Medical Billing Services in Tennessee
Billing, coding, credentialing and denial management for Tennessee practices, with Medicare claims through Palmetto GBA (Jurisdiction JJ) and Tennessee Medicaid handled by people who know the rules.
Medical billing for Tennessee practices
Tennessee runs its entire Medicaid program through managed care. TennCare members are assigned to Wellpoint, BlueCare or UnitedHealthcare Community Plan, so practices bill three MCOs with different payer IDs, authorization portals and appeal steps. Commercial volume is concentrated with BlueCross BlueShield of Tennessee and Cigna, and Medicare Part B claims go to Palmetto GBA in Jurisdiction J. The state has not expanded Medicaid, and rural counties in East and West Tennessee carry a high share of TennCare and Medicare patients.
SFA Solutions works with Tennessee practices across the state remotely. We work to file TennCare claims well inside the 120-day MCO window, track each plan's prior authorization rules, and hold commercial payers to Tennessee's 21-day prompt pay standard for electronic claims. Practices in Memphis, Nashville, Knoxville and smaller towns get the same process.
Tennessee at a glance
| Medicare contractor | Palmetto GBA, Jurisdiction JJ |
|---|---|
| Medicaid timely filing | TennCare MCOs must accept claims filed within 120 calendar days from the date of service (TennCare policy PAY 13-001), with later start dates for retroactive eligibility and third-party liability |
| NP practice authority | Restricted |
| Cities we serve | Nashville, Memphis, Knoxville, Chattanooga, Clarksville, Murfreesboro, Franklin, Johnson City, Jackson, Kingsport |
What Tennessee billing involves
These are the programs and rules our team works with for Tennessee claims.
Medicare
Palmetto GBA · JJTennessee Part B claims are processed by Palmetto GBA in Jurisdiction JJ. Medicare's filing limit is 12 months from the date of service, and appeals start with a redetermination within 120 days of the initial decision.
Tennessee Medicaid
TennCare (Tennessee's Medicaid program), plus CoverKids for children's health insurance and CHOICES for long-term services and supports
Portal: TennCare provider registration for Medicaid IDs; claims are submitted to the member's MCO through that plan's portal or a clearinghouse
Medicaid managed care
Nearly all TennCare members are enrolled with one of three MCOs: Wellpoint (formerly Amerigroup), BlueCare Tennessee, or UnitedHealthcare Community Plan. TennCare Select, which uses the BlueCare provider portal, serves certain groups of children.
Timely filing
TennCare MCOs must accept claims filed within 120 calendar days from the date of service (TennCare policy PAY 13-001), with later start dates for retroactive eligibility and third-party liability.
Commercial and Medicare Advantage
BlueCross BlueShield of Tennessee is the largest commercial payer, with Cigna (which has a large Tennessee presence), UnitedHealthcare and Aetna following. Humana, UnitedHealthcare and BlueCross BlueShield of Tennessee lead Medicare Advantage enrollment.
Prompt pay law
Tenn. Code Ann. Section 56-7-109 requires health insurers to pay clean claims within 21 days for electronic submissions and 30 days for paper submissions, with 1% per month interest on late payments. TennCare MCOs are held to separate prompt pay standards monitored by the state.
Nurse practitioners
Restricted practiceTennessee NPs need a supervising physician and written protocols, and the supervising physician relationship must be documented for payer credentialing. NPs can still enroll and bill under their own NPI with TennCare MCOs, Medicare and most commercial plans.
Credentialing
Providers register with TennCare to obtain a Medicaid ID, then credential separately with each MCO before seeing their members. The MCOs and BlueCross BlueShield of Tennessee use CAQH ProView, so an attested and current CAQH profile shortens turnaround. Medicare enrollment goes through PECOS with Palmetto GBA.
Billing challenges Tennessee practices face
Three MCOs and a short window
With all of Medicaid in managed care, a missed eligibility check means billing the wrong plan, and the 120-day filing limit leaves little room to rebill. Claims need to go out within days of the visit and every rejection needs same-week follow-up.
BCBST network rules
BlueCross BlueShield of Tennessee has several networks, and a provider can be in one and out of another. Network status needs to be confirmed per plan, or claims process out of network or deny.
Supervision documentation for NPs
Tennessee's supervision requirements mean NP credentialing files and claim setups need the supervising physician details on record. Missing or outdated information is a frequent cause of credentialing delays.
Our services in Tennessee
Medical Billing
Learn moreCredentialing & Payer Enrollment
Learn moreMedical Coding
Learn moreDenial Management
Learn moreA/R Recovery
Learn moreEligibility Verification & Prior Authorization
Learn moreMedical Billing Audit
Learn moreRevenue Cycle Management
Learn moreSpecialties we bill in Tennessee
Tennessee medical billing questions
What is the timely filing limit for TennCare?
Under TennCare policy, MCOs accept claims filed within 120 calendar days from the date of service. The clock starts later for retroactive eligibility and third-party liability cases, and some school-based therapy services get one year. Check the MCO's provider manual before relying on an exception.
Which MCOs serve TennCare members?
TennCare members are enrolled with Wellpoint, BlueCare Tennessee or UnitedHealthcare Community Plan. TennCare Select serves specific groups of children.
How fast must insurers pay claims in Tennessee?
Under Tenn. Code Ann. Section 56-7-109, insurers must pay clean electronic claims within 21 days and clean paper claims within 30 days. Late payments accrue interest at 1% per month.
Who is the Medicare contractor for Tennessee?
Palmetto GBA is the Medicare A/B MAC for Tennessee under Jurisdiction J. Part B claims, appeals and enrollment changes are processed by Palmetto GBA.
Get a free billing audit for your Tennessee practice
We will review your recent claims and denials against Tennessee payer rules and show you what can be recovered.
Nearby states
Primary sources
- TennCare Managed Care Contractors
- TennCare Policy PAY 13-001 Timely Filing
- TDCI Bulletin: Prompt Pay Provisions (Tenn. Code Ann. Section 56-7-109)
- Tennessee Board of Nursing APRN Notice and Formulary form
- CMS: A/B MAC Jurisdiction J (Palmetto GBA)
Payer rules change. Last reviewed against the primary sources above on . Confirm current rules with the payer before relying on them.
Request your free practice audit
An RCM specialist typically replies within one business day.