Required billing for Tennessee Medicaid network health care professionals

Last modified: July 9, 2024
Update: Added clarity regarding National Provider Identification number and Medicaid ID .

If your office employs an allied health care professional/mid-level practitioner who is providing services to TennCare members, you must submit the claim to us with the allied health care professional’s assigned National Provider Identification (NPI) number as the professional who is rendering services.  Allied health care professionals/mid-level practitioners must be registered with the State Medicaid agency and have an active Medicaid ID on the date of service.

What this means for you

Claims should not be filed under the supervising physician’s number. 

When an allied health care professional provides a service to a member, list the allied health care professional as the service provider on claims. If both an allied health care professional and a physician provide services to the same member during the same encounter, either the allied health care professional or the physician (but not both) may bill as the service provider on the claim. Billing depends on applicable reimbursement policies, such as the anesthesia reimbursement policy.

Resources

For more information about required billing, see:

• Your TennCare contract 
• The UnitedHealthcare Community Plan of Tennessee Provider Manual 

PCA-1-24-01236-Clinical-NN_06272024