
Medicare Advantage — Members receive incentives for completing screenings
Medicare Advantage — Amerigroup adopts Milliman Care Guidelines for inpatient rehabilitation, subacute rehabilitation and skilled nursing facility clinical reviews
Medicare Advantage – Medical Policies and Clinical Utilization Management Guidelines update
Medicare Advantage — Prior authorization requirements for Part B drugs Retacrit, Damoctocog and Ilumya
Medicare Advantage — MyDiversePatients.com
Medicare Advantage — Medical Policies Update
Medicare Advantage — Prior authorization requirements for Part B drugs: Azedra and Poteligeo
Medicare Advantage — Peer-to-Peer Process
Medicare Advantage — Prior authorization requirements for Cardiovascular Services
Medicare Advantage — CMS Selects Amerigroup for 2016 National RADV Audit
Medicare Advantage — Prior authorization requirements for part B drugs: Zevalin and Eptacog
Medicare Advantage — Prior authorization requirements for part B drug: Trelstar
Medicare Advantage — myNexus Network Contracting FAQ
Medicare Advantage — Utilization management decisions based on appropriateness of care, benefits
Medicare Advantage — Prior authorization requirements for CAR-T Therapy
Medicare Advantage — Amerigroup to conduct post-payment reviews of distinct procedural services modifiers
Medicare Advantage — Prior authorization requirements for part B drugs: Mylotarg and Mvasi
Remember to renew your TennCare CoverKids
Medicare Advantage — Prior authorization requirements for injectable drugs: Brineura, Tremfya and Zinplava
Medicare Advantage — Prior authorization requirements for Part B drugs: Rebinyn, Fibryna and Hemlibra
Medicare Advantage — Inpatient Readmissions Update
Medicare Advantage — Prior Authorization Requirements for Part B Drug - Evomela
Medicare Advantage — HEDIS Measure: Ensure Medication Reconciliation is Completed after Discharge
Medicare Advantage — Prior Authorization Requirement Change to Epidermal Growth Factor Receptor Testing
CPT Category II payment opportunity: TennCare
Budget reduction notification requirement for state fiscal year 2017 from Bureau of TennCare
Medicare Advantage — 2017 Annual Notice of Change
Medicare Advantage — Prior Authorization Requirements for Continuous Interstitial Glucose Monitoring
Physicians: Update to MU requirements for PIPP
Hospitals: Update to MU requirements for PIPP
Medicare Advantage — Clinical Cumulative Morphine Equivalent Dosing Point of Sale Edit effective January 1, 2017
Medicare Advantage — Assisting Members with Rheumatoid Arthritis Who May Be Missing Important Medications
Medicare Advantage — In-Home Bone Mineral Density Testing
Medicare Advantage — Contact Medicare Part B Specialty Pharmacy before Injections, Infusion Drug Prior Authorization Expire
Medicare Advantage — OptiNet webinar for all imaging providers
Medicare Advantage — HealthMap Solutions Gathering Diabetes Screening Results
Medicare Advantage — Medicare Notices and Provider Requirements
Medicare Advantage — Please Review Rx Changes to Help Members Find the Best Medication Values
Medicare Advantage — Additional Support Available for Members with Rare Conditions
Consent for Sterilization Form Approved for Continued Use
Medicare Advantage — 2016 Service Area Changes
Medicare Advantage — DSNP Training Invite
Medicare Advantage — House Call Program
Medicare Advantage — Precertification Required on Part B New Injectables
Chiropractic benefits managed by ASH effective June 1, 2015
Flu Vaccinations
Medicare Advantage Peer to Peer Changes
Medicare Advantage — 2015 Annual Notice of Change in Products
New Federally Qualified Health Center Billing Guidelines in Effect for Original Medicare
Inpatient Readmissions
Encourage Exercise to Prevent Falls
Upcoming Changes to Amerivantage (Medicare Advantage) Precertification Requirements
Medicare Advantage — Product Highlights Provider Letter
Medicare Requirements for Outpatient Therapy Claims
HEDIS Requirements for DMARD Therapy for Rheumatoid Arthritis
The Medicare Health Outcomes Survey
Medicare Advantage — Provider Requirements and Medicare Notices
Decrease Font Size Button Default Font Size Button Increase Font Size Button

Provider Self-Service

tn-state-styles.css
provider-survey.css
Login

Provider Survey

Please help us improve our provider website by taking this brief survey
Take Survey

 Provider Resources & Documents

expand Behavioral Health
Behavioral Health Case Management Flier
I/DD primary care provider survey
Tennessee Health Link Guidelines: Adult Medical Necessity Criteria
Tennessee Medicaid Behavioral Health Transitional Support — Community-Based Services (TBHTS-CBS)
CCFT Guidelines
Buprenorphine Medication Assisted Treatment (MAT) Program Description (Posted June 12, 2018)
Naltrexone Medication Assisted Treatment (MAT) Program Description
Behavioral Health HEDIS Brochure
Psychosocial Rehabilitation Medical Necessity Criteria
Naltrexone Provider Directory
BMAT Project ECHO
Continuous Treatment Team Services for Child and Adolescent SED Population
Infant Early Childhood Mental Health Assessment
Medicare Advantage BH ICR Training Presentation
Opioid Treatment Program (OTP) Description for SAMHSA Certified Facilities
BH Interactive Care Reviewer benefits brochure
Tennessee Health Link reconsideration process and form
expand CHOICES: Long-Term Supports & Services for Older Adults and Adults with Physical Disabilities
CHOICES Critical Incident Investigation Report Form
TennCare QuiLTSS Community Forums for Providers
2014 Maximum ACLF Room and Board Charges
Critical Incident Report One Sheet Guide
TennCareCHOICES Provider Orientation
expand Claims Submission and Reimbursement Policy
Practitioner and Facilities Emergency Department Policy
Emergent Diagnosis List - October 2018
Outpatient Laboratory Services — New Payment Policy
expand Clinical Practice Guidelines
Clinical Practice Guidelines Matrix
expand Employment and Community First CHOICES: Long-Term Services and Support for Individuals with Intellectual and Developmental Disabilities
ECF CHOICES Provider Quick Reference
Overview of Critical Incident Management in Employment and Community First CHOICES
ECF Critical Incident Reporting Training
ECF CHOICES Provider Investigation Form
ECF First CHOICES Quality Monitoring Overview
Exploration Timeframes and Log
Reportable Event Form
Employment Documentation Quick Reference
Discovery Report Template
Service Log Template
Job Development Plan Template
Job Coach Fading Plan Template
Supported Employment Small Group Service
Discovery Time Frames and Log
Training resources specific to addressing the behavioral health needs of individuals with an intellectual or developmental disability diagnosis
ECF CHOICES Reportable Events Guide
Joint PDMS Provider Notification
expand Enhanced Personal Health Care Program
Availity Access to Reports
expand Forms
Refund Notification Form
Provider Referral Form – Memphis (CareMore)
Psychological Testing Request Form
Recoupment Notification Form
Precertification Request Form
Provider Payment Dispute and Correspondence - Submission Form
Out-of-Network Precertification Request Form
Tennessee Health Link Provider Attestation Form
Neuropsychological Testing Request Form
Tennessee Health Link Opt-Out Form
Agency Plan of Care Form
Practitioner Call Coverage Form
Behavioral Health Discharge Medicare
BH Electroconvulsive Therapy - Medicare
BH Neuropsychological Testing - Medicare
Initial Member/Caregiver Training Checklist
Agency Plan of Care Form-Spanish
Medicare Advantage Prior Authorization Form
Behavioral Health Concurrent Review Form Medicaid
Behavioral Health Treatment Plan Request for Autism Spectrum Disorders
Sign up to receive email communications
expand ICD-10
Medicare Advantage Medical Record Documentation & Coding Tips
expand Manuals & QRCs
Medicaid Provider Manual
Member Handbook
Employment and Community First CHOICES Provider Manual Supplement
Medicare Provider Dispute, Grievance and Appeal FAQ
ECF CHOICES Provider Quick Reference Guide
expand Maternal Child Program
Maternity Care Management Notification
Healthy Rewards Flier
Electric, Nonhospital Grade Breast Pump Request Form
Primary Care Toolkit for NAS/NOWS Prevention and Post-Hospital Follow-Up
Update on Reimbursement for Early Elective Deliveries
Coding Reimbursement for EDD-Reminder
expand Medical Management Model
Health Education and Wellness
expand Newsletters - Archived
Provider News Issue 1 2014
Provider NewsBlast – May 2014
Provider NewsBlast – July 2014
Provider News Blast - October/November 2014
Provider NewsBlast – January 2015
Provider News Blast - March 2015
Provider NewsBlast - May 2015
Provider NewsBlast - July 2015
Provider NewsBlast - September 2015
Provider NewsBlast - November 2015
Provider NewsBlast - February 2016
Provider NewsBlast - May 2016
Provider NewsBlast - July 2016
Provider NewsBlast - September 2016
Provider NewsBlast - November 2016
Provider NewsBlast - January 2017
Provider NewsBlast - March 2017
Provider NewsBlast - May 2017
Provider NewsBlast - July 2017
Provider NewsBlast - September 2017
Provider NewsBlast - December 2017
Provider NewsBlast - March 2018
Provider NewsBlast - May 2018
Provider NewsBlast - July 2018
Provider NewsBlast - September 2018
November 2018 Provider NewsBlast
January 2019 Provider NewsBlast
March 2019 Provider NewsBlast
May 2019 Provider NewsBlast
July 2019 Provider NewsBlast
September 2019 Provider NewsBlast
November 2019 Provider NewsBlast
expand Newsletters - Current
January 2020 Provider NewsBlast
March 2020 Provider NewsBlast
May 2020 Provider NewsBlast
July 2020 Provider NewsBlast
September 2020 Provider NewsBlast
November 2020 Provider Newsblast
expand On-Demand Training Videos
MAT Virtual Education Session
expand Pharmacy
TennCare Clinical Criteria for Synagis Coverage
Makena Prior Authorization Form
TennCare Pharmacy Program PDL changes notice
Medical Injectable Prior Authorization
TennCare PDL updates Memo
expand Population Health
About Population Health
expand Quality Management
HEDIS Desktop Reference Guide for Medicaid Providers
HEDIS Coding Booklet
TN HEDIS 101 for Providers - Guideline Update
expand Quick Tools
Reimbursement Policies
Provider Contact Guide for UM and CM
Medicare Advantage 2020 Products
Medicare Advantage 2021 Products
expand Referral Directories
ECF CHOICES Referral Directory
expand Referral Directories
TennCare Provider Directory West - CoverKids eff 1/1/2021
TennCare Provider Directory South Middle - CoverKids eff 1/1/2021
expand State Communications
Rate Reduction letter & Memo (July 3, 2014)
Quality Payments to Nursing Facilities
QuILTSS Nursing Facility Value-Based Purchasing Quality Framework
TennCare Synagis Season 2014-2015 Information​
Health Care Innovation Initiative (3/2015 recorded webinar)​
QuILTSS #5 Bridge Payment Suspension
QuILTSS #6 Bridge Payment Submission
CLS Memo
Keeping TennCare Flyer
ACLF Room and Board Memo
TennCare Pharmacy Program Memo
TennCare Pharmacy Update - July 2016
Provider Notice for PDL Changes Effective January 1, 2017
Tennessee Health Link activity rate effective July 1, 2017
Billing Policy Change for Post-Partum VRLAC
TennCare Responding to the Opioid Epidemic
2018 VFC Annual Immunization Review Registration
Urine Drug Screen Limits - Change Effective January 1, 2019
Guidance for Providers on Nursing Facility Changes of Ownership
Termination of TennCare Providers Memo
Tennessee Immunization Information System (TennIIS) Quick Reference Guide - Reminder/Recall
Sterilization Consent Form Instructions
expand TennCare Episodes of Care
Episodes of Care Risk Methodology-Wave 1
Episodes of Care Risk Methodology-Wave 3
Episodes of Care Risk Methodology-Wave 5
Episodes of Care Risk Methodology-Wave 7
Episodes of Care - model design
Episodes of Care FAQ: Quick Reference
TennCare Feedback Session MEMO 2019
expand TennCare Kids
TennCare Kids Reminder Program
EPSDT Manual
2019 HEDIS 101 for providers
expand Training Programs
Nondiscrimination Training Materials
Cultural competency and patient engagement
Compliance Information (Fraud Card)
DSNP Overview Training
My Diverse Patients Training: Creating an LGBT-Friendly Practice
Improving the Patient Experience CME
Caring for Diverse Populations Toolkit
Information About 2020 Special Needs Plans
Coding Education CME/CEU
expand Tutorials
Medication Precertification Tutorial
Precertification Request Tutorial
expand Vendor/Partner Links & Information
TennCare forms for Providers
CareMore Operational Guidelines​
Centers for Medicaid and Medicare Services (CMS) HCBS Setting Rules Resources
American Academy of Pediatrics Resource to Help Get Patients Back to the Office
Tennessee

Do more online through Provider Self-Service!

  • File and check the status of medical claims
  • NEW — Submit Claims Payment Disputes electronically via Availity
  • Verify eligibility
  • Request precertification via the Interactive Care Reviewer (ICR)
  • Conduct an inquiry on the status of any precertification request via ICR
  • For more information on ICR such as features, support or training go to
    ICR-Help
  • Submit a Pharmacy Prior Authorization Request (if applicable)
  • And much more!

To log in, use your Availity ID and password. If you need an Availity ID, visit www.Availity.com to register today.

Visit Frequently Asked Questions about Availity for more information.

Join Our Network

Learn more about us or request an application below.


NCQA Health Plan Commendable logo NCQA Health Plan Multicultural logo
NCQA HEDIS Compliant logo NCQA LTSS Distinction logo